Puberty disorder

Question 1

Puberty

Answer 1

considered delayed if puberty has not started by
• Age 13 for female
• Age 14 for males

Question 2

Hypothalamic-pituitary-gonadal axis

Answer 2

system of signalling between the hypothalamus, pituitary and gonads

Question 3

Primary and secondary sexual characteristics

Answer 3

1. Primary -
   - Gonad devlopment
   - directly involved in sexual resproduction
2. Secondary
   - sex specific physical characteristic not necessary in sexual reproduction
   - pubic hair, breasts

Question 4

Tanner scale

Answer 4

Stage 1 - no pubic hair, flat chest, small penis/testes
Stage 2 - pubic hair, enlargement of testes,breasts grow
Stage 3 - pubic hair coarser, breast mounds, penis enlarge
Stage 4 - pubic hair covers pubic area, penis widens, breast enlargement forms mound on mound contour
Stage 5 -
Pubic hair to the inner thigh, adult size testes and breasts

Question 5

Delayed puberty

Answer 5

• progression through the tanner scale has not begun 13 in female, 14 in males
• Hypogonadism is v low levels of sex hormones and is often the cause
• Sex characteristics underdeveloped
• May result in permenant infertility

Question 6

Primary hypogonadism

Answer 6

1. Dysfunction of the gonads
• Gonad receptors do not respond to gonadotropin hormones
• Gonads unable to produce hromones
2. Low levels of gonadal hormone
3. Less feedback on pituitary hormones
4. Excess pituitary hormones

Question 7

Secondary hypogonadism

Answer 7

1. Low levels of LH and FSH

- Hypothalamus/Pituitary gland dysfunction for LH, FSH, GnRH production

Question 8

Causes of primary hypogonadism

Answer 8

Acquired - chemotherapy/ Trauma to gonads
Congenital -
Kleinfelter/Turner syndrome

Question 9

Causes of secondary hypogondism

Answer 9

Acquired - trauma/radiotherapy
Congenital-
• Kallman syndrome
• Panhypopituitarism
General-
• Chronic illness, excess exercise, malnutrition

Question 10

Constitutional delay

Answer 10

• Temporary delay in puberty
• Does not cause infertility
• Lack of Gn RH, however just a natural slowed maturation
• Genetic component

Question 11

Diagnosis

Answer 11

1. Comparison with the Tanner scale
2. Blood test
3. Medical history - underlying medical condition

Question 12

Treatment

Answer 12

• Constituional delay - not medical intervention
• hormone therapy
• Infertility treatments

Question 13

Precocious puberty

Answer 13

• If puberty begins before 8 in females and 9 in males

Question 14

Central precocious puberty

Answer 14

• Gonadotropin dependant puberty
• Early maturation of Hypothalamic - pituitary - gonadal axis
• Early rise of LH and FSH hormone
• Increase in sex hormone

Question 15

Cause of central precocious puberty

Answer 15

• Dysfunctional hypothalamus or pituitary

• Tumor - releases GnrH or HCG
• Infections/Cysts
• Radiation damage to the brain - impairs negative feedback
• Idiopathic precocious puberty

Question 16

Peripheral precocious puberty

Answer 16

• Gonadotropin independant puberty
- Overproduction of sex hormone production
• Cysts and tumors of ovaries
• McCune-Albright syndrome
• Dysfunction of thyroid/Adrenal glands
• Exogenous sex hormones - medication/creams

Question 17

Diagnosis of Precocious puberty

Answer 17

1. Early sexual maturation - emotional distress
2. Tanner scale
3. Gonadotropin levels -dependant or independant differentiation
4. MRI/Ultrasound - structural abnormalities in brain or gonads