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Unit 1 ID+LC > Puberty > Flashcards

Puberty Flashcards

1
Q

HPG axis is active when?

A

In fetal development

Continues to fxn in infancy “mini puberty”

(after infancy, axis enters quiescent state, referred to as juvenile pause)

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2
Q

What is HPG axis?

A

g

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3
Q

After infancy, HPG axis enters quiescent state, referred to as ________

A

juvenile pause

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4
Q

Gonadarche

A

pubertal onset started by RE-EMERGENCE of Hypothalamic GnRH secretion –>
Stim gonadotropins to secrete LH + FSH –>
bind receptors in ovaries/testes –>
gonadal maturation and the production of sex steroids.

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5
Q

Prepuberty vs puberty lvls of FSH

A

Prepuberty: FSH > LH

Puberty:
LH>FSH

  • early puberty may not be very helpful
  • pulses and peaks are happening at night, so measuring lvls during day may be no good
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6
Q

Lab evidence of puberty?

A

Serum sample of LH/FSH (during night)

or

Look at response of LH to a GnRH analog
- LH lvls >5-6 with pubertal response

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7
Q

Estrogen stimulated changes in girls (6)

A
  1. Breast development
  2. Genital growth (labia minora)
  3. Maturation of vaginal mucosa
  4. Uterine/endometrial growth
  5. Body compo changes (fat distribution more in hip)
  6. Menarche (E + prog)
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8
Q

Physical changes of Gonadarche in boys

A
  1. Enlargement of testes #1 way to tell
    - mediated by gonadotropins (FSH + LH)
    _________
    everything else is caused by androgens (T or DHEA-S, androstenedione)
  2. Scrotal changes
  3. Sexual hair
  4. Penile growth
  5. Prostatic/seminal vesicle growth
  6. Deepening of voice
  7. Increase in muscle mass
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9
Q

In both boys and girls, gonarche induces linear growth acceleration and bone age advancement. What is Bone age advancement mediated by?

A

Estrogen in both boys and girls

T is converted to E by aromatase in boys

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10
Q

What causes pubarche in both boys and girls?

A

Pubarche: pysical signs of pubic hair, axillary hair, body odor, and acne.

Increased production of adrenal androgens (DHEA-S, androstenedione)

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11
Q

Timing of puberty in girls

  • Attainment of Tanner 2 breast development
  • Menarche
A

Attainment of Tanner 2 breast development
- mean: 10.4

Menarche:
- mean 12.5 yrs

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12
Q 
Timing of puberty in boys
Testes > 3 ml
Pubic hair
Penile enlargement
Peak heigh velocity
A

Testes > 3 ml: 11.8 (9-14) yrs
Pubic hair: 12
Penile enlargement: 13
Peak heigh velocity: 14

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13
Q

Delayed puberty in boys and girls

A

no puberty signs by Boys: 14 yrs
Girls: 13 yrs

or lack of progression
Girls: No menarche by 4 yrs after puberty starts
Boys: No completion of genital growth after 5 yrs

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14
Q

Bone age is really physiologic age

A 
Onset of puberty is commensurate with child's biologic age (bone age)
Boys start puberty at bone age of:
11.5-12 yrs
Girls start puberty at bone age of:
10.5-11 yrs
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15
Q

Delayed puberty is due to?

A

Low gonadotropins
- HYPOgonadotropic (central) hypogonadism

Elevated gonadotropins
- HYPERgonadotropic (primary) hypogonadism

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16
Q

Constitutional growth delay

A

late bloomers

Grows nl --> 
falls to lower % --> grows at that percentage -->
Puberty --> 
jumps back up to original % -->
Reaches full growth potential
17
Q

How to diff betwn late bloomer and indiv w/ hypogonadotropic hypogonadism?

A
  1. Bone age
    ie: boy whos 15, and bone age is 13, and no pubertal signs: HH
  2. Adrenarchy
    ie: absence of adrenarchy: late bloomer
    ie: adrenarche
    15 y/o w. bone age of 15, small testes: HH
  3. Body habitus
    ie: late bloomers are typically thin
18
Q

Congenital causes of HYPOgonadotropic hypogonadism

A
  1. Part of multiple hormone deficiencies: septo-optic dysplasia
  2. Genetic syndrome: Prader willi syndrome
19
Q

Idiopathic hypogonadotropic hypogonadism (IHH)

A

isolated defect in GnRH or gonadotropins in the absence of any structural abnormalities of the hypothalamus or pituitary

20
Q

Kallman syndrome(579)

  • Causes
  • Presentation
A
  1. Failure of complete puberty
    - a form of hypogonadotropic hypogonadism
  2. Defective migration of GnRH cells
  3. Defective formation of olfactory bulbs

Presentation:

  • Low lvls of: GnRH, FSH, LH, T
  • Infertility
  • Ammenorrhea
21
Q

Acquired causes of Hypogonadotropic hypogonadism

A
  1. Pituitary or hypothalamic tumor
  2. Cranial irradiation
  3. CNS infxn
  4. Infiltrative diseases
    - histiocytosis, granulomatous disease, hemachromatosis
  5. Autoimmune hypophysitis

Unit 1 ID+LC (32 decks)

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