Puberty Flashcards
What is the definition of adrenarche?
Increase in adrenal androgens
What hormonones iniate andrenarche?
DHEA and Androstenedione
At what age do rise in adrenal androgens begin?
Age 6
What is the likely explanation of decreasing age of menarche?
improvement in health and nutrition
What is the general sequence of development?
Thelarche, pubarche, menarche
What race begins puberty the earliest?
African American
What stimulates growth in puberty for girls?
Estrogen, Growth hormone
What stimulates epiphyseal fusion?
Estrogen
When does menarche occur in relation to breast budding (thelarche)?
2.5 years following
How long does it take to establish an ovulatory pattern of bleeding?
1.5 years
What is the traditional definition of precocious puberty?
Onset of changes in girls before the age of 8
What is the most common central cause of precocious puberty?
Idiopathic
What is the most common peripheral cause of precocious puberty?
Ovarian cyst or tumor
What is the most likely diagnosis in a patient presenting with precocious puberty, Cafe Au Lait spots, cystic bone lesions?
McCune - Albright Syndrome
What is the most common cause of precocious puberty with onset after 4 years of age?
Idiopathic
What is the most common cause of precocious puberty with onset prior to 4 years of age?
CNS lesion
What is the first step in evaluation of a patient who presents with precocious puberty with breasts or pubic hair?
Bone age
During workup for precocious puberty with advanced bone age, what is the next step in management?
GnRH stimulation test
If a patient presents with precocious puberty and BOTH breasts and pubic hair, what is the next best step in management even with a normal bone age?
GnRH stimulation test
If a patient with precocious puberty has normal bone age and either breast OR pubic hair only, what is the next best step in management?
Observation
In a patient presenting with precocious puberty who has a high LH (Gonadotropin dependent) on GnRH stimulation test, what is the next step in management?
Brain MRI, TSH, Free T4, Pelvic US
In a patient presenting with precocious pubertty who has a normal LH (Gonadotropin independent) on GnRH stimulation test, what is the next best step in management?
Pelvic US, Estradiol, 17 OHP, Testosterone, DHEAS
How do you treat idiopathic precocious puberty?
GnRH agonist - depo Lupron
What is the definition of delayed puberty?
No breast development by 13 years of age, No menarche by 16 years of age
What is the most common type of delayed puberty?
Hypergonadotropic Hypogonadism
What values of FSH and LH suggest Hypergonadotropic Hypogonadism?
FSH > 20, LH > 40
What values of FSH and LH suggest Hypogpnadotropic Hypogonadism?
FSH <5, LH <5
What is the definition of primary amenorrhea?
Absence of menses by age 16
What is the differential diagnosis for hypergonadotropic hypogonadism?
Gonadal dysgenesis, Premature ovarian failure, 17 alpha hydroxylase deficiency
What are the two syndromes associated with gonadal dysgenesis?
Turner syndrome, Swyer syndrome
What is the differential diagnosis for hypogonadotropic hypogonadism?
Prolactinoma, Hypothyroidism, CAH, Cushings syndrome, Anorexia, Kallmans syndrome
What is the most common CNS or pituitary tumor associated with delayed puberty?
Craniopharyngioma
What is the differential diagnosis in a patient with delayed puberty with normal FSH and LH?
Mullerian agenesis, vaginal septum, imperforate hymen, androgen insensitivity syndrome
If you make the diagnosis of mullerian agenesis, what other tests should you order?
CT urogram, IVP, renal ultrasound
How often are abnormalities with the GU system present in mullerian agenesis?
33% of the time
What are the first set of tests to order in a patient with delayed puberty?
FSH, LH, Estradiol
if you diagnose a patient with hypergonadotropic hypogpnadism, what should you order?
Karyotype
If you diagnose a patient with hypogonadotropic hypogonadism, what should you order?
TSH/T4, prolactin, MRI brain/pituitary, bone age
What is the treatment for delayed puberty?
low dose estrogen, followed by progesterone after menses begin or 12-24 months following initiation of treatment
What is the most common cause of delayed puberty?
Gonadal dysgenesis
What is the differential diagnosis of a patient who presents with a short vagina, and no cervix?
Androgen insensitivity, mullerian agenesis, transverse vaginal septum
