puberty

Question 1

what are the developmental milestones for women

Answer 1

breasts (8) tits
axillary (9) pits
growth spurt (10) mits
menarche (11) lips

growth spurt always before menarche

Question 2

why is it important that growht comes before menarche

Answer 2

because estrogen keeps slowly building over time causing the build up of the endometrium slowly and during this time the bones are growing. and thus precocious puberty causes growth stunting. we must intervene to stop menarche so that the long bones can grow

Question 3

normal pituitary axis function

Answer 3

hypothalamus stimulates anterior pit with GnRH, anterior pit releases LH/FSH. LH/FSH from anterior pit stimulates ovaries to release estrogen and progesterone. estrogen stimulates endometrium and bones. adrenal glands release DHEAS and also effects the eendometrium

Question 4

what is the stimulation test?

Answer 4

when you stimulate the hypothalamic axis with leuprolide (GnRH).

Question 5

what is a positive stimulation test? what does this indicate/

Answer 5

when the axis responds to leuprolide..means that there is a central nervous system issue

Question 6

what issues in the ovaries cause issues in the hypo-pit axis?

Answer 6

germ cell tumors (sertoli leydig (testosterone), granulosa theca (estrogen). Cyst.

Question 7

classic patient for precocious puberty

Answer 7

8 yr old with secondary sex characteristics.

Question 8

what is the first thing we do when we suspect precocious puberty

Answer 8

look at bone age with a wrist X-ray. if bone age is 2 years greater than chronological age then it is positive

Question 9

if leuprolide stimulates LH then what?

Answer 9

then this is a central issue. need MRI to look for tumor.
if no tumor, then this is constitutional and you need to treat with leuprolide continously so that the bone age can catch up

Question 10

what if leuprolide test is negative

Answer 10

then need to look at peripheral issues. look at adrenal glands, ovaries, levels of DHEAS and testosterone.

Question 11

adrenal glands and CAH

Answer 11

when the adrenals are incapable of making glucocorticoids or cortisol, mineral corticoids. the adrenal attempts to makes more, but instead shunts the cholesterol into making androgens. thus give glucocorticoids.

Question 12

delayed puberty

Answer 12

no secondary sex by 13 or no bleeding by 15. need to look at bone age and FSH/LH. could be hypergonadotropic if FSH and LH are elevated. If not, prolactinoma/thyroid. need MRI pituitary lesion.

Question 13

constitutional delay

Answer 13

when there is delayed puberty with no findings. delayed is okay, and we need to wait. look for family history. is there is a family history then this is normal, do not need GH. OKAY TO WAIT