Puberty

Question 1

Definition of puberty?

Answer 1

Maturation of reproductive organs
Production of sex steroids (eg oestradiol/testosterone)
Develop secondary sexual characteristics
Attain capability to reproduce

Question 2

Puberty- Tanner staging
Thelarche
Breast development (girls)

Answer 2

Thelarche (breast development - girls)
Stage 1- prepubertal: elevation of papilla only
2: breast bud w elevation of breast and papilla and enlargement of Areola
3: further enlargement of breast and papilla w no separation of their contours
4: projection of areola and papilla to form a secondary mound
5-Adult: mature breast, projection of papilla only as areola conforms to breast contour

Question 3

Puberty - Tanner staging
Genitalia
Testicular volume in boys

Answer 3

Stage:
1-prepubertal: testes, penis and scrotum same size as early childhood
2: early enlargement of testes 2-6 cm3; scrotal skin reddens and changes in texture
3: penis Lengthens, testes enlarge 6-12 cm3; growth of scrotum
4: Further penniless and scrotal growth; testes 12-15 cm3
5: genitalia adult in size and shape, testes > 15 cm3

Question 4

Puberty - Tanner staging 
Pubic hair (male and female)

Answer 4

Stage:
1-prepubertal: vellus hair no different from abdominal hair
2: slightly pigmented, downy hair
3: darker, coarser, more curled hair
4: Adult pubic hair that does not reach thighs (axillary hair)
5: adult hair now on thighs

Question 5

Secondary sexual characteristics
Oestradiol
Testosterone

Answer 5

Oestradiol (girls):
Breast development 
Hair growth - pubic, axillary 
Sweat gland composition - skin oiliness/Acne 
Changes to external genitalia 

Testosterone (boys):
Deepening of voice
Hair growth - pubic then axillary, facial
Sweat gland composition- skin oiliness/ Acne
Changes to external genitalia

Question 6

Sequence of pubertal events

Adrenarche, growth spurt, menarche (for boys and girls)

Answer 6

Girls: 
Onset 8-13yrs 
Adrenarche: 6-9 yrs 
Growth spurt: 2-3 yrs 
Menarche: 5 

Girls:
1st sign - Thelarche
Late sign - menarche

Boys: 
Onset 9-14 yrs 
Adrenarche: 7-10 yrs 
Growth spurt: 3-4 yrs 
Sperarche: 4 yrs 

Boys - testicular size
Prepubertal < 4 mls
Adult size > 15 mls

Question 7

Hormonal changes during puberty

Answer 7

Adrenarche
DHEAS/DHEA

Gonadarche - activation of HPG axis

HPG axis:
Hypothalamic
Pituitary
Gonadal axis

Normal GnRH secretion is pulsatile (gonadorophin releasing hormone)