Puberty And Menstrual Disorders Flashcards
Big picture, how do we get a follicle to start growing to start the cycle over?
At the end of the previous cycle, estrogen and progesterone levels are low. This has a negative feedback response for FSH to be released and start maturing the egg.
What is the feedback mechanism of estradiol, gonadotropin and GnRH?
Estradiol stimulates GnRH to be released and the gonadotropins inhibit GnRH.
What are the two peaks of estrogen levels during the menstrual cycle?
1 day before ovulation and 5-7 days after ovulation
When is peak progesterone levels during menstruation?
5-7 days after ovulation
How do we define luteinization?
The follicle is stimulated by LH to become the corpus luteum
What is a primordial follicle?
Oocyte granulosa cell complex in a female fetus
What is the cumulus oophorus?
Inner most 3-4 layers of the granulosa cells that stick to the ovum before ovulation
What is the inner most layer called of granulosa cells and what is unique about this layer?
Corona radiata. It is released with the egg when ovulation occurs.
What is the corpus albicans?
When pregnancy does not occur, the corpus luteum is replaced by a scar
What is the only portion of the cycle that is visualized externally?
Menstrual stage
If conception does not happen by day 23, what happens?
Corpus luteum regresses and secretion of progesterone and estrogen drops.
There is marked constriction of the spiral arteries, ischemia, and the functionalis layer is sloughed.
What is the median age of menarche? What other development does it happen after?
12.4
Occurs 2-3 years after Thelarche at tanner stage 4
How do we define primary amenorrhea?
No menstruation by 13 without secondary sex development or
No menstruation by 15 with secondary sex development
Most normal cycles range how many days in the first year and by the third year what is that range?
21-45
21-35
How much blood loss is associated with anemia?
Greater than 80cc
What are the initial endocrine changes associated with puberty and what two changes does it lead to?
Adrenal androgen production
Axillary and pubic hair production
What 3 events really cause the onset of puberty?
Loss of gonadostat inhibition
Loss of CNS inhibition on GnRH
Sleep associated GnRH secretion
What does the GnRH lead to now?
Follicular maturation and sex steroid production which leads to the secondary sex features
What sort of completes puberty?
Getting the positive feedback mechanism of estrogen and LH compete.
What is the first sign of puberty and what hormone does it require?
Thelarche, or breast development.
Estrogen
What is pubarche and adrenarche and what does it require?
Pubic and axillary hair.
Androgens
What happens about 1 year before menses start?
Peak height velocity
How do we define precocious puberty and what are the ages in boys and girls?
Development of any secondary sexual characteristics prior to an age 2.5 standard deviations earlier then the expected age to start
9 and 8
What are the two subgroups of precocious puberty?
Heterosexual, become like a man
Isosexual, appropriate just early
What are 3 causes of heterosexual precocious puberty?
Androgen secreting tumor, CAH, and exposure to exogenous androgens
where are the androgen secreting tumors most commonly found and how do we treat them?
Ovaries (sertoli leydig cell tumor)
Surgery
2 causes of iso sexual precocious puberty?
Full activation of HPA too early which is true iso sexual
Estrogen secreting tumor
What are the 2 specific causes of true isosexual early puberty and how do we diagnose them?
Idiopathic: give GnRH to see if they get a response of LH rise.
CNS disorder: MRI of head and usually they present with neuro symptoms before early sexual development.
How do we treat iso sexual early period?
Give GnRH agonist to suppress pituitary release of FSH and LH
2 syndromes that fall under the group of pseudoisosexual early period?
McCune Albright syndrome and Peutz jeghers syndrome
