Puberty And Menstrual Disorders

Question 1

Big picture, how do we get a follicle to start growing to start the cycle over?

Answer 1

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.

Question 2

What is the feedback mechanism of estradiol, gonadotropin and GnRH?

Answer 2

Estradiol stimulates GnRH to be released and the gonadotropins inhibit GnRH.

Question 3

What are the two peaks of estrogen levels during the menstrual cycle?

Answer 3

1 day before ovulation and 5-7 days after ovulation

Question 4

When is peak progesterone levels during menstruation?

Answer 4

5-7 days after ovulation

Question 5

How do we define luteinization?

Answer 5

The follicle is stimulated by LH to become the corpus luteum

Question 6

What is a primordial follicle?

Answer 6

Oocyte granulosa cell complex in a female fetus

Question 7

What is the cumulus oophorus?

Answer 7

Inner most 3-4 layers of the granulosa cells that stick to the ovum before ovulation

Question 8

What is the inner most layer called of granulosa cells and what is unique about this layer?

Answer 8

Corona radiata. It is released with the egg when ovulation occurs.

Question 9

What is the corpus albicans?

Answer 9

When pregnancy does not occur, the corpus luteum is replaced by a scar

Question 10

What is the only portion of the cycle that is visualized externally?

Answer 10

Menstrual stage

Question 11

If conception does not happen by day 23, what happens?

Answer 11

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.

Question 12

What is the median age of menarche? What other development does it happen after?

Answer 12

12.4

Occurs 2-3 years after Thelarche at tanner stage 4

Question 13

How do we define primary amenorrhea?

Answer 13

No menstruation by 13 without secondary sex development or

No menstruation by 15 with secondary sex development

Question 14

Most normal cycles range how many days in the first year and by the third year what is that range?

Answer 14

21-45

21-35

Question 15

How much blood loss is associated with anemia?

Answer 15

Greater than 80cc

Question 16

What are the initial endocrine changes associated with puberty and what two changes does it lead to?

Answer 16

Adrenal androgen production

Axillary and pubic hair production

Question 17

What 3 events really cause the onset of puberty?

Answer 17

Loss of gonadostat inhibition
Loss of CNS inhibition on GnRH
Sleep associated GnRH secretion

Question 18

What does the GnRH lead to now?

Answer 18

Follicular maturation and sex steroid production which leads to the secondary sex features

Question 19

What sort of completes puberty?

Answer 19

Getting the positive feedback mechanism of estrogen and LH compete.

Question 20

What is the first sign of puberty and what hormone does it require?

Answer 20

Thelarche, or breast development.

Estrogen

Question 21

What is pubarche and adrenarche and what does it require?

Answer 21

Pubic and axillary hair.

Androgens

Question 22

What happens about 1 year before menses start?

Answer 22

Peak height velocity

Question 23

How do we define precocious puberty and what are the ages in boys and girls?

Answer 23

Development of any secondary sexual characteristics prior to an age 2.5 standard deviations earlier then the expected age to start
9 and 8

Question 24

What are the two subgroups of precocious puberty?

Answer 24

Heterosexual, become like a man

Isosexual, appropriate just early

Question 25

What are 3 causes of heterosexual precocious puberty?

Answer 25

Androgen secreting tumor, CAH, and exposure to exogenous androgens

Question 26

where are the androgen secreting tumors most commonly found and how do we treat them?

Answer 26

Ovaries (sertoli leydig cell tumor)

Surgery

Question 27

2 causes of iso sexual precocious puberty?

Answer 27

Full activation of HPA too early which is true iso sexual

Estrogen secreting tumor

Question 28

What are the 2 specific causes of true isosexual early puberty and how do we diagnose them?

Answer 28

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.

Question 29

How do we treat iso sexual early period?

Answer 29

Give GnRH agonist to suppress pituitary release of FSH and LH

Question 30

2 syndromes that fall under the group of pseudoisosexual early period?

Answer 30

McCune Albright syndrome and Peutz jeghers syndrome