Puberty Flashcards
How is puberty defined
Growth acceleration
Primary sexual growth genitals grow and ovulation/ spermatogensis
Secondary sexual characteristics. Hair breast voice oily skin
What is Thelache and when does it normally occur in girls
What is pubarche
Breast development girls first sign of puberty girls 10.8y ( 8-13.5)
Pubic hair development
Gonadarche onset of gonads working testicular vol >4mls
Menarche av 12.7 years
Growth spurt max spurt about 11.5 girls early in puberty
Spermatogenesis 13.5-14 y av in boys middle puberty boys
True precocious puberty ( pubertal levels of FSH/LH and sex hormones ) causes and are they different in girls and boys?
Causes 1 neurogenic - tumors/CNS disease/ TRAUMA
2 Idiopathic
Boys 75 % caused by neurogenic CNS lesion
Girls about 90% idiopathic
Precocious pseudo puberty. What is this ?
What are the causes
Raised sex steroids levels but low FSH and LH
CAUSES
CAH
Gn independence (Mc cure Albright/ testosterone)
Ad tumor
Normal variations
What are the lower limits of normal sexual development in girls
Is early puberty common in girls /boys
Girls
Breast development <8years (10.9yrs is normal)
Pubic hair <8yrs
Menache <10years. (Normally 12.7)
Boys
Testicular enlargement <9 years ( 11.5 =normal)
Pubic hair <9 y ( 11.5yrs =normal)
These have family /ethnic background effects them
Girls have early puberty more than boys
What blood tests are useful in early puberty
FSH /LH/Testosterone/Oestrogen/
17OHP AND DHEAS (helps pick peripheral causes)
Consequences of percousious puberty
Tall in childhood. Short in adult hood Psychological impact ?increased risk of sexual abuse Early menopause Treatment if needed needs to be individualized
Treatment of percousious puberty
1 treat the underlying cause in males (75% neurogenic eg brain tumor
2pubertal suppression GnRH agonists depo infection 4-12/52
Mccune-allbright syndrome. Features
Peripheral PP. (girls»_space;> boys)
Low FSH /LH high DEAS and 17OHP
Clinically PP peripheral
Bone polyostotic fibrous dysphasia
Irregular pigmented lesions
Other endocrine oversecretion Hyperthyroidism/Adredal /pituitary
Premature thelache
Common during first 2 years of life Can be B2/B3 without other signs Growth vel normal /bone age normal Can be present from birth Regresses by about 2years 2nd peak about .6yrs Important can be the first sign of Central PP follow up is needed Ask about exogenous oestrogen
If ATYPICAL /PROGRESSIVE. Bone age/ pelvic USS /FSH/LH O/PROLACTIN /GnRH test
Premature adrenache. What is it and is it serious?
Adrenache without gonads usually benign
Oily skin/acne/ adult body odor. No associated changes in gonads
Girls <8 years. Boys <9years
RARE <6yrs think CAH 17OHP and a bone age
Ovarian cysts
Normal at any age <6mm usually can be up to 10mm
Can get larger cysts in puberty bery in girls
Solid /complex masses. Germ cell tumors / ovarian neoplasms
Gynicomastica
Common mid puberty about 50% males 14-15years ( testicular size 8-15 mm) Bilateral/Assam Resolves spontaneity Investigation if exaggerated Check testicular vol >4mm
Other causes Marijuana/drugs Sex steroid secreting tumor PAIS Hypogonadism Klienfelters syndrome XXY Systemic illness
Delayed puberty definition
No changes in girls by 13years
No changes in boys by 14years
No periods in girls 15.5-16 years
Arrested pubery
DD delayed puberty. VS pathological ( needs treatment )
Classification of delayed puberty pathological (3 classes )
Primary. Hypogonadism. Gonadal problem
2ary pituitary
3ar hypothalamus
Primary hypogonadism features
High FSH/LH low testosterone/oestrogen
Chromosomal. 45XO. 47XXY
Trauma/torsion testicle
Radiation/ chemotherapeutic damage
2ary hypogonadism
Causes. Tumors trauma radiation
Genetic pit def
Low FSH/LH LOW oestrogen/testosterone
No rise in FSH/LH after GnRH trail
Tertiary hypogonadism features on blood tests and causes
Normal variation
Following sickness in childhood eating disorder/ sport
Tumor/infection/ radiotherapy
Low FSH/LH/O/T/ rise in FSH/LH after a GnRH trial
What features are important in the HISTORY wiht delayed puberty
8
1 growth velocity plot the growth and velocity on charts
2 testicular descent ( bilaterally absent testicles
3 medical illness /eating disorders
4 sport
5 endocrine (TSH )/neuro he
6I head injury
7 family hx
8 ANOSMIA no smell Kellmans syndrome delayed pubery
Examination in delayed puberty
Growth /growth velocity
Pubertal staging
Genital staging in males
Neuro fundi and smell ( kellmans syndrome and 2/3ary causes of delayed puberty)
Investigations of delayed puberty
Bone age X-ray ( left wrist)
FSH/LH and O/T
SEX steroid levels
Others chromosomes XO XXY TSH Growth hormone if short GnRH ?MRI of head Pelvic uss
Maturation delay in growth and puberty
Features
Commonest causes of delayed puberty (boys»_space;>girls)
U assoc with short statue and delayed growth
Bone age affected by about 2 yrs
NO pathological cause
Normal adult height prediction
Growth hormone NOT indicated
+ve family history of delayed growth common
In boys can give a low dose of androgen oral/I I
Primes the HPG
Growth spurt and safe and predictable
Girls rare need intervention
Treatment of primary /secondary/tertiary Hypogonadism
Long term treatment needed for both M/F
Males. Get to full adult height
Testicles will remain small
Fertility specialist ( difficult if primary hypogonadism
Women
Oestrogen alone initially and later P
If primary damage poor fertility
