Puberty

Question 1

Name 3 factors that can affect puberty

Answer 1

Malnutrition
Chronic diseases
Low BMI
Renal failure
Chrons Exercise (females)
Endocrine (thyroid, adrenal)
Psychological (emotional deprivation)
Moderate obesity = advanced puberty
Morbid obesity = delayed puberty

Question 2

Describe the pubertal changes that occur in men

Answer 2

1. External genitalia: penic increases in size, scrotal pigmentation, rugal folds
2. Hair growth: moustache, beard, male pattern hair (head, axillae, body, pubic)
3. Linear growth: 8cm per year in growth spurt
4. Accessory sex organs: seminal vesicles develop secretory activity
5. Voice: larynx size increases and vocal cords thicken (deeper voice)
6. Psyche: more aggressive, increased libido, sexual potential develops

Question 3

Describe the tanner stages of breast development

Answer 3

1. No palpable glandular tissue, areola not pigmented
2. Glandular tissue palpable. Nipple and areola project as single mound—breast bud
3. Increased glandular tissue, breasts enlarge, increased size areola, contours breast and areola remain in a single plane
4. Further breast enlargement, increased pigmentation areola. Areola and nipple form a secondary mound above the breast
5. Mature form. Areola and nipple no longer project from the breast

Question 4

Describe the tanner stages of pubic hair development

Answer 4

1. None
2. Occasional wispy strands, usually along labia
3. More, darker, coarser hair extending superiorly over the pubis
4. Dark, coarse, curly hair covering mons pubis in adult pattern, but not extending to medial aspects of the thigh
   
   5. Mature form, hair extends to thigh

Question 5

What is precocious puberty?

Answer 5

Premature development of secondary sexual chacteristics (or menarche in girls).

At of before the age of 9.

Caused by premature secretion of gonadotrophins (can be idiopathic or due to CNS lesions/meningitis)

Question 6

Main factors influencing the onset of puberty

Answer 6

Pulsatile release of GnRH from the hypothalamus

Body weight

Question 7

Treatment of delayed puberty

Answer 7

Constitutional delay: short-term low dose steroid treatment

Hypergonadotrophic: sex steroid replacement

Hypogonadatrophic: sex steroid replacement, GnRH administration

Question 8

Classification of delayed puberty

Answer 8

Constitutional: healthy children who have a slower rate of development than average. Height appropriate for bone age, family history

Hypogonadotrophic: defects in the CNS

Hypergonadotrophic: defects in the gonads

Question 9

Briefly describe the development of secondary sexual characterstics in boys and girls

Answer 9

Boys:
Early stages of pubertal changes are increase in size of the testis and pubic hair (age 10)
Growth spurt begins ~11 and is more rapid than in girls, stops at 18
Penis elongates between 11-17
Development complete at 18

Girls:
Breast buds and pubic hair begin to develop (age 8)
Growth spurt begins at ~9 and is complete at 14/15
Menarche begins between 10-16
Development complete at 16

Question 10

Precocious pseudopuberty

Answer 10

Results from secretion of androgens from teh adrenal glands or testis. Virilisation occurs but sperm is not produced.

Caused by adrenal hyperplasia.

Patients have eleveated serum hydroxyprogesterone. May have adrenal tumours.