Puberty and Adolescent GYN Flashcards
What is Adrenarche?
Regeneration of the zona reticularis in the AC
Secretion of sex hormones
What is Gonadarche?
Age 8
GnRH secreted by hypothal
Stim AP to secrete FSH and LH
no Phenotypic change yet
What is Thelarche?
Breast Bud devt
First phenotypic sign of puberty
in response to estrogen
Age 11
What is Pubarche?
Onset of pubic Hair growth Age 12 w/ axillary hair growth 2/2 Inc Androgens Follows Thelarche Precedes Menarche by 2yrs
What is menarche?
Onset of menses
12-13 yo or 2.5 years after bb devt
2yr before regular ovulatory menstrual cycles
What happens during the Prepubertal years?
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
What factors tend to make puberty onset earlier?
Urban setting
Closer to the equator
Lower altitudes
Mildly obese
What defines precocious puberty?
Breast dev before 7yo
pubic hair before 8yo
menses before 10yo
F:M 23:1
What causes Precocious puberty?
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
What causes Pseudoprecocious puberty?
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
What is McCune Albright Synd?
Multiple Bone fractures
Cafe-au-lait spots
Precocious puberty
A mutation causes ovary to produce estrogen without need for FSH (independant from H-P)
What is Congenital adrenal Hyperplasia?
21-Hydroxylase Deficiency
What are the goals of Tx for Precocious Puberty?
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
What labs are assessed in Prec Puberty?
Bone age
Vaginal smear for Estrogen
What are the effects oprecocious puberty?
Increases risk of sexual abuse
Higher risk for breast cancer. Shorter adult height than they would have otherwise
What are the causes of Delayed puberty?
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
What is the Tx of Hypergonadotropic HypoG
GH to normalize height
Estrogen at normal time of puberty
Progestins AFTER Tanner stage IV to allow normal breast development
What is Constitutional Delay (Delayed Puberty)
Healthy but have slower rate of physical maturation
Chronic Dz
Poor intake
What is Kallman Syndrom?
Olfactory tracts are hypoplastic
Arcuate nucleus of the hypothalamus does not secrete GnRH
No sense of smell and no BReast Devt
Administer Exogenous hormones
What are the Anatomic Causes of Delayed puberty?
Mullerian agenesis: Vaginal, uterine or ovarian agenesis
Imperforate hymen
What are the tanner stages of Breast Development?
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
What are the tanner stages of PH Development?
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
