Puberty Flashcards
What is adrenarche, and when does this occur?
-Regeneration of the zona reticularis in the adrenal cortex
Occurs between ages 6-8
What is gonadarche, and when does this begin?
Pulsatile release of GnRH from the hypothalamus begins, causing release of LH/FSH
Are there phenotypic changes with adrenarche? Gonadarche?
No
What are the basophils of the anterior pituitary? Acidophils?
B-FLAT
GPA
What is thelarche, and what does it occur? What occurs with this?
Occurs around age 11
Breast bud development and first phenotypic signs of puberty
During what stage of puberty do phenotypic changes occur? What is the hormone that is responsible for this?
Thelarche
Estrogen
What is pubarche, and when does this occur? What causes this to occur?
Onset of pubic and axillary hair growth around age 12
result of increased androgens
True or false: having pubarche prior to thelarche is a concerning finding
False- normal variant, especially in black females
Pubarche precedes menarche by approximately how many years?
2
What is menarche, and what does this occur?
Onset of menses
Avg age 12.5 years
How long does it take for menstrual cycles to become regular?
2 years
What is the very first sign of puberty?
Growth acceleration
What hormone is responsible for increasing estrogen production?
FSH
What hormone is responsible for increasing androgens and progesterones production?
LH
What is the main form of estrogen?
Estradiol
What is the enzyme that converts testosterone to estrogen?
Aromatase
What is the general progression of the HPA axis from in utero to childhood?
High in utero, but drops after delivery d/t loss of maternal hormones.
Pulsatile release increases in infancy, peaking around 12-18 months, when negative feedback ensues
What happens to the HPA axis in the prepubertal years?
Downregulation of HPA with reduction in GnRH
-Increases in ovarian size and vaginal length
What happens to the uterine body / cervix ratio as females progress through childhood?
Increases (1:1 to 3:1)
What happens to GnRH production around 8 years of age?
Increased amplitude and frequency of GnRH release
Which is produced in larger amounts during puberty: LH or FSH?
LH
What is the positive and negative feedback mechanisms on the HPA axis with estrogen?
Estrogen increases LH/FSH alone, but decreases with inhibin
When does the growth peak occur?
2 years after breast budding and 1 year prior to menarche
True or false: there is limited growth potential after menarche. Why or why not?
True since epiphyseal plates close
What fraction of total body calcium is laid down during puberty
1/2
How long is the process of sexual maturation for girls?
4.5 years
What is the definition of precocious puberty (breast, pubic hair, and menstruation times)?
- Breast development before 7 years
- Pubic hair development before 8 yr
- Menstruation before 10 yr
In which gender does precocious puberty happen more often?
Girl:boy 23:1
What are the two general types of precocious puberty?
GnRH dependent or independent
What is the most common cause of GnRH dependent precocious puberty?
Idiopathic
What can cause GnRH independent precocious puberty?
Ovarian cysts/tumors
Adrenal tumors
What is McCune-Albright syndrome? S/sx (3)?
Genetic disease that causes the ovary to produce estrogen without FSH, characterized by at least two of the following:
- precocious puberty
- Polyostotic fibrous dysplasia
- Unilateral café au lait spots
Which type of congenital adrenal hyperplasia causes precocious puberty in females?
21-hydroxylase
Draw out adrenal pathway
Draw
What is the test that is 100% specific for 21-hydroxylase deficiency?
Elevated 17-OH progesterone
What general type of medication is used to prevent precocious puberty?
GnRH agonists like Leuprolide
What is the use and MOA of leuprolide?
GnRH agonist that decreases GnRH release in precocious puberty of for BPH
How do you use leuprolide to prevent precocious puberty?
Continuously
How can you tell that you are using the correct amount of Leuprolide? (3)
- Decrease in estrogen to prepubertal range
- Regression of breast development
- Cessation of menses
What is the best test to assess for precocious puberty?
Bone age
What are the labs that are useful for determining the etiology of precocious puberty?
- Vaginal smear for estrogen effect
- hormone levels
(Early/late) puberty and (early/late) menopause increases the risk for breast cancer. (fill in the blank)
Early puberty and late menopause (longer fertile period = higher risk)
What are the signs of delayed puberty (secondary sex characteristics, menarche, menses)?
- No secondary sex characteristics by age 13
- No menarche by 15
- Menses has not begun after 5 years after thelarche
What is the usual cause of hypogonadotropic hypogonadism?
Turner’s syndrome
What is Kallmann syndrome?
a genetic condition where the primary symptom is a failure to start puberty or a failure to fully complete it. It occurs in both males and females and has the additional symptoms of hypogonadism and almost invariably infertility. Kallmann syndrome also features the additional symptom of an altered sense of smell; either completely absent (anosmia) or highly reduced (hyposmia).[1][2] Kallmann syndrome occurs when the hypothalamic neurons that are responsible for releasing gonadotropin-releasing hormone (GnRH neurons) fail to migrate into the hypothalamus during embryonic development
What are the two major causes of delayed puberty?
Hypergonadotropic hypogonadism
Hypogonadotropic hypogonadism
What is the genotype of Turner’s syndrome?
XO
What are the characteristics of the ovaries with Turner’s syndrome?
Streaked gonads with absence of ovarian follicles
What is the treatment for hypergonadotropic hypogonadism?
- GH to reach height
- Estrogen administration at normal time of puberty
Progestins should not be given to hypogonadotropic hypogonadism until when? Why?
Tanner stage IV o prevent breast developing an abnormal contour
What is the most common cause of hypogonadotropic hypogonadism?
Constitutional delay
True or false: with constitutional delay, the height is appropriate for the bone age
True
What happens with hyperprolactinemia to GnRH release?
Decreases
What is the most common tumor associated with delayed puberty? Where does this usually arise from?
Craniopharyngioma
From Rathke’s pouch (oral ectoderm)
What is Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome)?
Congential absence of vagina, and probably uterus and fallopian tubes
BUT normal ovarian function
What is the most common cause of amenorrhea in women with normal breast development?
Mullerian agenesis
True or false: there is normal ovarian function with Mullerian agenesis
True
What other organ is commonly affected with Mullerian agenesis?
Renal
What is an imperforate hymen?
Genital plate canalization is incomplete, so hymen is closed
What happens in menarche with an imperforate hymen?
Little bleeding, causing pelvic pain and bruising in the area
What is the definitive treatment for an imperforate hymen?
Hymenotomy
What is Tanner breast stage 1?
Elevation of the papilla only
What is Tanner breast stage 2?
elevation of the breast and papilla as a small mound
What is Tanner breast stage 3?
Further enlargement of breast and areola, with NO separation of contours
What is Tanner breast stage 4?
Secondary mound
What is Tanner breast stage 5?
Projection of papilla only, resulting from recession of the areola to the general contour of the breast
What is Tanner pubic hair stage 1?
None
What is Tanner pubic hair stage 2?
Sparse growth of long, slightly pigments, downy hair
What is Tanner pubic hair stage 3?
Dark hair that spreads over the junctions of the pubes
What is Tanner pubic hair stage 4?
Dark hair over the mons, but not thighs
What is Tanner pubic hair stage 5?
Dark hair over the thighs
What is the typical sequence of puberty? (4)
- Accelerated growth
- Thelarche
- Pubarche
- Menarche
When do black girls tend to start menses?
11 years old
