Lecture 3 - Adolescent Medicine Flashcards
SMR
Sexual Maturity Rating (SMR)
Females - Pubic hair + breast
Males - Pubic hair + testicular volume + penile changes
SMR 1 for females
no pubic hair
pre-pubertal breast
SMR 2 for females
Sparse, vellus pubic hair
bud under areola
SMR 3 for females
dark, burly, lateral spread pubic hair
mound beyond areola, single contour
SMR 4 for females
adult, no thigh extension pubic hair
secondary areolar mound
SMR 5 for females
adult, extends to thighs for pubic hair
adult size breast, single contour
When is the average age of menarche for women?
between 12 and 13
By what age has SMR 5 been met for women?
typically by 15 years of age
SMR 1 for males
no pubic hair
testicular volume <4
pre-pubertal penile changes
SMR 2 for males
sparse, vellus pubic hair
>4ml testicular volume
slight increase in size of penis
SMR 3 for males
dark, curly, lateral spread of pubic hair
>8ml testicular volume
increase in length of penis
SMR 4 for males
adult, no thigh extension for pubic hair
>12ml testicular volume
increase in width of penis
SMR 5 for males
adult, extends to thighs for pubic hair, >16-20 testicular volume, adult size penis
What is the definition of delayed puberty in females?
no thelarche by age 13
What is the definition of delayed puberty in males?
no testicular growth by age 14
In regards to abnormal puberty in females, which is more likely to be seen as benign, precocious or delayed?
Precocious puberty
SMR 2 prior to age 8
More likely to be constitutional (benign)
Delayed puberty - no thelarche by age 13 years - is more likely to be pathologic
Thelarche
The onset of female breast development
Delayed puberty in females
No thelarche by age 13
No pubic hair by age 14
No menarche by age 16
More than 3-5 years between thelarche to menarche
Precocious puberty in females?
Onset of puberty too early
Can be normal in females
SMR 2 prior to age 8
Which is more likely to be benign in men, precocious puberty or delayed?
Delayed puberty more constitutional in men
Precocious puberty (SMR 2 prior to age 9) is more concerning in men
Precocious puberty in men?
SMR 2 prior to age 9 years
Delayed puberty in men?
No testicular growth by age 14 years
No pubic hair by age 15 years