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endocrinology lectures phase 2 > puberty > Flashcards

puberty Flashcards

1
Q

what does puberty describe

A

the physiological, morphological, and behavioural changes as the gonads switch from infantile to
adult forms

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2
Q

what is the definitive sign of puberty onset in girls

A

Girls – menarche – first menstrual bleeding

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3
Q

what is the definitive sign of puberty onset in boys

A

boys – first ejaculation – often nocturnal

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4
Q

do the first definitive signs of puberty signify fertility

A

no

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5
Q

when do secondary sexual characteristics occur

A

at puberty

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6
Q

what are the secondary sexual characteristics for 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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7
Q

what are the secondary sexual characteristics for boys

A

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

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8
Q

what is the tanner scale

A

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

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9
Q

stage 1 of tanner scale - boys

A
  • Prepubertal: No pubic hair
  • Testicular length <2.5 cm
  • Testicular volume <3.0 mL
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10
Q

stage 2 of tanner scale - 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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11
Q

stage 3 of tanner scale - boys

A
  • Thicker, curlier hair spread to mons pubis
  • Growth of penis in width and length; further growth of testes
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12
Q

stage 4 of tanner scale - 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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13
Q

stage 5 of tanner scale - boys

A
  • Adult-type hair spread to medial surface of thighs
  • Genitalia adult size and shape
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14
Q

what does an orchidometer measure

A

testicular volume in ml

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15
Q

stage 1 of tanner scale - girls

A
  • Prepubertal: No pubic hair
  • Elevation of papilla onl
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16
Q

stage 2 of tanner scale - 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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17
Q

stage 3 of tanner scale - girls

A

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

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18
Q

stage 4 of tanner scale - 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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19
Q

stage 5 of tanner scale - girls

A
  • Hair adult-type and distributed in classic inverse triangle
  • Adult contour breast with projection of papilla only
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20
Q

what is the first visible change of puberty for girls

A

Thelarche – breast development

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21
Q

what induces breast develpment

A

oestrogen

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22
Q

how long does breast development take

A

about 3 years

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23
Q

3 effects of oestrogen on breast

A
  • Ductal proliferation
  • Site specific adipose deposition
  • Enlargement of the areola and nipple
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24
Q

can breasts be unilateral

A

yes for several months

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25
Q

Other hormones involved in breast development

A

prolactin, glucocorticoids, insulin

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26
Q

describe pre pubertal uterus

A
  • Corpus : cervix ratio 1:2
  • Tubular shape
  • Length 2-3 cm
  • Volume 0.4-1.6 ml
  • Endometrium single layer of
    cuboidal cells
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27
Q

describe pubertal - adult uters

A
  • Corpus : cervix ratio 2:1
  • Pear shape
  • Length 5-8 cm
  • Volume 3-15 ml
  • Endometrium increased
    thickness
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28
Q

describe pre pubertal ovaries

A
  • Volume 0.2-1.6 ml
  • Non functional
29
Q

describe pubertal - adult ovaries

A
  • Volume 2.8-15 ml
  • Multicystic
30
Q

what to check in a pevlic ultrasound - females

A
  • Are the Mullerian structures present?
  • Morphology of uterus?
  • Morphology of ovaries?
31
Q

describe pre pubertal vagina

A
  • Reddish in colour
  • Thin atrophic columnar epithelium
  • pH neutral
    *Length 2.5-3.5 cm
32
Q

describe pubertal - adult vagin

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
    dischargein the months
    before menarche
  • Length 5-8 (-12)cm
33
Q

what happens 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

34
Q

what do Adrenal androgens & ovarian androgens cause

A

growth of pubic and axillary hair

35
Q

define precocious puberty

A

onset of secondary sexual characteristics before 8 years (girls), 9 years (boys)

36
Q

what can Menarche before 9 yrs cause

A

may lead to short stature

37
Q

define delayed puberty

A

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

38
Q

what can delayed puberty lead to

A

reduced peak bone mass and osteoporosis

39
Q

describe female HPG axis

A

hyppthalamus -> GnRH

anterior pituitary -> LH & FSH

FSH -> bind to granulosa cells -> convert androgens to oestrogen

LH -> act on theca cells -> produce andorgens

40
Q

describe male HPG axis

A

hyppthalamus -> GnRH

anterior pituitary -> LH & FSH

LH -> stimulate leydig cells to make testeosterone

FSH -> stimulates sertoli cells to make ABG & inhibin

41
Q

what are physical change aat puberty controlled by

A

by gonadal and adrenal sex steroids regulated by the
gonadotrophins, LH and FSH

42
Q

what is the Hypothalamic maturation hypothesis
(GnRH pulse generator)

A

– Puberty only requires increased hypothalamic GnRH
– Emphasises the direct link 1CNS and pituitary and hypothalamic GnRH neurons

43
Q

at the start if puberty what factors regulate GnRH secretion (INCREASED STIMULATORY FACTORS)

A

glutamate and kisspeptin

44
Q

at the start if puberty what factors regulate GnRH secretion (DECREASED INHIBITORY FACTORS)

A

mostly through GABAergic neurons secreting γ-aminobutyric
acid (GABA) and opioidergic neurons

45
Q

what is adrenarche

A

Maturational process of the adrenal gland

46
Q

which species is adrenarche observed in

A

Only observed in humans and in some old world primates

47
Q

impacts of adrenarche

A

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

48
Q

what is pubarche

A

Most pronounced clinical result of adrenarche

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

49
Q

treatment of precocious puberty

A

GnRH superagonist to suppress pulsatility of GnRH secretion

50
Q

what % of children have delayed puberty

A

3%

51
Q

is delayed puberty more common in girls or boys

A

boys

52
Q

what can delay in puberty lead to

A

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

53
Q

Indications for investigation of delayed puberty - girls

A
  • Lack of breast development by 13 yrs
  • More than five years between breast development and menarche
  • Lack of pubic hair by age 14 yrs
  • Absent menarche by age
    15-16 yrs
54
Q

Indications for investigation of delayed puberty - boys

A
  • Lack of testicular enlargement by age 14 yrs
  • Lack of pubic hair by age 15 yrs
  • More than 5 years to complete genital enlargement
55
Q

diseases associated with delayed puberty

A

Idiopathic (constitutional) delay in growth and puberty

Hypogonadotrophic hypogonadism

Hypergonadotrophic hypogonadism

56
Q

what is Idiopathic (constitutional) delay in growth and puberty

A

– delayed activation of the hypothalamic pulse
generator

57
Q

what is Hypogonadotrophic hypogonadism

A

sexual infantilism related to to gonadotrophin
deficiency

58
Q

lab investigations for delayed puberty

A
  • Complete red blood count
  • U + E, renal, LFT
  • LH, FSH
  • Testosterone/ oestradiol
  • Thyroid function, prolactin
59
Q

what test to do in all girls with short stature

A

karyotyping

Physical examination/ biochemistry suggestive of
genetic syndrome

60
Q

functional cuases for delayed puberty

A

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

61
Q

what is hypogonadism

A

Reduction or absence of hormone secretion of the gonads.

62
Q

what happens to ovary in female hypogonadism

A

Oestrogen goes down
Lack of feedback
LH and FSH increase

63
Q

what happens to hypothaalmys and pituitary in hypogonadism

A

LH and FSH low
No response to feedback
Oestrogen decreases

64
Q

what happens to testes in male hypogonadims

A

Testosterone goes down
Lack of feedback
LH and FSH increase

65
Q

what happens to hypothalamus and pituitary in hypogonadism

A

LH and FSH low
No response to feedback
Testosterone decreases

66
Q

what is primary hopogonadsm

A

ovary or testes fails

67
Q

what is secondary hypogonadims

A

hypothalamus or pituitary fails

68
Q

describe tuner syndrome

A

Turner syndrome – 45, X0 girls

Renal malformations – horseshoe kidney (fusion of the kidney)
Short stature
Cardiovascular malformations – aortic arch, spontaneous rupture
1 in 2000 girls

endocrinology lectures phase 2 (17 decks)

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