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203: Theme 2: Reproductive system, fetal development, pregnancy and birth > Physiology of puberty > Flashcards

Physiology of puberty Flashcards

1
Q

Definition of puberty

A

The stage of physical maturation in which an individual becomes physiologically capable of pro-creation

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2
Q

Physical changes in girls

A

Growth spurt

Breast growth

Pubic hair

Axillary hair

Menstruation

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3
Q

Endocrine changes in puberty

A

H-P-G synchrony- established in foetal life

Until puberty- neural mechanisms suppress GnRH release

At 6-9 years- pulsatile nocturnal GnRH release

Increased GnRH leads to increased FSH and LH

Ovaries and testes become sensitised to the effects of FSH and LH

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4
Q

Testes

A

Production of gametes (sperm)
- sertoli cells under FSH control

Production of androgens (testosterone)

  • leydig cells under LH control
  • 95% from testes, 5% from adrenals

Testosterone in blood- converted to DHT in the target organs

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5
Q

Follicular phase of the ovarian cycle

A

Initially E rises (FSH) with LH surge in mid cycle

Ovulation occurs

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6
Q

Luteal phase in ovarian cycle

A

Negative feedback after ovulation

No further ovulation in the same cycle

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7
Q

Age of menarche

A

Related to general health, genetic and nutritional factors

Mean age is falling

1/8 girls now reach menarche while at primary school

Body weight and % fat important

  • mean weight at menarche is 47.8kg
  • 16-24% fat
  • athletes, patients with anorexia- late onset
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8
Q

Adrenarche

A

Adrenal androgens- responsible for axillary and pubic hair

ACTH stimulates zona reticularis of adrenal cortex

DHEAS and androstenedione

  • girls- starts by 6, adequate levels by 8
  • boys- starts by 8, adequate levels by 10
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9
Q

Chronological order of puberty in girls

A

Growth spurt

Breast development

Pubic hair

Axillary hair

Menarche

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10
Q

Chronological order of puberty in boys

A

Testicular volume

Penile length

Pubic hair

Growth spurt

Axillary/ facial hair

Deep voice

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11
Q

Ages for disorders of puberty

A

Early or precocious

  • girls under 8 years
  • boys under 9 years

Delayed

  • girls over 14 years
  • boys over 14 years
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12
Q

Precocious puberty

A

Early or premature puberty

Presence of true pubertal features at a young and inappropriate age

Normal variant

  • premature thelarche
  • premature adrenarche
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13
Q

Concerns raised by early onset

A

Possible underlying sinister cause

Emotional and psycho-social upheaval at an inappropriately young age

Early cessation of growth leading to decreased final adult height

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14
Q

Precocious puberty- central

A

Long acting LHRH analog therapy

  • sustained supra-physiological LHRH levels
  • paradoxical cessation of gonadotrophin release
  • stops further pubertal progression

Pubertal progression resumes when treatment stopped

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15
Q

Normal variants

A

Premature thelarche

  • isolated breast development
  • usually seen in children <2-3 years

Premature adrenarche

  • isolate pubic hair development
  • caution: first sign of puberty in some
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16
Q

Pseudo- precocious puberty in females

A

Iso-sexual or feminising
- MAS, ovarian/ adrenal

hetero-sexual or masculinising
- CAH, ovarian/ adrenal

17
Q

Psuedo- precocious puberty in males

A

Iso-sexual or masculinising
- CAH, adrenal/ leydig cell tumour

Hetero-sexual or feminising
- adrenal

18
Q

Delayed puberty

A

Absence of true pubertal onset at an appropriate age

Not necessarily lack of period in a girl

X-files- very important

Normal variant
- constitutional growth and pubertal delay

19
Q

Concerns raised by delay

A

Possible sinister underlying cause

Fear that puberty will never occur

Emotional and psychosocial upset of immaturity, specially when associated with short stature

Long term sequelae: reduced bone mineralised

20
Q

Klinefelter syndrome

A

1/1000 male infants

47 XXY/ multiple X

Behavioural problems

Androgen deficiency

Azoospermia/ infertility

Micro-genitalia

Lifelong testosterone replacement therapy

21
Q

Turner syndrome

A

1/2000 live female births

Triad: short stature, streak gonads, primary amenorrhoea

Dysmorphic features- webbing of neck, cubitus valgus

Coarcatation of aorta, horse shoe kidneys

Early clue- lymphedema

Turner mosaic

22
Q

Normal variant of gonadotrophin deficiency

A

Constitutional delayed growth and puberty

More common in boys

Small and short in school days

Late onset of puberty

Bone age delayed slightly

Family history- often present

Normal adult height

203: Theme 2: Reproductive system, fetal development, pregnancy and birth (25 decks)

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