Physiology of growth and development

Question 1

what is puberty

Answer 1

onset of sexual maturity, when the secondary sexual characteristics appear and the reproductive organs become functional

Question 2

when does puberty start in terms of hormones

Answer 2

when the hypothalamus resumes producing GnRH and we see down stream effects of sex hormones

Question 3

what is the tanner scale

Answer 3

No hair.
Stage 2: Downy hair.
Stage 3: Scant terminal hair.
Stage 4: Terminal hair that fills the entire triangle overlying the pubic region.
Stage 5: Terminal hair that extends beyond the inguinal crease onto the thigh.

Question 4

what is adrenarche

Answer 4

the spontaneous release of weak androgens from the adrenal glands. Ordinarily precedes puberty by 2 years

Question 5

when do children experience growth spurts due to GH

Answer 5

postnatal after first 2 years of life and pubertal growth spurt during adolescence

Question 6

when does puberty begin in boys and girls

Answer 6

girls 11

boys 13

Question 7

what hormone halts bone growth

Answer 7

oestrogen

Question 8

what does GH do to soft tissues

Answer 8

increases the size of the cells and increases the number of cells

Question 9

LH acts on what cells to release androgens which with with aromatase make oestrogen from what cells. these cells also make inhibin which inhibits FSH on anterior pituitary. oestrogen inhibits both on hypothalamus and ant pituitary

Answer 9

theca cells and then granulosa cells

Question 10

leydig cells make testosterone from androstenedione and Sertoli cells lead to what

Answer 10

spermatogenesis

Question 11

in females what does oestrogen do and in males to

Answer 11

prompts breast development , ovarian and uterine maturation, fat redistribution and bone growth. In males, testosterone prompts bone growth, body hair and penile, scrotal and testicuarl maturation as well as first eject.

Question 12

in uk on average females are regarded as having precocious puberty if breast tanner II on menarche before what age
delayed puberty if breast tanner II after hat age or menarche after

for males this range is from 9-14

Answer 12

before 8 years
13 years
15 years

girls growth spurt first but boys longer

Question 13

what to hormones regulate GH

Answer 13

GHRH and somatostatin growth hormone inhabiting hormone GHIH

Question 14

15yr old small and struggling at school and hasn’t reached menarche. wide neck and spaced nipples and soft systolic murmur. breast tanner I and oubic tanner III and mild body odour. FSH and LH are at upper limit 3 times is oestrogen high or low

gem

what is responsible fro her pubic hair

Answer 14

oestrogen low fault with the ovaries

adrenal glands - adrenarche

Question 15

is kleinfelters do they start puberty on time

Answer 15

yes and then it tails off

Question 16

review 14 year old girl without menarche. otherwise health and performs. breast Tanner ! and no pubic hair. mother menarche at 15
does she have delayed puberty

what tests would you like to do

Answer 16

yes

FSH and LH and oestrogen - always do biochemistry first

might also want to do routine bloods to rule out hypothyroidism and anaemia and consider preg test

Question 17

18 year old boy no developing. small testes, microphallus and absent chest hair. voice not broken and not interested in sex and denies erections. and no sense of smell

what tests and what condition

Answer 17

FSH and LH and testosterone

MRI Brain- olfactory bulbs, bone age scan, genetic testing (KAL1), prolactin, cortisol, TSH and T4, GnRH challenge

kallmann syndrome - gonads work if simulated - administration of sex hormones

Question 18

17yr old boy. puberty started at 14 and started shaving at 16. she had erections and ejaculated. last two months these have abrubtly stopped and he’s developed mild gynaecomastia.

FSH LH and testosterone are below normal levels what is going on

Answer 18

hyperprolactinaemia - puberty has been interrupted therefore this is acquired.

prolactin inhibits GnRH

hypogonadotrophic hypogonadism

Question 19

7 year old daughter breast tissue development and has vaginal bleeding. Breast tanner III with pigmentation of the aerial. no pubic hair and mild LIF pain.

what likely hormones

Answer 19

low FSH and LH and high oestrogen

USS or MRI - where is the oestrogen coming from as not driven by pituitary. abdominal clue as ectopic cause like ovarian tumour or cyst.

gonadotrophin-indepenedt precocious puberty

Question 20

most common cause of

Answer 20

gonadotrophin-indepenedt precocious puberty

Question 21

maine cafe au last spots and dysplastic bones do you know diagnosis

Answer 21

McCune albright syndrome MAS - gonadotrophin independent precocious puberty classic triad of cafe au lait( MAINE) , precocious puberty( multiple cysts normally female) and fibrous dyspalsis

commonly confused with neurofibromas

Question 22

8 year old girl pubic hair and requires deodorant. pubic tanner III and breast tanner I. no sydmorphic features - what tests

Answer 22

FHS, LH oestrogen and testosterone. this all at normal levels and no further development this is girl is going through adrenarche. - commonly weak and benign as small release

Question 23

8 year old boy shot u in height. genitals developed rapidly. energetic boy and has tanner 4-5 midl acne and body odour. bursts into spontaneous laughter without cause
blood show very highFSH,LH and testosterone what is it

what test to confirm diagnosis

Answer 23

gonadotrophin- dependent as testoerone is responding to the FSH and LH

MRI and brain stem

Question 24

what is an example of gonadotrophin dependent precocious puberty

Answer 24

hyopthalamic hamartoma

affects boys more
precocious puberty and gelastic epelipesy
causes spontaneous GnRH release from hypothalamus
also caused by hypothyroidism, head tuaem, CNS infection or tumour

Question 25

precocious puberty caused by

Answer 25

gonadotrophin-independent - production of sex hormones - goandtophisn not elevated

gonadotrophin-depends - high sex hormone with gonadotrophin elevated

Question 26

actions of GH

Answer 26

lipolysis
protein synthesis
decrease glucose uptake

sitmateles cell growth and proliferation icnlduign chondrocyte sand mypobalsts

Question 27

13yr old boy has prognathism. Tanner 4

tests

Answer 27

GH, IGF-1, prolactin, TSH and T4, LH and FSH and cortisol

glucose tolerance test after - this would suppress the GH

Question 28

if GH and IGF-1 why do you perform a glucose tolerance test

Answer 28

in a healthy patient the GH should be suppressed

growth hormones works directly and indirectly through IGF-1. normally GH is suppressed by glucose. excess growth hormone before the fusion of the epiphysis results in gigantism. after the plate is acromegaly.