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General Gynecology > Puberty > Flashcards

Puberty Flashcards

1
Q

What is the definition of adrenarche?

A

Increase in adrenal androgens

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2
Q

What hormonones iniate andrenarche?

A

DHEA and Androstenedione

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3
Q

At what age do rise in adrenal androgens begin?

A

Age 6

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4
Q

What is the likely explanation of decreasing age of menarche?

A

improvement in health and nutrition

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5
Q

What is the general sequence of development?

A

Thelarche, pubarche, menarche

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6
Q

What race begins puberty the earliest?

A

African American

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7
Q

What stimulates growth in puberty for girls?

A

Estrogen, Growth hormone

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8
Q

What stimulates epiphyseal fusion?

A

Estrogen

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9
Q

When does menarche occur in relation to breast budding (thelarche)?

A

2.5 years following

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10
Q

How long does it take to establish an ovulatory pattern of bleeding?

A

1.5 years

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11
Q

What is the traditional definition of precocious puberty?

A

Onset of changes in girls before the age of 8

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12
Q

What is the most common central cause of precocious puberty?

A

Idiopathic

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13
Q

What is the most common peripheral cause of precocious puberty?

A

Ovarian cyst or tumor

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14
Q

What is the most likely diagnosis in a patient presenting with precocious puberty, Cafe Au Lait spots, cystic bone lesions?

A

McCune - Albright Syndrome

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15
Q

What is the most common cause of precocious puberty with onset after 4 years of age?

A

Idiopathic

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16
Q

What is the most common cause of precocious puberty with onset prior to 4 years of age?

A

CNS lesion

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17
Q

What is the first step in evaluation of a patient who presents with precocious puberty with breasts or pubic hair?

A

Bone age

18
Q

During workup for precocious puberty with advanced bone age, what is the next step in management?

A

GnRH stimulation test

19
Q

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?

A

GnRH stimulation test

20
Q

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?

A

Observation

21
Q

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?

A

Brain MRI, TSH, Free T4, Pelvic US

22
Q

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?

A

Pelvic US, Estradiol, 17 OHP, Testosterone, DHEAS

23
Q

How do you treat idiopathic precocious puberty?

A

GnRH agonist - depo Lupron

24
Q

What is the definition of delayed puberty?

A

No breast development by 13 years of age, No menarche by 16 years of age

25
Q

What is the most common type of delayed puberty?

A

Hypergonadotropic Hypogonadism

26
Q

What values of FSH and LH suggest Hypergonadotropic Hypogonadism?

A

FSH > 20, LH > 40

27
Q

What values of FSH and LH suggest Hypogpnadotropic Hypogonadism?

A

FSH <5, LH <5

28
Q

What is the definition of primary amenorrhea?

A

Absence of menses by age 16

29
Q

What is the differential diagnosis for hypergonadotropic hypogonadism?

A

Gonadal dysgenesis, Premature ovarian failure, 17 alpha hydroxylase deficiency

30
Q

What are the two syndromes associated with gonadal dysgenesis?

A

Turner syndrome, Swyer syndrome

31
Q

What is the differential diagnosis for hypogonadotropic hypogonadism?

A

Prolactinoma, Hypothyroidism, CAH, Cushings syndrome, Anorexia, Kallmans syndrome

32
Q

What is the most common CNS or pituitary tumor associated with delayed puberty?

A

Craniopharyngioma

33
Q

What is the differential diagnosis in a patient with delayed puberty with normal FSH and LH?

A

Mullerian agenesis, vaginal septum, imperforate hymen, androgen insensitivity syndrome

34
Q

If you make the diagnosis of mullerian agenesis, what other tests should you order?

A

CT urogram, IVP, renal ultrasound

35
Q

How often are abnormalities with the GU system present in mullerian agenesis?

A

33% of the time

36
Q

What are the first set of tests to order in a patient with delayed puberty?

A

FSH, LH, Estradiol

37
Q

if you diagnose a patient with hypergonadotropic hypogpnadism, what should you order?

A

Karyotype

38
Q

If you diagnose a patient with hypogonadotropic hypogonadism, what should you order?

A

TSH/T4, prolactin, MRI brain/pituitary, bone age

39
Q

What is the treatment for delayed puberty?

A

low dose estrogen, followed by progesterone after menses begin or 12-24 months following initiation of treatment

40
Q

What is the most common cause of delayed puberty?

A

Gonadal dysgenesis

41
Q

What is the differential diagnosis of a patient who presents with a short vagina, and no cervix?

A

Androgen insensitivity, mullerian agenesis, transverse vaginal septum

General Gynecology (11 decks)

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