Puberty: advancements, delays, investigation and management Flashcards
What is thelarche
- First visible change of puberty - Induced by estrogen
- Completed in aprx 3 years
- Effects of estrogen on the breast §
-Ductal proliferation - Site specific adipose deposition
- Enlargement of the areola & nipple
- May be unilateral for several months
- Other hormones involved in breast development
- prolactin, glucocorticoids, insulin
what would you be looking for in a pelvic ultrasound
- Are the Mullerian structures present?
- Morphology of uterus?
- Morphology of ovaries?
What are the pre pubertal features of the vagina
- Reddish colour
- Thin atropic columnar epithelium
- Neutral pH
- Length 2.5-3.5 cm
What are the pubertal features of the vagina
- dulled red in comparison to pre puberty
- thickening of epithelium
- cornification of superficial layer
- acidic pH
- Secretion of discharge
- length 5-12 cm
Describe Adrenarche
- Maturationa of adrenal gland
- Developmental process where a specialized subset of cells arises forming the androgen- producing zona reticularis (ZR)
- Developmentally programmed peri- pubertal activation of adrenal androgen production
– Premature or exaggerated adrenarche up to 2 yrs earlier - increase DHEA and DHEA-S
- Mild advanced boneage,axillary
- hair, oily skin, mild acne, body odour
- More pronounced in obesechildren
What is precocious puberty
development of secondary sexual characteristics before 8 years of age in girls and 9 years in boys.
How would you investigate delayed puberty in females
- lack of breast developments by 13
- more that 5 years between breat developments of menarche
- lack of pubic hair by 14
- absent monarch by 15-16
how would you investigate delayed puberty in males
- Lack of testicular enlargement by age 14 yrs
- Lack of pubic hair by age 15 yrs
- More than 5 years to complete genital enlargement
what would be included in a history taking for delayed puberty (list 5)
Ansent of started then arrested
Family history
Symptoms
Perinatal history
Prior illness
Exericde and diet
Neurological symptoms/disorders
Hypoglycemia
Cancer history
Testicular syndrom
All girls with short stature should have what test
- karyotyping, CGH array
-Ruling out turner syndrom
why would we measure bone age
- skeletal maturiry = bone age
- Delayed bone age in GH deficiency
- Advanced bone age in precocious puberty
Describe Kallman syndrome
- hypogonoaotrophic hypogonasism
- 1/10k, m:f 4:1
- Anosmia in 75%
- Failure of migration of of GNRH neurons
- Multiple generic causes
– X-linked, autosomal recessive or autosomal dominant
– Mutations in Kal-1, FGF-receptor 1, prokineticin – GnRH-receptor, GPR54 (normoosmic)
