Puberty and related disorders

Question 1

Function of O

Function of T

Female HPO axis

Male MPT axis

Answer 1

Breast growth
Skeletal maturation
Growth

Increased muscle, penis, testes, hair growth
Deep voice

HPO
GnRH => FSH => follicle dev => inhibin release
LH => theca cells => androgens => granulosa cells (via aromatase) => O

GnRH => FSH => Sertoli cells => inhibin
LH => Leydig cells => T => Sertoli (via aromatase) => O

Question 2

When would puberty be delayed in females
-thelarche
-pubarche
-menarche, 2ndary characteristics
-thelarche, menarche gap

Answer 2

13, no thelarche
14, no pubarche
16, no menarche or 2ndary characteristics
5 year gap between thelarche and menarche

Question 3

When would puberty be considered delayed in males
-testes volume <4ml
-pubarche
-testes, penile growth

Answer 3

14, testes volume <4ml
15, no pubarche
5+ years to finish penile, testes growth

Question 4

When does puberty occur in females

What is the order

Describe each Tanner stage

Answer 4

8-13
Adrenarche => gonadarche => thelarche => growth spurt => pubarche, menarche

T1, prepubertal
T2, breast bud, some pubic hair
T3, increased breast size, dark coarse hair
T4, 2nd mound areola, increased area
T5, 2nd mound lost, thigh spread

Question 5

When does puberty occur in males

What is the order

Describe each Tanner stage

Answer 5

9-14
Adrenarche => gonadarche => pubarche => growth spurt => facial hair, spermarche

T1, prepubertal
T2, 4ml testes, some pubic hair
T3, 10ml testes, increased penis length, dark coarse hair
T4, 16ml testes, increased penis length and width, increased area
T5, 25ml testes, adult penis, thigh spread

Question 6

Describe the menstrual cycle

Key days

Answer 6

1-5
Period
FSH rises => several follicles mature in follicular phase => O rises

6-14
Increased O => proliferation of endometrial lining

14
Increase in O => LH peaks => ovulation

15-28
Luteal phase
P released by corpus luteum => secretory phase (prep for implantation)
If no pregnancy => P falls and FSH rises

Question 7

Early puberty
-possible causes
-presentation
-investigations
-management

Answer 7

Possible causes
Central - GnRH issue
-idiopathic
-CNS tumour/disorder
Peripheral - T or O issue
-T or O secreting tumours
-adrenal - CAH, tumour
-McCune Albright (cafe au lait, fibrous dysplasia, early puberty)
-exogenous steroids

Presentation - signs of puberty

Ix
-bone scan => advanced bone age
-FSH, LH, O, T

Mx
-depends on cause
-GnRH agonist to suppress puberty temporarily
-aromatase inh + anti androgen