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Gynaecology > Puberty > Flashcards

Puberty Flashcards

1
Q

What is puberty

A

the transition from primary characteristics (at birth) to secondary characteristics.

there is an andolscent growth spert and profound physiological and psychological changes.

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2
Q

What are mature gametes called? (2)

A

spermatazoa and oocytes

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3
Q

What is thelarche and what ages does it occur in?

A

breast development

9-13

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4
Q

What is adrenarche?

A

secretion of adrenal androgens (DHEA, DHEA-S)

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5
Q

What does adrenarche do?

A

1) growth of pubic /axillary hair

2) growth in height

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6
Q

What happens in adrenarche in females with Addison’s disease?

A

have minimal pubic hair whilse the rest of puberty progresses

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7
Q

What happens to females iwth Turner’s syndrome (45XO) in adrenarche

A

normal adrenarche /pubarche but abnormal menarche due to defective ovaries

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8
Q

When does menarche become regular?

A

As oestrogen continues to rise

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9
Q

What is the first sign of puberty for males?

A

testicular growth at 12 years (10-15 years)

if testicular volume > 4 ml it indicates onset of puberty

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10
Q

At what age is the maximum height spurt for males

A

at 14

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11
Q

What is the first sign of puberty in females?

A

breast development at around 11.5 years (9-13)

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12
Q

When does height spurt as females?

A

before menarche

there is only about 4% of height following menarche

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13
Q

What are 3 normal changes in puberty?

A
  1. gynaecomastia may develop in boys
  2. asymmetrical breasts can grown
  3. diffuse enlargement of the thyroid gland may be seen
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14
Q

What is the definition of precocious puberty?

A

onset of secondary sexual characterstic before age 8 in girls or 9 in boys.

it is more common in females

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15
Q

What is gonadotrophin dependant precocious puberty also known as? (3)

A

‘central’
‘true’
consonance maintained

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16
Q

What is gonadotrophin independant precocious puberty also known as?

A

‘pseudo’
‘false’
loss of consonance

17
Q

What is true or central precosious puberty

A

caused by excess GnRH secretion

idiopathic = common in females
secondary = trauma, radiotherapy, intracranial tumour or CNS damage

FSH and LH is raised

18
Q

What is gonadotrophin independant precoscious puberty also known as?

loss of consonance

A

due to excess sex hormones

Low FSH and LH due to negative feedback

19
Q

what is pseudo or false precosious puberty caused by (6)

A
  • ovarian: tumours
  • testicular: tumours activating LH mutations on leyding cells which release testosterone
  • adrenal: CAH in males
  • primary hypothyroidism: high levels of TSH acts on LH/FSH receptors causing a release of sex steroids
  • McCine-Albright syndrome (cafe au lait spots)
  • exposure to exogenous steroids
20
Q

What are the 4 investigations to measure precosious puberty

A
  • Auxology (accurate measurements of height, body proportions + weight
  • pubertal staging
  • bone age estimation
    measuring adrneal steriods - increased in tumours + in CAH the precursors of androgens
21
Q

What are hte scoring systems used for pubertal staging?

A

Tanner stage
Ferriman scoring system
Gallwey scoring system for hirusitism

22
Q

What are the treatments invovled to dampen down the effects of sex steroids in precocisou puberty?

A
  • anti-androgens
  • 5-alpha reducatse inhibitors
  • aromatase inhibitors (inhibits conversion of testosterone to oestrogen)
  • long acting GnRH analogues
23
Q

What is delayed puberty defined as?

A

lack of any pubertal signs by the age of 13 years in girls and 14 years in boys

24
Q

What are the causes of delayed puberty? (2)

A
  1. consituitional delay

2. Organic Cuases

25
Q

What is constitutional delay due to?

A

temporary dealy due to severe illness in childhood e.g. mumps

affects both growth and puberty

26
Q

What are the two types of organic causes of delayed puberty?

A
  1. Hypothalamic (hypogonadotrophic hypogonadism - low levels of LH/FSH and low levels of sex steroids)
  2. Gonadal (hypergonadotrophic hypogonadism - high levels of LH/FSH and low levels of sex steroids)
27
Q

What is an example of a congenital GnRH deficiency in hypothalmic organic causes of delayed puberty?

A

Kallman syndrome - failure of migration GnRH neurons - check ansomia (lack of smell)

28
Q

What are the 4 treatments for delayed puberty?

A

Testosterone for males
Oestrogen for females
Oxandrolone (synthetic steroid)
Kallman’s can be treated using pulsatile GnrH as the gonads are still functioning

29
Q

Does menarche equate to fertility?

A

no

in the 1st year 80% of cycles are anovulatory

Gynaecology (4 decks)

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