Paeds: Puberty

Question 1

What hormone is needed to stop bone growth (bone fusion)?

Answer 1

Oestrogen

Question 2

What hormones released from the hypothalamus and pituitary control puberty?

Answer 2

1) GnRH (gonadotropin releasing hormone) by hypothalamus
2) LH
3) FSH
4) Neuroendocrine hormones

Question 3

What hormones released elsewhere in the body control puberty in women?

Answer 3

1) Oestradiol
2) Progesterone
3) Adrenal androgen precursors

Question 4

What hormones released elsewhere in the body control puberty in men?

Answer 4

1) Testosterone
2) Dihydrotestosterone (DHT)
3) Adrenal androgens
4) Oestrodiol

Question 5

What is gonadarche?

Answer 5

Activation of the gonads by LH and FSH

Question 6

What is adrenarche?

Answer 6

Increase in production of androgens by the adrenal cortex leading to apocrine body odour and acne

Question 7

What is thelarche?

Answer 7

Appearance of breast tissue due to oestrodiol

Question 8

What is menarche?

Answer 8

First menstrual bleed due to oestradiol on endometrial lining (non-ovulatory)

Question 9

What is spermarche?

Answer 9

First sperm production incl. nocturnal sperm emissions (due to FSH, LH stimulating production of testosterone)

Question 10

What is pubarche?

Answer 10

Appearance of pubic (and axillary) hair, due to androgens

Question 11

What is the role of oestradiol and progesterone in female puberty?

Answer 11

Menstruation

Question 12

What are the roles of oestrodiol in female (and male) puberty?

Answer 12

1) Breast development
2) Growth acceleration
3) Skeletal maturation

Question 13

How is oestradiol made from androgens (testosterone?)?

Answer 13

Via the enzyme aromatase

Question 14

What is the action of LH in males?

Answer 14

Stimulate Leydig cells

Question 15

What is the action of FSH in males?

Answer 15

Stimulate Sertoli cells

Question 16

What extra hormone produced by gonads inhibits gonadotroph cells in the pituitary?

Answer 16

Inhibin (inhibin B in males)

Question 17

What is the role of testosterone in male puberty?

Answer 17

1) Increased muscle mass
2) Penile growth
3) Deepened voice
4) Hair growth

Question 18

At what time of the day should you test someone’s hormone levels and why?

Answer 18

First thing in the morning

• There is a surge of hormones in the morning
• Timing is circadian

Question 19

What kind of puberty can happen in infancy?

Answer 19

Mini-puberty

Question 20

Why are gonadotropins low in childhood?

Answer 20

GnRH neurons are suppressed

Question 21

Why does do LH and FSH increase in menopause?

Answer 21

Bc negative feedback from oestrogen is occurring

Question 22

What is typically the first stage of puberty and what happens after that?

Answer 22

Adrenarche - then breast/testicular development then pubic hair

Question 23

How long does puberty take in women?

Answer 23

2-2.5 years

Question 24

What are the stages of puberty in women?

Answer 24

1) Thelarche (breast buds) - age 10
2) Pubic/axillary hair
3) Menarche (first period) - age 12-13

Question 25

When is peak height velocity for females, after which is steeply falls?

Answer 25

Age 11.5

Question 26

When do girls generally stop growing?

Answer 26

After they get their period

Question 27

When does puberty typically complete/finish in women?

Answer 27

Age 14

Question 28

What are the stages of puberty in men?

Answer 28

1) Increased in testicular volume (11.5)
2) Pubic hair stage 2 (12)
3) Sperm in urine (14.5)
4) Completion of puberty, pubic hair stage 5 (15)
5) Strength spurt (15.5)

Question 29

When is peak height velocity in males after which it steeply falls?

Answer 29

Age 13.5

Question 30

What is the last stage of puberty in males that is equivalent to period in women?

Answer 30

Facial hair and voice break

Question 31

What question should you ask males to determine when puberty finished?

Answer 31

When they started shaving

Question 32

Describe the tanner stages of male genitalia/hair development

Answer 32

• 1-5 for genital size and pubic hair
• 1-3 for axillary hair
• 1 = nothing
• 2 = first show

Question 33

What is the normal adult testicular volume?

Answer 33

20-25 ml

Question 34

At what testicular volume does it go from pre-pubescent to pubertal?

Answer 34

4ml

Question 35

Describe the tanner stages of female breast, hair and period development

Answer 35

• B1-5 for breast
• P1-5/6 for pubic hair
• A1-3 for axillary hair
• P0 or P1 for period

Question 36

If you’re not sure which tanner stage someone is at how should you describe it?

Answer 36

1) Pre-pubertal
2) In puberty
3) Finished puberty

Question 37

What are the determinants of pubertal timing?

Answer 37

1) Genetics - most important, when parents had first period/shave e.g. if parents were delayed know it is normal for family
2) Environment
3) Race - Afro-Caribbean girls/boys tend to go into adrenarche early
4) Exercise
5) Health status/medication

Question 38

How does exercise affect pubertal timing?

Answer 38

• Intense physical activity switches off the pubertal axis

- Body knows that women isn’t in a state to have a baby e.g. not enough fat

Question 39

How does health status/medication affect pubertal timing?

Answer 39

• If can’t sustain pregnancy or not in a healthy state to have a child
• High dose steroids delays/blocks periods but still have adrenarche

Question 40

What are other changes associated with puberty?

Answer 40

1) Anaemia
2) Gynaecomastia
3) Acne

Question 41

How common is anaemia in boys and girls aged 12-15 years?

Answer 41

1) Girls - 2% incidence of anaemia, 9% incidence of iron deficiency
2) Boys - < 2%

Question 42

Describe gynaecomastia in teenage boys

Answer 42

• Approx ½ of teenage boys have gynaecomastia - average age 13, not much can do
• Persists for 6-18 months - check genetics and oestrogen
• More likely if fatter - fat gets aromatised to oestrogen

Question 43

What causes acne in puberty?

Answer 43

• Caused by androgenic stimulation

- Higher serum levels of dehydroepiandrosterone sulfate (DHEAS)