ICL 2.4: Normal Puberty/Disorders of Puberty/Precocious Puberty Flashcards
a 10 year old boy has started puberty. these changes pubic hair growth, testis growth and body growth spurt. what is the usual progression?d
testis growth –> hair growth –> body growth spurt
an 8 year old girl has started to exhibit changes of puberty including pubic hair growth, menarche, breast growth and body growth spurt. what is the normal sequence?
breast growth –> pubic hair –? body growth spurt –> menarche
do you treat precocious puberty?
not always!
treat if it’s pathologically caused or if it’s related to adult impairment
does sexual abuse effect puberty?
there are increased reports that precocious puberty is associated with child sexual and physical abuse
when do boys vs. girls get referred for delayed puberty?
girls with delayed puberty are referred fro evaluation less frequently than boys with delayed puberty
4 year old girl with acne since age 3. rapid growth compared to twin brother. 1st tooth in at 4 months old.
what things would you ask?
premature adrenarche
- parent height and puberty pattern –> mom is 5’6”with menarche at 10, dad is 6’with normal puberty
- past medical history –> N/A
- family history –> N/A
- growth chart
- bone age –> look at hand bones to look at patterns of fusion and calcifications to determine how old the bones are
- labs –> LH, FSH, testosterone normal but DHEA-S is mildly elevated
when do boys usually stop growing?
16.5 years old
what is premature adrenarch?
benign for most kids
can present as acne, body odor, axillary hair or pubic hair without other signs of puberty
no treatment needed
just in case though you need to asses for benign adrenal hyperplasia that could be causing the elevated DHEA like 21-alpha-hydroxylase deficiency
what does increased weight gain in kids indicate?
increased weight gain is associated with increased height velocity
in true precocious puberty you have accelerated growth!
what is the presentation for congenital adrenal hyperplasia?
- baby boy born full term presents at 1-2 weeks old with jaundice, colic and lethargy
state newborn screen positive for elevated 17OHP
- 6 year old boy with pubic hair development, normal prepubertal testes without masses, height is 90%, bone age is 12.2 years and testosterone levels in the low adult range, 17-alpha-hydroxyprogesterone was markedly elevated
how does lavender oil effect puberty?
can cause elevated estrogen and result in premature thelarche aka breast development
what is the peak growth veolicty in males vs females?
13-14 in males
11-12 in females
what hormones controls growth?
growth during childhood depends o thyroid hormone and GH
the adolescent growth spurt depends on estradiol and GH levels in both genders
estradiol first promotes growth by acting on bone and increasing GH
then they get so high they cause closure of the epiphyseal growth plates which ends growth
what is delayed puberty?
absence of secondary sexual characteristics by an age at which 95% of children have initiated sexual maturation
13 years old without breast development for girls and 14 without testicular enlargement for boys
what is hypogonadotropic hypogonadism?
delayed puberty with low LS and FSH
usually self correcting, aka late bloomers
