Puberty: delays, investigation and management Flashcards
Thelarche breast development
First visible change of puberty, induced by oestrogen, may be unilateral for several months
Effects of oestrogen on breast
Ductal proliferation
Site specific adipose deposition
Enlargement of the areola and nipple
Other hormones alongside oestrogen involved in breast development (thelarche)
Prolactin, glucocorticoids, insulin
The prepubertal endometrium is a single layer of ______ cells
cuboidal
The prepubertal uterus is ______ shaped
tubular
The pubertal uterus is ___ shaped
pear
Is the vagina acidic before puberty?
No, pH neutral
Oestrogen increases size and thickness of labia m____ and m_____
majora and minora
Oestrogen causes the hymen to ______ and clitoris to enlarge
thicken
What stimulates the vestibular glands to begin secretion?
oestrogen
Adrenal androgens and ovarian androgens causes
growth of pubic and axillary hair
Adrenarche
Maturational process of the adrenal gland. Specialised subset of cells arises forming the androgen-producing zona retucularis
Up to 80% of females and only 30% of males with precocious puberty is idiopathic. Therefore, especially for males, need to rule out…
Brain tumour
How to differentiate between True precocious puberty and precocious pseudopuberty
Lh:FSH ratio > 1 in true precocious puberty
LH:FSH ratio < 1 in precocious pseudopuberty
Treatment for “true” precocious puberty
GnRH super-agonist to suppress pulsatility of GnRH secretion
Precocious Pseudo-Puberty is GnRH…
independent
What are causes of “true” precocious puberty?
Idiopathic precocious puberty
CNS tumours
CNS disorders
Secondary central precocious puberty
Psychocial (ie adoption from abroad)
Causes of Precocious Pseudo-Puberty
Increased androgen secretion
Gonadotropic secreting tumours
McCune-Albright syndrome
Ovarian cyst
Oestrogen secreting neoplasm
Iatrogenic or exogenous sex hormones
Delayed puberty occurs in about _% of children
3%
Indications for investigation of delayed puberty in girls
Lack of breast development by 13 y/o
More than 5 years between breast development and menarche
Lack of pubic hair by 14 y/o
Absent menarche by age 15-16
Indications for investigation of delayed puberty in boys
Lack of testicular enlargement by age 14
Lack of pubic hair by 15 y/o
More than 5 years to complete genital enlargement
Constitutional delay of growth and puberty (CDGP)
Most common cause, more common in boys, extreme of normal physiologic variation
Delay in bone maturation, delay in adrenarche
Lab investigations for delayed puberty
Complete red blood count
U&E, LFT, coeliac ab
LH,FSH
Testosterone/Oestradiol
Thyroid function, prolactin
Karyotyping, CGH array in all girls with short stature (screening for Turner’s syndrome)
Low concentrations of LH, FH, testosterone/oestrogen can be seen during…
quiescent phase and early puberty
True or false: There is delayed bone age in GH deficiency
True
There is _____ bone age in precocious pubery
advanced
Kallman Syndrome
Hypogonadotrophic hypogonadism, anosmia in 75%, failure of migration of GNRH neurons
What are other signs of Turner’s Syndrome?
Recurrent otitis media, short stature
Klinefelter Syndrome
Affects approx. 1 in 1000 males,
reduced secondary sexual hair
Primary hypogonadism
Azoospermia, Gynaecomastia, Osteoporosis, tall stature, reduced IQ in 40%
20-fold increase risk of breast cancer
