Hormonal DO

Question 1

Criteria for diagnosis include development of female secondary sexual characteristics
and accelerated growth before age 8 in girls and age 9 in boys.

Answer 1

Precocious puberty

Question 2

Precocious puberty is more common in

Answer 2

girls than boys

Question 3

Normal Pubertal Landmarks

• The most common initial change is thelarche _______
• This is followed by adrenarche ___
• Maximal growth rate occurs age____
• Finally, the last change is menarche______

Answer 3

(breast development at age 9–10).

(pubic and axillary hair at age 10–11).

11 and 12.

(onset of menses at age 12–13).

Question 4

This involves only one change—either thelarche, adrenarche, or menarche.

This condition is the result of either transient hormone elevation or unusual end-organ sensitivity. Management is conservative

Answer 4

Incomplete Isosexual Precocious Puberty

Question 5

All changes of puberty are seen including breast development, growth spurt, and menstrual bleeding.

The primary concern is premature closure
of the distal epiphyses of the long bones, resulting in short stature.

Fertility and sexual
response are not impaired.

Answer 5

Complete Isosexual Precocious Puberty

Question 6

Complete Isosexual Precocious Puberty

Gonadotropin-dependent happens because?

Answer 6

This occurs because of increased secretion of estrogens that are dependent on premature release of gonadotropins from the hypothalamus and pituitary.

Question 7

Complete Isosexual Precocious Puberty

Gonadotropin-dependent

The most common explanation is constitutional without a pathologic
process present, accounting for 80% of precocious puberty.

Answer 7

Idiopathic

Question 8

Complete Isosexual Precocious Puberty

Gonadotropin-dependent

Idiopathic

mx

Answer 8

Management is GnRH agonist suppression (leuprolide or Lupron) of gonadotropins until appropriate maturity or height has been reached

Question 9

CNS pathologies that may lead to Complete Isosexual Precocious Puberty

Gonadotropin-dependent

Answer 9

This may include hydrocephalus,von Recklinghausen disease, meningitis, sarcoid, and encephalitis

Question 10

Complete Isosexual Precocious Puberty

Gonadotropin-independent occurs when?

Answer 10

This occurs when estrogen production is independent of gonadotropin secretion from the hypothalamus and pituitary

Question 11

Complete Isosexual Precocious Puberty

Gonadotropin-independent

What are the 2 conditions?

Answer 11

McCune-Albright syndrome

Granulosa cell tumor

Question 12

Also known as polyostotic fibrous dysplasia, this disorder is characterized by autonomous stimulation of aromatase enzyme production
of estrogen by the ovaries.

The syndrome includes multiple cystic bone lesions and café au lait skin spots.

This accounts for 5% of precocious puberty

Answer 12

McCune-Albright syndrome.

Question 13

Mx of McCune-Albright syndrome.

Answer 13

administration of an aromatase enzyme inhibitor.

Question 14

A rare cause of precocious puberty is a gonadal-stromal cell ovarian tumor that autonomously produces estrogen. A pelvic mass will be identified on examination or pelvic imaging

Answer 14

Granulosa cell tumor

Question 15

wide range of physical and emotional difficulties, as well as the more severe affective changes included in premenstrual dysphoric disorder (PDD).

Answer 15

Premenstrual Syndrome (PMS)

Question 16

Dx of PMS

Answer 16

• Must be recurrent in at least 3 consecutive cycles
• Must be absent in the preovulatory phase of the menstrual cycle
• Must be present in the 2 postovulatory weeks
• Must interfere with normal functioning
• Must resolve with onset of menses

Question 17

Management of PMS and PMDD

Proven treatments include the following:

Answer 17

Selective serotonin reuptake inhibitors (SSRIs).

Yaz (drospirenone/ethinyl estradiol)

Question 18

only_____, ______ and ______ have been shown in controlled, double-blind trials to be superior to placebo for the more severe symptoms of PDD.

Answer 18

fluoxetine, alprazolam (Xanax), and GnRH agonists

Question 19

Recently reported double-blind trials of _______ have shown reductions of
40–75% in troublesome behavioral and emotional symptoms

Answer 19

fluoxetine

Question 20

______are the treatment of choice for emotional symptoms of PMS.

Answer 20

SSRIs

Question 21

Unproven treatments for PMS include the following

Answer 21

Progesterone therapy
Diuretics
Pyridoxine