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Paediatrics > Puberty > Flashcards

Puberty Flashcards

1
Q

What is adrenarche and when does it occur?

A
  1. Activation of zona reticularis - increased adrenal androgen production.
  2. Before puberty (6-8 years)
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2
Q

What is thelarche and when does it occur?

A
  1. Breast development

2. 2-3 years before menarche

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3
Q

What is gonadarche and when does it occur?

A
  1. Increasing testicular volume

2. 12 years of age

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4
Q

What is pubarche and when does it occur?

A
  1. Appearance of pubic hair.

2. 6 months after thelarche (girls), 1-2 years after initial testicular enlargement (boys).

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5
Q

What is menarche and when does it occur?

A
  1. Onset of menstruation.

2. Just under 13 years

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6
Q

What is spermarche and when does it occur?

A
  1. Onset of sperm production.

2. 13-14 years.

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7
Q

What hormonal change causes enlargement of testes?

A

Pulses of pituitary gonadotrophins

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8
Q

What hormonal changes causes breast enlargement in girls and penis enlargement in boys?

A

Gonadal sex steroid production

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9
Q

What hormonal change causes pubic hair to form?

A

Adrenal androgen production

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10
Q

What are the Tanner stages in girls?

A
  1. Pre-pubertal
  2. Areola enlarges, breast buds, sparse pigmented hair along labia.
  3. Breast grows beyond areola, nipple elevates, hair becomes darker/coarser.
  4. Areola and papilla project above breast, secondary mound, adult type hair in small area.
  5. Adult breast contour, projection of papilla only, adult hair type and distribution.
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11
Q

What are the Tanner stages in boys?

A
  1. Pre-pubertal, testicular volume <2.5ml
  2. Sparse hair around penis base, testes and scrotum enlarge, scrotal skin thins and reddens.
  3. Darker/coarse/curly hair spreads laterally, further testes and penis growth.
  4. Adult type hair in small area, further penis growth, scrotal skin darkens.
  5. Adult hair type and distribution, and genitalia.
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12
Q

What is the definition of puberty?

A

Period of sexual maturation during which a child’s body undergoes physical changes to become an adult body with functional reproductive organs.

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13
Q

What is the normal age for puberty in boys and girls?

A

9-14 for boys, 8-13 for girls.

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14
Q

Which genders are precocious and delayed puberty more common in?

A
  1. Precocious - girls

2. Delayed - boys

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15
Q

What is the definition of delayed puberty?

A

Lack of any breast development by 13 in girls and testicular volume <4ml by 14 years in boys.

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16
Q

What are the central causes of delayed puberty?

A

Pituitary/hypothalamus:

  1. Constitutional delay
  2. Chronic disease
  3. Malnutrition/anorexia nervosa
  4. Pituitary tumours/radiotherapy
  5. Congenital GnRH deficiency
17
Q

What are the peripheral causes of delayed puberty?

A

Gonads:

  1. Turner’s syndrome
  2. Klinefelter’s syndrome
  3. Bilateral testicular damage (torsion/mumps)
18
Q

What is this a presentation of?
Boy, tall stature, mild learning difficulties, lack of body and facial hair, long arms and legs, gynaecomastia, female body fat distribution, small firm tester, subfertile.

A

Klinefelter’s syndrome

19
Q

What is the genotype of Klinefelter’s syndrome and what are the hormone levels (LH/FSH/testosterone)?

A
  1. XXY

2. High LH/FSH, low testosterone

20
Q

What is this a presentation of?

Boy, delayed puberty, anosmia, hypogonadism.

A

Kallmann’s syndrome

21
Q

What is the pathophysiology of Kallmann’s syndrome, what is the inheritance pattern, and what are the hormone levels (LH/FSH/sex hormones)?

A
  1. Failure of GnRH neurones to migrate to the hypothalamus.
  2. X-linked recessive
  3. Low FSH/LH, low sex hormones
22
Q

How is delayed puberty investigated?

A
  1. Formal puberty staging, growth, body composition
  2. Dysmorphic features - karyotype
  3. Bone age radiographs
  4. Pelvic USS, brain MRI
  5. LH, FSH, E2, testosterone
  6. TFTs, inflammatory markers
23
Q

What are the differences in hormone levels between primary and secondary hypoG-hypoG?

A
  1. Primary hypoG-hypoG - low sex hormones, normal/high FSH and LH
  2. Secondary hypoG-hypoG - every thing is low
24
Q

What is the management for delayed puberty?

A
  1. All with constitutional delay enter puberty spontaneously.
  2. If delay is causing distress, can be induced by testosterone or oestrogen.
25
Q

What is precocious puberty?

A

Signs of puberty before 8 in girls and 9 in boys.

26
Q

What are the central causes of precocious puberty?

A

Pituitary/hypothalamus:

  1. Familial early puberty
  2. Hypothyroidism
  3. Obesity
  4. Idiopathic
  5. Brain tumour
27
Q

What are the peripheral causes of precocious puberty?

A

Gonads/adrenal:

  1. Ovarian, testicular, or adrenal tumours
  2. Congenital adrenal hyperplasia
  3. Exposure to exogenous sex steroid hormones
28
Q

What are the clinical features of central precocious puberty?

A

Concordant and progresses normally

29
Q

What are the clinical features of peripheral precocious puberty?

A
  1. Girls - clitoromegaly and hirsutism

2. Boys - increased penis length without testicular enlargement

30
Q

How is precocious puberty investigated?

A
  1. Bone age radiography
  2. Boys - high early morning testosterone
  3. Girls - high oestrogen
  4. 17-OH progesterone on short synacthen for CAH
  5. GnRH stimulation test - LH and FSH rises in central, not in peripheral
  6. Left and right spermatic vein sampling for Leydig tumours
  7. Adrenal and pelvic USS
  8. MRI brain if suspecting tumour
31
Q

What is the management for precocious puberty?

A
  1. Some choose to progress through puberty
  2. Can halt puberty using GnRH agonists (SC/nasal)
  3. Treat peripheral causes by treating the cause, GnRH won’t work.

Paediatrics (148 decks)

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