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phase 2a > puberty > Flashcards

puberty Flashcards

1
Q

what do ovarian oestrogens do?

A

regulate the growth of breast and female genitalia

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2
Q

what do ovarian and adrenal androgens do?

A

control pubic and axillary hair

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3
Q

what occurs at puberty for girls?

A

ovarian oestrogens
ovarian and adrenal androgens

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4
Q

what occurs at puberty for boys?

A

testicular androgens

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5
Q

what do testicular androgens do?

A

External genitalia and pubic hair growth
–enlargement of larynx and laryngeal muscles
——-> voice deepening

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6
Q

describe the prepubertal hair for boys in stage 1

A

no pubic hair

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7
Q

what is the the testicular length and volume for stage 1 of boys?

A

testicular length <2.5 cm
testicular volume < 3.0 mL

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8
Q
A
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9
Q

describe stage 2 of the tanner stages in boys

A

Sparse growth of slightly curly pubic hair, mainly base of penis * Testes > 3 mL (>2.5 cm in longest diameter)
* Scrotum thinning and reddening

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10
Q

describe stage 3 of the tanner stages in boys

A

Thicker, curlier hair spread to mons pubis
* Growth of penis in width and length; further growth of testes

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11
Q

describe stage 4 of the tanner stages in boys

A
  • Adult-type hair, not yet spread to medial surface of thighs
  • Penis further enlarged; testes larger, darker scrotal skin colour
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12
Q

describe stage 5 of the tanner stages in boys

A
  • Adult-type hair spread to medial surface of thighs * Genitalia adult size and shape
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13
Q

describe stage 1 of the tanner stages in girls

A

Prepubertal: No pubic hair * Elevation of papilla only

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14
Q

describe stage 2 of the tanner stages in girls

A
  • Sparse growth of long, straight or slightly curly, minimally pigmented hair, mainly on labia
  • Breast bud noted/ palpable; enlargement of areola
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15
Q

describe stage 3 of the tanner stages in girls

A

*Darker, coarser hair spreading over mons pubis * Further enlargement of breast and areola,
with no separation of contours

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16
Q

describe stage 4 of the tanner stages in girls

A

Thick adult-type hair, not yet spread to medial surface of thighs
* Projection of areola and papilla to form secondary mound above level of breast

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17
Q

describe stage 5 of the tanner stages in girls

A
  • Hair adult-type and distributed in classic inverse triangle * Adult contour breast with projection of papilla only
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18
Q

what is thelarche

A

beginning of breast development - its the first visible change of puberty

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19
Q

what is thelarche induced by

A

estrogen

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20
Q

how long is thelarche

A

completed in around 3 years

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21
Q

what are the effects of estrogen on the breast

A
  • Hair adult-type and distributed in classic inverse triangle * Adult contour breast with projection of papilla only
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22
Q

what are the other hormones involved in breast development?

A

prolactin, glucocorticoids, insulin

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23
Q

what are the Definitive signs of puberty onset in girls

A

menarche - first menstrual bleeding

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24
Q

what are the Definitive signs of puberty onset in boys?

A

first ejaculation – often nocturnal

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25
Q

what are the secondary sexual characteristics that occur at puberty with girls?

A

-Ovarian oestrogens regulate the growth of breast and female genitalia
-Ovarian and adrenal androgens control pubic and axillary hair

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26
Q

what are the secondary sexual characteristics that occur at puberty with boys?

A

Testicular androgens – external genitalia and pubic hair growth, enlargement of larynx and laryngeal muscles (voice deepening)

27
Q

define the ‘ tanner stages’

A

A scale that defines physical measurements of development based on external primary and secondary sex characteristics.

28
Q

describe the prepubertal vagina

A

Reddish in colour
* Thin atrophic columnar
epithelium * pH neutral
*Length 2.5-3.5 cm

29
Q

describe the pubertal vagina

A
  • Dulling of the reddish colour
  • Thickening of the epithelium
  • Cornification of the superficial layer
    stratified squamous epithelium
  • pH acidic 3.8-4.2
  • Secretion of clear whitish discharge in the months before menarche
  • Length 5-8 (-12)cm
30
Q

describe the maturation of the external genitals under the effect of oestrogens

A

-Labia majora & minora increase in size & thickness – Rugation & change in colour of the labia majora
– Hymen thickens
– Clitoris enlarge
– Vestibular glands begin secretion

31
Q

describe the maturation of the external genitals with adrenal androgens and ovarian androgens

A

– Growth of pubic & axillary hair

32
Q

what is precocious puberty?

A

onset of secondary sexual characteristics before 8 yrs (girl), 9 yrs (boy)

33
Q

early menarche at what age may lead to short stature?

A

before 9 years

34
Q

what is delayed puberty?

A

absence of secondary sexual characteristics by 14 years (girls), 16 years (boy)

35
Q

what does delayed puberty lead to?

A

leads to reduced peak bone mass and osteoporosis

36
Q

what does the hypothalamic maturation hypothesis emphasise?

A

the direct link CNS and pituitary and hypothalamic GnRH neurone

37
Q

what does puberty require in terms of hypothalamic maturation hypothesis?

A

increase

38
Q

what is adrenarche?

A

Maturational process of the adrenal gland
Developmental process where a specialized subset of cells arises forming the androgen- producing zona reticularis (ZR)

39
Q

where is adrenarche observed?

A

in humans and in some old world primates

40
Q

what can adrenarche physically show? ( signs/ symptoms)

A

Mild advanced bone age, axillary hair, oily skin, mild acne, body odour

41
Q

who is adrenarhe more pronounced in?

A

obese children

42
Q

what is pubarche?

A

Most pronounced clinical result of adrenarche

43
Q

what is pubarche the result of?

A

Result of androgen action on the pilosebaceous unit transforming vellus hair into terminal hair in hair-growth prone parts of the skin

44
Q

what are the indications for investigation of delayed puberty for girls?

A
  • lack of breast development by 13 years
  • more than 5 years between breast development and menarche
  • lack of pubic hair by age 14 yrs
  • absent menarche by age 15-16
45
Q

what are the indications for investigation of delayed puberty for boys?

A
  • lack of testicular enlargement by age 14 years
  • lack of pubic hair by age 15 yrs
  • more than 5 years to complete genital enlargement
46
Q

what are causes of “True” (Central) Precocious Puberty (GnRH dependent)?

A
  • Idiopathic precocious puberty
  • CNS tumours
    – Optic glioma associated with NF1
    – Hypothalamic astrocytoma
  • CNS disorders
    – Developmental abnormalities, hypothalamic
    harmartoma
    – Encephalitis, Brain abscess
    – Hydrocephalus, Myelomeningocele, Arachnoid cyst
    – Vascular lesion
    – Cranial irradiation
  • Secondary central precocious puberty
  • Psychosocial, i.e. adoption from abroad
47
Q

what are causes of Precocious Pseudo-Puberty (GnRH independent

A

Increased androgen secretion
– Congenital adrenal hyperplasia (21OHD, 11OHD)
– Virilizing neoplasm
– Leydig cell adenoma
– Familial Male Precocious Puberty – Testotoxicosis
* Gonadotropin secreting tumours
– Chorioepitheliomas, germinoma, teratoma
– Hepatoma, choriocarcinoma
* McCune-Albright syndrome
* Ovarian cyst
* Oestrogen secreting neoplasm
* (Hypothyroidism)
* Iatrogenic or exogenous sex hormones

48
Q

what is delayed puberty ?

A

Idiopathic (constitutional) delay in growth and puberty
– delayed activation of the hypothalamic pulse generator

49
Q

what is Hypogonadotrophic hypogonadism?

A

– sexual infantilism related to to gonadotrophin
deficiency

50
Q

what is Hypergonadotrophic hypogonadism?

A

– primary gonadal problems

51
Q

what does a delay in puberty lead to?

A

leads to delay in acquisition of secondary sex characteristics, psychological problems, defects in reproduction and reduced peak bone mass.

52
Q

what is CCDGP?

A

CONSTITUTIONAL DELAY
OF GROWTH AND PUPERTY

52
Q
A
53
Q

what does CDGP cause?

A
  • Delay in bone maturation, delay in adrenarche
54
Q

when history taking what do you look for ?

A

Totally absent or started and then arrested
* Family history
– constitutional delay – Infertility
– delayed puberty
* Review of symptoms * Perinatal history
* Prior medical illness * Medication
* Psychosocial deprivation

55
Q

what laboratory investigations take place ?

A

Complete red blood count
U + E, renal, LFT
LH, FSH
Testosterone/ oestradiol
Thyroid function, prolactin

56
Q

functional causes of delayed puberty

A

Chronic renal disease
Chronic lung disease
Anorexia nervosa
Psychosocial/ stress
Drugs

57
Q

what is hypogonadism ?

A

the reduction or absence of hormone secretion of the gonads

58
Q

what is female primary hypogonadism?

A

the ovary fails => Oestrogen goes down => Lack of feedback => LH and FSH increase

59
Q

what is female secondary hypogonadism?

A

Hypothalamus/Pituitary fail!
=> LH and FSH low
=> no response to feedback => oestrogen decreases

60
Q

what is male primary hypogonadism?

A

The testis fails!
=> Testosterone goes down => Lack of feedback
=> LH and FSH increase

61
Q

what is male secondary hypogonadism?

A

Hypothalamus/Pituitary fail!
=> LH and FSH low
=> no response to feedback => testosterone decreases

62
Q
A

phase 2a (67 decks)

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