Puberty And Its Disorders Flashcards

0
Q

What are the two characteristics of pubertal growth spurt and acquisition of secondary sex?

A
  1. Adrenarche

2. Gonadarche

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1
Q

What is puberty?

A
  • Secondary characteristics develop
  • Gonads produce mature gametes;
    Testes produce spermatozoa
    Ovary produce oocytes
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2
Q

What is adrenarche?

A

Change in adrenal androgen secretion

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3
Q

What is pubarche?

A

Appearance of pubic/auxiliary hair
Induced by adrenal androgen secretion
Increase sebum production which can lead to acne

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4
Q

What is gonadarche?

A

Activation do gonadal steroid production

Dependent on hypothalamic GnRH

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5
Q

What does puberty depend on?

A

The reactivation of GnRH release

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6
Q

What does GnRH do in primary puberty?

A

Synthesised and secreted from hypothalamus and stimulates the pituitary and gonads in utero

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7
Q

GnRH neurones are restrained for the next 10 years or so

TRUE or FALSE

A

TRUE

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8
Q

What happens to GnRH during puberty?

A

Restraining mechanism is removed and pulsatile GnRH secretion is resumed stimulation pulsatile release of gonadotrophins

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9
Q

Theories of onset of puberty

A
  1. Adrenal androgens and GnRH
  2. Melatonin
  3. Body weight hypothesis
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10
Q

What does the Andrenal androgens puberty theory state?

A

That the rising levels of adrenal androgen secretions may help to reinstate the activity of the GnRH neurones.

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11
Q

What does the melatonin puberty theory state?

A

That as the body mass increases during puberty the relative circulating melatonin concentration is reduced which in turn could decrease the inhibitory effect of melatonin on GnRH neuronal activity

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12
Q

What the body weight hypothesis state?

A

When children reach a critical body weight, puberty behinds. This shows that body fat is a better predictor of the onset of puberty than body weight.

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13
Q

What can delay the onset of puberty?

A

Under nutrition and strenuous activity

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14
Q

How can leptin be the trigger to puberty?

A
In starvation (low leptin) there is a decreased activity of HPG axis
Obesity increases leptin and earlier puberty occurs 
Low levels of leptin = decreases LH
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15
Q

What does kisspetin do?

A

Stimulates GnRH neurones as their receptors (GPR54s) are found in GnRH neurones

16
Q

What happens if a mutation occurs in GPR4 or the gene coding for kisspetin?

A

Abnormal development of GnRH neurones –> hypogonasism
Failure to enter puberty
Hypothalamic hypogonadism

17
Q

What is precocious sexual development?

A

If puberty occurs during 8 years old for girls and 9 for boys but pubertal changes are in consonance

18
Q

What is consonance?

A

When the order of pubertal changes is uniform

19
Q

What is the consonance in female?

A

Breast bud –> public hair begins –> peak height spurt –> menarche –> pubic hair adult –> breast adult

20
Q

What is the consonance in male?

A

Genital development –> pubic hair begins –> peak height spurt –> genitalia adult –> pubic hair adult

21
Q

What happens in gonadotrophin dependent precocious puberty?

A

In consonance
Excess GnRH secretion - idiopathic or secondary
Express gonadotrophin secretion - pituitary tumour

22
Q

What happens in gonadotrophin independent precocious pseudopuberty?

A

Loss of consonance
Testotoxicosis - activating mutation of LH receptor
McCune Albright - mutation of alpha subunit of G protein hyperactivity of endocrine glands
Sex steroid secreting tumour or exogenous steroids

23
Q

How to test for precocious sexual development?

A

Anti androgens
5 alpha reductase inhibitor
Aromatase inhibitor
Long lasting GnRH analogue (precocious puberty)

24
Q

What is pubertal delay?

A

No secondary sexual maturation by 13 in girls or 14 in boys

Secondary to chronic illness

25
Q

Example of hypogonadotrophic hypogonadism

A

Kallman’s syndrome

Hypopituitarism

26
Q

Examples of hypogonadism

A

Gonadal dysgenesis
Klinefelter’s syndrome (low sex steroid levels)
Turner’s syndrome (xo)

27
Q

How to treat delayed puberty?

A

Testosterone in males
Oestrogen in female
Oxandralone