Puberty

Question 1

What is the 1st sign of puberty in females?

• Exceptions

Answer 1

Thelarche

**the exception here is African American females that may undergo adrenarche as early as 5 or 6

Question 2

When does the peak growth velocity in a female occur?
•Age
• Placement among the arches
• Tanner Stage

Answer 2

Age - Typically around 12

• Often between Thelarche and Menarche (typically preceeds menarche by about 6 mo)

Pts are often between Tanner 2 and 3

Question 3

What should you do if you see no breast + vaginal bleeding ?

Answer 3

Probably NOT precocious puberty (unless McCune Albright is the etiology)

Question 4

What is the most important determining factor of when menarche will occur?

Answer 4

Genetics

Question 5

Give the 5 tanner stages of pubic hair.

Answer 5

1. No Hair
2. Sparse Downy Hair
3. Curly Black hair
4. More hair
5. Hair extends to the medial thigh

Question 6

Give the 5 tanner stages of breast development.

Answer 6

1. Elevation of papillae only
2. Elevation of Papillae and Areolar enlargement
3. Breast enlargement w/o separation of contour
4. Projection of areolae to form secondary mount
5. Projection of Papillae only, areolae recess to breast contour

Question 7

What diagnostic test do you need to do to confirm INCOMPLETE precocious puberty?

Answer 7

X ray to make sure bone development is not more than 2 years ahead of chronological age