Puberty

Question 1

Normal age of onset

Answer 1

Boys 9-14 (13)

Girls 8-13 (11)

Question 2

Growth spurt

Answer 2

At males (Tanner 4)
At females (Tanner3)

Question 3

Testicular examination

Answer 3

Bilateral enlargement: central PP
Prepubertal testes: pseudo
Unilateral enlargement: gonadal tumour

Question 4

Central PP

Answer 4

Breast/Testicular enlargement
Pubic hair
Growth spurt (increased GV and advanced bone age).

Question 5

Causes of Central PP

Answer 5

1)Brain
Tumour (Hamartoma, astrocytoma,glioma) 
Infxn ( meningitis,encephalitis)
Trauma 
Radiation
Hydrocephalus 
2) Endocrine
Prolonged primary hypothyroidism

Question 6

Pseudo PP

Answer 6

Boys: 
ISO leyding cell tumour (present with asymmetrical testicular enlargement)
CAH
Girls:
ISO McCune Albright syndrome 
Hetero CAH

Question 7

McCune Albright

Answer 7

Autosomal recessive 
Unilateral cafe au lait (coast of main)
Polyostotic fibrosis dysplasia 
Endocrinopathies 
Pseudo pp
Cushing 
Acromegaly 
Hyperthyroidism 
Hypophosphatemic rickets
Dx; 
Increased hormones levels
Increased ALkaline phosphatase 
Molecular gene testing
X-ray of long bones ground glass
Tx:
Estrogen inhibitors
Tamoxifen

Question 8

Obesity-related precocious sexual development

Answer 8

Central mechanism: Obesity causes increased secretion of leptin

Peripheral mechanism: Obesity causes insulin resistance and compensatory hyperinsulinemia