L5: Puberty Flashcards
Def of Puberty
- Period during which individuals become capable of sexual reproduction.
- The series of biological changes that lead to reproductive capabilities.
Def of Adrenarche
- Activation of the adrenal cortex for the production of adrenal androgens.
- Becomes biochemically apparent at age of 6 years in both girls and boys
Def of Gonadarche
Activation of the gonads by the pituitary hormones FSH & LH
Def of Pubarche
Def of Thelarce
Def of Menarche
Def of Spermarche
Detection of Adrenarche
becomes biochemically apparent at about 6 years of age in both girls & boys.
Relation of Adrenarche to HPG Axis
- It seems to be unrelated to the pubertal maturation of the HPG axis.
- It generally precedes activation of the HPG axis, or gonadarche by 2-3 years.
When Does Gonadarche start?
Puberty in Males
- Age
11-12 years of age
Puberty in Males
- Events
Puberty in Males
- Completion at the age of …..
16-17 years
Puberty in Females
- Age
10-11 years
Puberty in Females
- Events
Puberty in Females
- Completed by age …..
15 - 16 years
Tanner Staging of puberty by gondal Development
Tanner Staging of puberty
Tanner stage is assigned independently to genitalia, pubic hair, and breast (e.g., a person can have Tanner stage 2 genitalia, Tanner stage 3 pubic hair).
Tanner Staging of puberty by gondal Development
- Stage I
Tanner Staging of puberty by gondal Development
Stage II
Tanner Staging of puberty by gondal Development
- Stage III
Tanner Staging of puberty by gondal Development
- IV
Tanner Staging of puberty by gondal Development
- V
Tanner Staging of puberty by Breast Development
Tanner Staging of puberty by Breast Development
- I
Tanner Staging of puberty by Breast Development
- II
Tanner Staging of puberty by Breast Development
- III
Tanner Staging of puberty by Breast Development
- IV
Tanner Staging of puberty by Breast Development
- V
Tanner Staging of puberty by pubic Hair Development
- Stage I
Tanner Staging of puberty by pubic Hair Development
- Stage II
Tanner Staging of puberty by pubic Hair Development
- III
Tanner Staging of puberty by pubic Hair Development
- IV
Tanner Staging of puberty by pubic Hair Development
- V
Triggering factors of puberty
Factors affecting the timing of puberty
Assessment of pubertal development
Assessment of Testicular Volume
Testicular volume is measured using Prader orchidometer
- A series of 3D ellipsoids with volume from 1 - 25 ml or more.
Assessment of Penile Length
- Penile length is measured from pubic ramus till the tip of glans.
- Mean stretched penile stretch length at 1 year = 3.75 cm (+- 0.54 cm)
- late childhood = increase to 4.84 CM
- late puberty = increase to 9.5 cm (+- 1.12 cm)
Male hypothalamic maturation occurs …… female.
1- 2 years after
Night time levels of testesterone are ….. than daytime.
higher
- Estradiol mediates the growth spurt, bone maturation and epiphyseal closure in boys just as in girls.
- Estradiol also induces at least modest development of breast tissue (gynecomastia) in a large portion of boys.
…
Girls complete puberty by ages 15 - 16 while boys by ages 16 - 17.
..
Sequence of Puberty
- In Boys
Sequence of Puberty
- In Girls
Def of Delayed Puberty
Classification of Delayed Puberty
Causes of Temporary delays of puberty
Causes of Temporary delays of puberty
- Constitutional delay
Causes of Temporary delays of puberty
- Chronic Illness
Causes of Temporary delays of puberty
- Nutritional Disorders
Causes of Temporary delays of puberty
- Endocrinopathies
Causes of Hypogonadotropic hypogonadism (2ry hypogonadism)
Causes of Hypogonadotropic hypogonadism (2ry hypogonadism)
- Pathophysiology
- hypothalamic-pituitary
- Low FSH and LH = low serum testosterone or estrogen
Causes of Hypogonadotropic hypogonadism (2ry hypogonadism)
- Congenital
Causes of Hypogonadotropic hypogonadism (2ry hypogonadism)
- Acquired
Causes of Hypergonadotropic hypogonadism (1ry hypogonadism)
Causes of Hypergonadotropic hypogonadism (1ry hypogonadism)
- Pathophysiology
- gonads
- low serum testosterone or estrogen = High FSH and LH + lack of pubertal development
Causes of Hypergonadotropic hypogonadism (1ry hypogonadism) in Males
Causes of Hypergonadotropic hypogonadism (1ry hypogonadism) in Males
- Congenital
Causes of Hypergonadotropic hypogonadism (1ry hypogonadism) in Males
- Acquired
Causes of Hypergonadotropic hypogonadism (1ry hypogonadism) in Females
Causes of Hypergonadotropic hypogonadism (1ry hypogonadism) in Females
- Congenital
Causes of Hypergonadotropic hypogonadism (1ry hypogonadism) in Females
- Acquired
Characters of Constitulional delay of puberty
Characters of Idiopathic hypogonadotropic hypogonadism
Characters of Kallman syndrome
Gonadotropin deficiency accompanied
anosmia
Compare between Klienfelter Syndrome & Turner Syndrome in terms of:
- Incidence
- Karyotype
- Caused by
- CP
Dx of Delayed Puberty
- Hx
- Labs
- Rads
Dx of Delayed Puberty
- Medical History
++ family history of delayed onset of puberty, tanner staging.
Dx of Delayed Puberty
- Labs
Dx of Delayed Puberty
- Rads
X-ray of the non-dominant hand and wrist (bone age).
- A skeletal age of 10 in girls & 12.5 in boys correlates with onset of pubertal development.
TTT of Delayed Puberty
- Constitutional growth delay
- Other pathologies
TTT of Delayed Puberty
- Constitutional Delay
TTT of Delayed Puberty
- Other pathologies
- TTT Underlying Cause
- Hormonal Therapy
TTT of Delayed Puberty
- Hormonal therapy
- TST
- estradiol
- GnRH & Gonadotropins
TTT of Delayed Puberty
- testosterone
TTT of Delayed Puberty
- estradiol
TTT of Delayed Puberty
- GnRH & Gonadotropin
Def of Precocious Puberty
It is the onset of puberty is < 8 years in girls and < 9 years in boys.
Factors affecting Precocious Puberty
Types of Precocious Puberty
Types of Benign or non-progressive pubertal variants
- Premature thelarche
- Premature adrenarche
- Premature menarche
Def of Premature thelarche
Isolated breast development, either unilateral or bilateral.
Characters of Premature thelarche
Dx of Premature thelarche
Serum (LH) and estradiol concentrations are typically in the prepubertal range
Age of Premature thelarche
Occurs in two peaks:
- 1st 2 years of life
- 6-8 years
Def of Premature adrenarche
- The early development of pubic hair at 8 in girls and 9 in boys with or without axillary hair and odor, and/or small amount of acne.
Etiology of Premature adrenarche
- Increased Production of adrenal androgens at an earlier than normal age
- Hypersensitivity of pilosebaceous to androgen
INVx for Premature adrenarche
BA & Height in Premature adrenarche
There is slight advance in Height and Bone age.
atypical premature adrenarche
Def of Premature menarche (vaginal bleeding)
The presence of isolated, self-limited vaginal bleeding in the absence of other secondary sexual characteristics prior to the age of 8 years.
Etiology of Premature menarche (vaginal bleeding)
Dx of Premature menarche (vaginal bleeding)
By Exclusion
DDx of Premature menarche (vaginal bleeding)
Consider a foreign body, local masses, and McCune-Albright syndrome
Labs in Premature Adrenarche
Labs in CAH
Labs in Adrenal Tumor
Labs in Ovarian Tumor
approach to the diagnostic evaluation for isolated premature pubarche
Mechanism of Central (True) Precocious Puberty (Gonadotropin-dependent)
From activation of the HPG axis at an earlier-than normal age.
Characters of Central (True) Precocious Puberty (Gonadotropin-dependent)
Etiology of Central (True) Precocious Puberty (Gonadotropin-dependent)
Central (True) Precocious Puberty (Gonadotropin-dependent)
- INVx
Central (True) Precocious Puberty (Gonadotropin-dependent)
- TTT
GnRH agonist (To prevent premature closure of epiphyseal plate)
Def of Peripheral (pseudo) Precocious Puberty (Gonadotropin independent)
It refers to gonadal or adrenal sex steroid secretion or from exogenous sources not resulting from activation of HPG axis
Characters of Peripheral (pseudo) Precocious Puberty (Gonadotropin independent)
Isosexual or contrasexual.
Etiology of Peripheral (pseudo) Precocious Puberty (Gonadotropin independent)
INVx for Peripheral (pseudo) Precocious Puberty (Gonadotropin independent)
LH & FSH levels are suppressed.
- Not increase substantially with (GRH) stimulation.
TTT of Peripheral (pseudo) Precocious Puberty (Gonadotropin independent)
Evaluation of Precocious Puberty
