Normal and Abnormal Puberty

Question 1

The presence of _____ or ______ ____ development prior to age six years in girls warrants thorough evaluation

Answer 1

The presence of breasts or pubic hair development prior to age six years in girls warrants thorough evaluation

Question 2

The presence of breasts and pubic hair development prior to eight years in girls warrants evaluation with a ______, ______and a _____ ___ as the minimum evaluation

Answer 2

The presence of breasts and pubic hair development prior to eight years in girls warrants evaluation with a history, physical and a bone age as the minimum evaluation

Question 3

The first stage of puberty in girls is…

Answer 3

Initiation of the growth spurt

Question 4

Absence of secondary sex characteristics in girls by age __ warrants evaluation

Answer 4

14

Question 5

Absence of ______in young women at age 16 years in the presence of ________ characteristics warrants evaluation

Answer 5

Absence of menstruation in young women at age 16 years in the presence of secondary characteristics warrants evaluation

Question 6

What is the last stage of puberty in females?

Answer 6

Menstruation

Question 7

What is the primary hormone responsible for breast development?

Answer 7

Estrogen

Question 8

What causes development of pubic/axillary hair in females?

Answer 8

DHT (5α reductase)

Question 9

What two structures are responsible for testosterone production in the female?

Answer 9

Testosterone production divided between adrenal gland and ovaries

Question 10

Describe the origins of the two components of the developing vagina

How do they eventually form the vagina?

Answer 10

Upper 2/3 is of Mullerian origin; Lower 1/3 forms from the urogenital sinus

Both must fuse and the dividing membrane must undergo apoptosis

Question 11

What is precocious puberty?

Answer 11

The occurrence of breasts, pubic/axillary hair, and or menstruation prior to 7-8 years of age

Question 12

What are the two categories of precocious puberty?

Answer 12

Gonadotropin Independent

Gonadotropin Dependent

Question 13

What is Gonadotropin independent precocious puberty and what are some examples?

Answer 13

Tumor processes in the ovary or adrenal gland or abnormal enzymatic process in hormone producing organs

Examples: CAH, McCune Albright, Adrenal tumor, ovary cell tumors

Question 14

What causes gonadotropin dependent precocious puberty?

Answer 14

Premature activation of Hypothalamic-Pituitary-Ovarian axis or adrenal axis

Question 15

What is the most important reason for evaluation of precocious puberty?

Answer 15

Child may be saddled with extremely short height due to premature closure of epiphyseal growth plate

Question 16

What endocrine evaluation is associated with the premature presence of each of the following:

• Breasts:
• Pubic/axillary hair development:
• Menstruation:

Answer 16

• Breasts – Estrogen, FSH
• Pubic/axillary hair development – testosterone, LH
• Menstruation – estrogen, FSH, LH

Question 17

What genetic disorder can cause a lack of ovaries in a female?

Answer 17

Turners syndrome

Question 18

When a female presents with lack of menstruation, what is the most important diagnosis to rule out first?

How do you test for this?

Answer 18

Pregnancy

hCG levels

Question 19

Lack of ovarian steroid production may be the result of… (3)

Answer 19

Absence of dysgenesis

Abnormal receptors

Abnormal steroidal production

Question 20

What is bone age?

Answer 20

Measurement of the maturation of a child’s bones