Puberty and Adolescent GYN

Question 1

What is Adrenarche?

Answer 1

Regeneration of the zona reticularis in the AC

Secretion of sex hormones

Question 2

What is Gonadarche?

Answer 2

Age 8
GnRH secreted by hypothal
Stim AP to secrete FSH and LH
no Phenotypic change yet

Question 3

What is Thelarche?

Answer 3

Breast Bud devt
First phenotypic sign of puberty
in response to estrogen
Age 11

Question 4

What is Pubarche?

Answer 4

Onset of pubic Hair growth
Age 12
w/ axillary hair growth
2/2 Inc Androgens
Follows Thelarche
Precedes Menarche by 2yrs

Question 5

What is menarche?

Answer 5

Onset of menses
12-13 yo or 2.5 years after bb devt
2yr before regular ovulatory menstrual cycles

Question 6

What happens during the Prepubertal years?

Answer 6

Downreg of hypo-pit with red in GnRH pulses
Inc ovarian size
Vagina lengthens (4cm =>8 cm lin late childhood)
Uterine corpus/cervix ratio increases 3:1
Adrenarche

Question 7

What factors tend to make puberty onset earlier?

Answer 7

Urban setting
Closer to the equator
Lower altitudes
Mildly obese

Question 8

What defines precocious puberty?

Answer 8

Breast dev before 7yo
pubic hair before 8yo
menses before 10yo
F:M 23:1

Question 9

What causes Precocious puberty?

Answer 9

Caused by GnRH dep/ind sex hormone production
2/2 early activation of the H-P-G axis
Idiopathic most common
Other: Infection, inflammation, injury of the CNS

Question 10

What causes Pseudoprecocious puberty?

Answer 10

sex hormone production of androgens and estrogens independant of H-P stimulation
Ovarian cysts/tumors, McCune-Albright syndrome, adrenal tumors, hormone or alt medicine ingestion

Question 11

What is McCune Albright Synd?

Answer 11

Multiple Bone fractures
Cafe-au-lait spots
Precocious puberty
A mutation causes ovary to produce estrogen without need for FSH (independant from H-P)

Question 12

What is Congenital adrenal Hyperplasia?

Answer 12

21-Hydroxylase Deficiency

Question 13

What are the goals of Tx for Precocious Puberty?

Answer 13

Arrest and diminish sexual maturation until a normal pubertal age and to maximize adult height
GnRH agonists for GnRH dep
Supression of gonadal steroidogenesis for GnRH indep

Question 14

What labs are assessed in Prec Puberty?

Answer 14

Bone age

Vaginal smear for Estrogen

Question 15

What are the effects oprecocious puberty?

Answer 15

Increases risk of sexual abuse

Higher risk for breast cancer. Shorter adult height than they would have otherwise

Question 16

What are the causes of Delayed puberty?

Answer 16

Hypergonadotropic HypoG
-Gonadal dysgenesis (turner XO)
Hypogonadotropic HypoG
-Const delay
-Kallman synd
-anorexic
-pit tumor
-hyperprolactin
-drug use
Anatomic causes
-mullerian agenesis
Imperforate hymen
Transverse vaginal septum

Question 17

What is the Tx of Hypergonadotropic HypoG

Answer 17

GH to normalize height
Estrogen at normal time of puberty
Progestins AFTER Tanner stage IV to allow normal breast development

Question 18

What is Constitutional Delay (Delayed Puberty)

Answer 18

Healthy but have slower rate of physical maturation
Chronic Dz
Poor intake

Question 19

What is Kallman Syndrom?

Answer 19

Olfactory tracts are hypoplastic
Arcuate nucleus of the hypothalamus does not secrete GnRH
No sense of smell and no BReast Devt
Administer Exogenous hormones

Question 20

What are the Anatomic Causes of Delayed puberty?

Answer 20

Mullerian agenesis: Vaginal, uterine or ovarian agenesis

Imperforate hymen

Question 21

What are the tanner stages of Breast Development?

Answer 21

B1: papilla only
B2: Elev of br and pap, enlarge of areola diameter
B3: Enl of Br and Ar w/ no sep of contour
B4: Enl w/ proj of areola and pap to form 2nd mound above Br
B5: pap only 2/2 recession of the areola to contour of breast

Question 22

What are the tanner stages of PH Development?

Answer 22

PH1: none
PH2: sparse of long slight pigmented downy hair along labia
PH3: Darker, coarser, curlier, over pubic junct
PH4: Adult in type over the mons but not to med thigh
PH5: Adult in quant and type sp to med thigh. inverse triangle