Female Puberty abnormalities

Question 1

Female Puberty process

Answer 1

Thelarche (breast buds)/Pubarche (androgen production) -> Menarche/growth spurt -> Ovulation

Question 2

Endocrinologic timeline

Answer 2

• Fetal/Newborn: GnRH secreted at 4 wks; gonadotropin riuses at 20 wks; reduced by neg feedback till delivery + peaksd at 3 months
• Childhood: HPO suppresed ages 4-10 by gonadostat + CNA
• Late Prepubertal period: adrenal androgen -> pubic/axilary hair; sleep-a/s pulsatile GnRH release
• ## Pubertal: INCin Hormones LH>FSH 0> Sex hormones + 2nd characteristics; estradiol -> LH surge + ovulation

Question 3

Precociouys Puberty

• Eti
• A/S
• Tx

Answer 3

• Early puberty before age 6/7
• Eti: Idiopathic, CNS lesions, endo/exogenous sex steroids;
• A/s McCune Albright Syndrome (Polyosthotic fibrous dysplasdias, irregular cutaneous pogmentation, precocious puberty)
• Tx: R/O life threatening eti, prevent trauma, prevent epiphyseal closure

Question 4

Delayed Menarche w/ adequate 2nd sexual development d/d (6)

Answer 4

Polycystic ovarian syndrome
Adult onset congenital adrenal hyperplasia
Imperforate hymen
Transverse vaginal septum
Vaginal agenesis (Rokitansky syndrome)
Androgen insensitivity

Question 5

Mayer-Rokitansky-Kuster-Hauser Syndrome

- Eti

Answer 5

• Eti: Mullerian dysgenesisl most common cause of amenorrhea in women w/ normal breast dev

Question 6

Delayed Puberty w/ inadequate 2nd sex development

Answer 6

• Constitutional delay
• Kallmann’s syndrome
• pit/parasellar tumor
• Weight loss
• Gonadal dysgenesis

Question 7

Kallman Syndrome

- Eti

Answer 7

• Eti: Hypoplastic olfactoryt tracts; non-secreting arcuate nucleus

Question 8

Female Athlete

Answer 8

• disordered eating
• menstrual dysfunction
• osteoporosis