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Year 2 RE > Physiology of Puberty > Flashcards

Physiology of Puberty Flashcards

1
Q

What is the definition of puberty?

A
  • transition from childhood to reproductive maturity
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2
Q

Puberty is the transition from childhood to reproductive maturity. At what ages does this generally occur in males and females?

A
  • males = 9-14 years

- females = 8-14 years

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3
Q

During puberty there are physical changes in the individual. What are the 3 physical changes that generally occur?

A

1 - growth spurt
2 - secondary sex characteristics (pubic + axillary hair, breasts and voice changes)
3 - menarches (menstrual cycle) in females and spermatogenesis in males

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4
Q

What is a growth spurt?

A
  • individual increases in size and weight associated with increased appetite
  • increased muscle and bone growth
  • increased fat stored in the body
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5
Q

Arrange the chronological order of puberty in females below:

Pubic hair (Pubarche)
Menstruation (Menarche)
Axillary hair (Adrenarche)
Growth spurt
Breast development (Thelarche)
A 
1st = Growth spurt
2nd = Breast development (Thelarche)
3rd = Pubic hair (Pubarche)
4th = Axillary hair (Adrenarche)
5th = Menstruation (Menarche)
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6
Q

Arrange the chronological order of puberty in males below:

Penile length
Deep voice
Pubic hair
Growth spurt
Testicular enlargement
Axillary and facial hair
A 
1st = Testicular enlargement
2nd = Penile length
3rd = Pubic hair
4th = Growth spurt
5th = Axillary and facial hair
6th = Deep voice
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7
Q

What is the hypothalamus-pituitary-gonadal axis?

A
  • axis composed 3 things, hypothalamus, anterior pituitary gland and gonads
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8
Q

The hypothalamus-pituitary-gonadal axis is composed 3 things, hypothalamus, anterior pituitary gland and gonads. Is this active during pregnancy?

A
  • active in utero but stops shortly after birth until puberty
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9
Q

The hypothalamus-pituitary-gonadal (HPG) axis is composed 3 things, hypothalamus, anterior pituitary gland and gonads and is active during pregnancy. Does this continue to remain active when we are born?

A
  • males = first 2 months
  • females = first 2 years
  • after these periods the HPG axis becomes quiescent, called MINIPUBERTY
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10
Q

Once a child reaches the age of puberty the hypothalamus-pituitary-gonadal (HPG) axis, composed 3 things, hypothalamus, anterior pituitary gland and gonads becomes active. What does the hypothalamus then begin secreting?

A
  • gonadotrophin-releasing hormone (GnRH)
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11
Q

Once a child reaches the age of puberty the hypothalamus-pituitary-gonadal (HPG) axis, composed 3 things, hypothalamus, anterior pituitary gland and gonads becomes active. Following the secretion of gonadotrophin-releasing hormone (GnRH) the anterior pituitary gland is stimulated, which results in the release of what 2 hormones?

A 
1 = follicle-stimulating hormone (FSH) 
2 = luteinizing hormone (LH) from
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12
Q

Once a child reaches the age of puberty the hypothalamus-pituitary-gonadal (HPG) axis, composed 3 things, hypothalamus, anterior pituitary gland and gonads becomes active. Following the secretion of gonadotrophin-releasing hormone (GnRH) the anterior pituitary gland is stimulated, which results in the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). What hormones do LH and FSH then stimulate the release of in male and females?

A
  • males = testosterone

- females = estrogen and progesterone

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13
Q

In males what do the secretions of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate in the male gonads?

A
  • LH = stimulation of Leydig cells that release testosterone
  • FSH = increases production of inhibin B and androgen binding protein by sertoli cells, which is important for spermatogenesis
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14
Q

In females what do the secretions of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate in the female gonads?

A
  • LH and FSH stimulate ovarian follicles

- mainly FSH though

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15
Q

In females what do the secretions of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate ovarian follicles. The ovarian follicles are composed of a primary oocyte surrounded by a layer of granulosa and theca cells (see image below). How does FSH act on granulosa cells?

1 - convert androstenedione into androgen
2 - convert estradiol into androgen
3 - convert androstenedione into estradiol and progesterone
4 - convert androstenedione into testosterone

A

3 - convert androstenedione into estradiol and progesterone

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16
Q

In females what do the secretions of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) stimulate ovarian follicles. The ovarian follicles are composed of a primary oocyte surrounded by a layer of granulosa and theca cells (see image below). LH binds and acts on the theca cells to do what?

1 - produce androstenedione and androgen
2 - produce estradiol and androgen
3 - produce androstenedione and estradiol
4 - produce androstenedione and testosterone

A

1 - produce androstenedione and androgen

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17
Q

Luteinizing hormone (LH) stimulate ovarian follicles and theca cells of the follicles. During the follicular phase of female sexual cycle LH levels surge, causing what to happen?

A
  • ovulation

- release of oocyte into fallopian tubes

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18
Q

Once ovulation has occurred Luteinizing hormone (LH) release is important for maintaining the corpus luteum (remnants of the ovarian follicle). Once the corpus luteum is formed what 2 hormones does this then trigger the release of?

1 - estradiol and progesterone
2 - progesterone and testosterone
2 - human placental lactogen and progesterone

A

1 - estradiol and progesterone

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19
Q

What are the 3 main roles estradiol have in females during puberty?

A

1 - breast development
2 - growth acceleration
3 - skeletal maturation

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20
Q

What is the main role of progesterone during puberty?

1 - follicular development
2 - menstrual cycles and prepare the uterus for pregnancy
3 - corpus luteum stability
4 - ovulation

A

2 - menstrual cycles and prepare the uterus for pregnancy

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21
Q

What is the main role for follicle-stimulating hormone (FSH) during puberty?

A
  • stimulate follicular development in ovaries

- increase estradiol production

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22
Q

What 2 hormones provide negative feedback in puberty in females following the menstrual cycle that feedback to the hypothalamus and anterior pituitary gland, thus causing the following:

  • decreased gonadotropin releasing hormone (GnRH)
  • decreased follicle stimulating hormone (FSH)
  • decreased luteinising hormone (LH)
A
  • estradiol and progesterone

- produced by the corpus luteum

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23
Q

What are the 4 key functions of testosterone in puberty?

A

1 - increased muscle mass
2 - penile growth
3 - deepened voice
4 - hair growth

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24
Q

Which cells in the anterior pituitary gland secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH)?

A
  • gonadotroph cells
25
Q

In addition to changes that occur in the gonads there are extragonadal hormonal changes. Which hormones are released from the adrenal gland that play a role in secondary sexual characteristics and growth of sex accessory structures such as the prostate?

A
  • androgens
26
Q

In addition to changes that occur in the gonads there are extragonadal hormonal changes. Which hormones is released from the anterior pituitary gland that is important in growth in puberty?

A
  • growth hormone (GH)

- GH increases insulin like growth factor which aids with growth

27
Q

In addition to changes that occur in the gonads there are extragonadal hormonal changes. Which hormones is released from the anterior pituitary gland that is involved in increasing metabolic rate and promotion of tissue growth?

A
  • thyroid stimulating hormone
28
Q

What are the 3 main factors that contribute to the timing of when puberty actually occurs?

A

1 - genetics
2 - environmental
3 - neuroendocrine

29
Q

What are neuroendocrine cells?

A
  • cells that receive neuronal input

- as a consequence of this input, hormones are released into the blood

30
Q

Which 3 neuroendocrine peptides are involved in the timing of puberty?

1 - kisspeptin, neurokinin B, lactate dehydrogenase
2 - kisspeptin, neurokinin B, dynorphin A
3 - kisspeptin, vreatine kinase, dynorphin A
4 - prolactin, neurokinin B, dynorphin A

A

2 - kisspeptin, neurokinin B, dynorphin A

31
Q

Neurokinin B is a neuropeptide involved in puberty. How does Neurokinin B affect the timing of puberty?

1 - increases kisspeptin and increases GnRH release
2 - increases kisspeptin and increases LH release
3 - increases kisspeptin and increases FSH release
4 - increases kisspeptin and increases testosterone release

A

1 - increases kisspeptin and increases GnRH release

- kisspeptin is a neuropeptide involved in the regulation of gonadotrophin releasing hormone

32
Q

What is meant by precocious puberty?

A
  • early puberty occurs
  • boys <8 years
  • girls <9 years
33
Q

What is delayed puberty?

A
  • a child’s puberty is delayed

- girls and boys >14 years

34
Q

Precocious puberty is when early puberty occurs (boys <8 years and girls <9 years). This can be further subdivided into 2 categories, which are what?

A

1 - Central or True precocious puberty = Gonadotrophin dependent
2 - Peripheral or Pseudo-precocious puberty = Gonadotrophin independent

35
Q

What are the 3 most common causes of central/GNRH dependent precocious puberty, early puberty occurs (boys <8 years and girls <9 years)?

A

1 - brain tumour
2 - raised intracranial pressure
3 - CNS malformation

36
Q

The 3 most common causes of of central/GNRH dependent precocious puberty, early puberty occurs (boys <8 years and girls <9 years) are brain tumours, raised intracranial pressure and CNS malformation. What is the initial trigger of precocious puberty?

A
  • premature activation of the hypothalamus-pituitary-gonadal axis (HPG)
  • mutations in the kisspeptin (GnRH regulator)
37
Q

What are 3 most common clinical signs of peripheral/GnRH independent precocious puberty?

A

1 - secondary sexual characteristic develop too early but its not true puberty
2 - premature thelarche (breast development)
3 - premature adrenarche (or pubarche) (hair development)

38
Q

Peripheral or Pseudo-precocious puberty, which is GnRH independent is characterised by high levels of what?

A
  • sex hormones
39
Q

Peripheral or Pseudo-precocious puberty, which is GnRH independent is characterised by high levels of sex hormones. What are the 3 most common causes of high sex hormones in peripheral or Pseudo-precocious puberty?

A

1 - ingestion of sex steroids
2 - hormone-producing tumours (usually of the ovaries or testes)
3 - abnormalities of the adrenal gland, normally a tumour (over-production of androgens)

40
Q

Precocious puberty is early puberty occurs (boys <8 years and girls <9 years), most commonly caused by brain tumours, raised intracranial pressure or CNS malformation. What is the clinical management of precocious puberty?

A
  • identify and block underlying cause
41
Q

Precocious puberty is early puberty occurs (boys <8 years and girls <9 years), most commonly caused by brain tumours, raised intracranial pressure or CNS malformation. The clinical management of precocious puberty is to identify and rectify the cause. Who should patients with precocious puberty be referred to?

A
  • endocrinologists
42
Q

Central GnRH dependent precocious puberty is early puberty occurs (boys <8 years and girls <9 years), most commonly caused by brain tumours, raised intracranial pressure or CNS malformation. The clinical management of precocious puberty is to identify and rectify the cause. Patients with precocious puberty should be referred to an endocrinologists. Which 4 hormones would be measured at baseline?

A

1 - leutenising hormone (LH)
2 - follicular stimulating hormone (FSH)
3 - Testosterone
4 - gonadotrophin releasing hormone (GnRH)

43
Q

If gonadotrophin releasing hormone (GnRH) analogues can be used. Why would GnRH agonist be used?

1 - GnRH analogues have opposite affect of endogenous GnRH
2 - GnRH analogues inhibit endogenous GnRH
3 - GnRH cause continuous pulsatile GnRH release, initially increase GnRH and then it drops
4 - GnRH analogues de-sensitive hypothalamus so lower GnRH

A

3 - GnRH cause continuous pulsatile GnRH release, initially increase GnRH and then it drops
- after a period of time the sex hormones then decrease

44
Q

If central/GnRH dependent precocious puberty has been identified in a patient, gonadotrophin releasing hormone (GnRH) antagonists can be used. Why would GnRH antagonist be used?

A
  • block gonadotrophin receptors in pituitary gland

- all sex hormones decrease

45
Q

If precocious puberty has been identified in a patient, gonadotrophin releasing hormone (GnRH) analogues can be used, such as GnRH agonist and antagonists. Would these medication be commonly used for both:

1 - Central or True precocious puberty = Gonadotrophin dependent
2 - Peripheral or Pseudo-precocious puberty = Gonadotrophin independent

A
  • no
  • central = yes
  • peripheral = no as we need to identify the cause and treat that
46
Q

Delayed puberty is when a child’s puberty is delayed (girls and boys >14 years). Is this more common in boys or girls?

A
  • boys
47
Q

Delayed puberty is when a child’s puberty is delayed (girls and boys >14 years). What are some of the most common causes of delayed puberty?

A
  • long-term illness, such askidney disease
  • malnutrition (GIT disease or eating disorder)
  • problems with ovaries, testes, thyroid glandor pituitary gland
  • genetic condition, such asTurner syndromeand Klinefelter syndrome
48
Q

Delayed puberty is when a child’s puberty is delayed (girls and boys >14 years). Which can be caused by central or peripheral issues. Primary hypogonadism/hypergonadotropic hypogonadism is a form of peripheral defects. What is the likely cause of this?

1 - GnRH is abnormal and ineffective at stimulating the pituitary gland
2 - LH and FSH bind but have no effect on testes or ovaries
3 - LH and FSH bare dysfunctional and have no effect on testes or ovaries
4 - LH and FSH bind to testes and ovaries but receptors do not respond

A

2 - LH and FSH bind but have no effect on testes or ovaries

- gonads are unresponsive to leutenising hormone and follicular stimulating hormone

49
Q

Delayed puberty is when a child’s puberty is delayed *girls and boys >14 years). Which can be caused by central or peripheral issues. Primary hypogonadism/hypergonadotropic hypogonadism is a form of peripheral defects. There is decreased gonad development and activity and/or the gonads are unresponsive to leutenising hormone and follicular stimulating hormone. What key hormones does this cause a reduction in females and males?

A
  • females = oestradiol

- males = testosterone

50
Q

Delayed puberty is when a child’s puberty is delayed *girls and boys >14 years). Which can be caused by central or peripheral issues. Primary hypogonadism/hypergonadotropic hypogonadism is a form of peripheral defects. There is decreased gonad development and activity and/or the gonads are unresponsive to leutenising hormone and follicular stimulating hormone. What are some of the most common causes?

A
  • Turner’s Syndrome(where there’s gonadal dysgenesis (defective development))
  • Post-malignancy chemo / radiotherapy
  • Surgery can cause gonadal failure.
  • Polyglandular autoimmune syndromes
51
Q

Turners syndrome is a cause of primary hypogonadism/hypergonadotropic hypogonadism a form of peripheral defects. What is turners syndrome?

A
  • female only chromosome defect (X chromosome is absent or partially absent)
  • lack of complete set of chromosomes leads to under developed female sex characteristics
52
Q

Turners syndrome is a cause of primary hypogonadism/hypergonadotropic hypogonadism a form of peripheral defects. Turners syndrome is a genetic disorder in women that causes peripheral delayed puberty. How can this present clinically?

A
  • patients are short
  • brown spots on skin
  • webbed neck
  • widely spaced nipples
  • shield like thorax
53
Q

Turners syndrome is a cause of primary hypogonadism/hypergonadotropic hypogonadism a form of peripheral defects. Turners syndrome is a genetic disorder in women that causes peripheral delayed puberty. How can this be treated?

A
  • growth hormones

- sex hormones

54
Q

Klinefelter syndrome is a cause of primary hypogonadism/hypergonadotropic hypogonadism a form of peripheral defects. Klinefelter syndrome is a genetic disorder, mainly affecting men who gain an extra chromosome. What can this extra X chromosome cause?

A
  • tall but thin and poor muscle tone
  • small penis and testes
  • can treat with testosterone
55
Q

Delayed puberty is when a child’s puberty is delayed (girls and boys >14 years). Which can be caused by central or peripheral issues. Central issues, also called hypogonadotropic hypogonadism syndrome causes what to happen?

A
  • defects that affect the hypothalamus or pituitary gland

- results in low gonadotrophin and/or FH and FSH levelsq

56
Q

Delayed puberty is when a child’s puberty is delayed *girls and boys >14 years). Which can be caused by central or peripheral issues. The key central effect is called Congenital hypogonadotropic hypogonadism, which is a defect affecting the hypothalamus or pituitary gland, resulting in low gonadotrophin and/or FH and FSH levels. What are the 3 most common causes of this?

A
  • congenital defect
  • tumour
  • rare genetic mutations
57
Q

Delayed puberty is when a child’s puberty is delayed *girls and boys >14 years). Which can be caused by central or peripheral issues. The key central effect is called Congenital hypogonadotropic hypogonadism, which is a defect affecting the hypothalamus or pituitary gland, resulting in low gonadotrophin and/or FH and FSH levels. How can we diagnosis this?

A
  • gonadotrophin releasing hormone (GnRH) stimulation test
  • response to GnRH determines the cause
  • imaging can help but structure does not always predict function
58
Q

Delayed puberty is when a child’s puberty is delayed *girls and boys >14 years). Which can be caused by central or peripheral issues. The key central effect is called Congenital hypogonadotropic hypogonadism, which is a defect affecting the hypothalamus or pituitary gland, resulting in low gonadotrophin and/or FH and FSH levels. How can we treat this?

A
  • treatany underlying cause

- hormone replacement therapy

59
Q

If we suspect a patient as having delayed puberty, what basic hormones should be measured at baseline?

A
  • leutenising hormone (LH),
  • follicular stimulating hormone (FSH)
  • testosterone
  • thyroid hormones (stimulates GH)
  • growth hormone (GH)

Year 2 RE (53 decks)

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