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Senoir paeds > Puberty-Endocrine Aspect > Flashcards

Puberty-Endocrine Aspect Flashcards

1
Q

Puberty is the stage of _________________ , ending in _________________.

Involves morphological, physiological and behavioural changes.

Commence toward the end of the __________ decade of life.

The changes of puberty occur because of orderly, sequential changes in endocrine activity.

A

sexual maturity ; reproductive capability.

first

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2
Q

Puberty

Occurs between ___-____ years of age in girls.
____-_____ years of age in boys. [range of 12- 20yrs]

A

8 - 14

9 - 14

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3
Q

Endocrine Control of Puberty

List 7

A

Gonadotropin Releasing Hormone[GnRH]

Gonadotropins [Follicular Stimulating Hormone(FSH) & Luteinizing Hormone (LH)]

Growth Hormone

Insulin-like Growth Factor 1[IGF1]
Gonadal Steroids
Insulin
Leptin

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4
Q

Inhibin

A peptide hormone secreted by the ________ cells of the ________ and the ________ cells of the ________ .

It (Up or Down?) regulates ______ synthesis

It Inhibits secretion of ______

A

follicular; ovary; sertoli; testes

Down; FSH

FSH

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5
Q

Hypothalamo-Pituitary-Gonadal Axis

The beginning of adolescent-related puberty is a function of the hypothalamo- pituitary-gonadal axis maturation.

_________ in the frequency of GnRH [Gonadotropin Releasing Hormone] pulse stimulation is one of the important neuroendocrine mechanisms.

A

↑

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6
Q

Sequential events leading to puberty

In ________ and in the first ________________ , the hypothalamic-pituitary- gonadal (HPG) axis shows a period of activity.

Becomes quiescent by ____________ of age until the time of puberty.

A

utero

few postnatal months

6 months

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7
Q

Sequential events leading to puberty (2)

Pulsatile secretion of ________ from the _________ results in pulsatile secretion of the _________ gonadotropins, ______ and _________ .

Increasing LH production triggers an increase in production of ____________,
While, increasing FSH stimulates the growth and maturation of the _______________ and ______________

A

GnRH; hypothalamus; pituitary

LH and FSH

sex steroids

seminiferous tubules and the ovarian follicles.

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8
Q

IGF [Insulin Growth Factor 1]

IGF-1 is an important modulator of growth during childhood and adolescence.

IGF-1 conc _______ markedly through puberty reaching peak values approx ______ later in boys than in girls.

A

↑

1yr

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9
Q

Insulin

Insulin is also important for normal growth.

Plasma insulin levels ________ throughout childhood but the rise is particularly pronounced during _________ with a strong positive correlation with _______.

A

↑

puberty

IGF-1

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10
Q

LEPTIN

A protein hormone produced by __________ .

Important in (male or female?) puberty which usually will not proceed until an adequate body mass has been achieved.(at least ______kg)

A

adipose tissues ; female

40

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11
Q

GONADAL STEROIDS

 Sex steroids induce a _________ growth spurt even when _______ is absent, suggesting that oestradiol acts on both on the _______________________ and _________

A

subnormal; GH

secretion of GH from the pituitary & the growth plate.

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12
Q

Sex steroids

 Oestrogen is important for skeletal __________ and __________ of the __________.
It also augments ______ release.

 Testosterone is an _____bolic hormone and acts on androgen receptors in responsive tissues throughout the body.

A

maturation

fusion of the epiphysis.

GH ( anabolic

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13
Q

Sex steroids

 Oestrogen is important for skeletal __________ and __________ of the __________.
It also augments ______ release.

 Testosterone is an _____bolic hormone and acts on androgen receptors in responsive tissues throughout the body.

A

maturation

fusion of the epiphysis.

GH ( anabolic

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14
Q

Hormones behind somatic signs of puberty
Boys

FSH, LH
• Growth of __________ (__________)
• __________ production

Testosterone
• Growth of __________, __________.
Sexual hair, acne, adult sweat odour, muscles, voice change

Oestrogen
-__________ closure -__________

A

testicles ; spermatogenesis

Testosterone ; scrotum ; penis.

Epiphyseal ; Gynecomastia

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15
Q

Hormones behind somatic signs of puberty
Girls

FSH, LH
• _________ maturation (size, follicles)
• _________ production

Estradiol
• Growth of _________, _________, fat over buttocks, thighs, vaginal discharge, menstruations

Testosterone
Sexual _______, ______, adult _________, muscles, libido

A

Ovarian ; Estradiol

breasts; uterus,

hair, acne, adult sweat odour

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16
Q

PUBERTAL STAGING
The physical changes of puberty in individuals are defined by the ________ stages.
Females-Breast development and pubic hair
Males- External Genitalia and pubic hair

A

Tanner

17
Q

PUBERTY AND GROWTH-2
Also the testes _______________________________ hence the later puberty.

Growth spurt starts with the ______________ and moves (proximally or distally?) to finish with the ___________.

A

require high levels of gonadotropin stimulation than ovaries

hands & feet

Proximally; trunk

18
Q

WEIGHT GAIN IN PUBERTY
Marked changes in body composition occur during puberty.
Boys gain approx ____kg in wt over puberty (from 12-18yrs) ____% being accounted for by ___________ [FFM]
Girls gain approximately _____kg only ____% being FFM.

A

30; 82

fat-free mass

18.5; 68

19
Q

Contributing Factors to Timing of Puberty

___________ (twins)
___________ ___________ (SGA)
Changing life condition (___________) Chemicals, environment
___________ status (anorexia nervosa) ___________-situations (sport, war)
Brightness, ___________ (blind girls)
Climate

A

Genetics
Intrauterine development
adoption
Nutritional
Stress
photoperiods

20
Q

PRECOCIOUS PUBERTY

Conventional Definition:

___________________ present before age:
– 8 years in girls – 9 years in boys

Lawson Wilkins Pediatric Endocrine Society (LWPES) statements (1999, 2003):
Girls present early puberty at age:
 _____years (African-American girls)
 —— years (White girls )

A

2 or more pubertal signs

6-8
7-8

21
Q

Causes of Precocious Puberty (PP)

Origin in CNS (gonadotropin ________ [CPP]) • Idiopathic (most often _______)
• Tumours (harmatoma, optic glioma)
• Increased _______________
• Defects of _____________ function eg Testotoxicosis

A

dependent

familial; intracranial pressure

LH receptor

22
Q

Causes of Precocious Puberty (PP)

Primary cause in gonads(gonadotropin ___________ [PPP]
• Tumours
• ____________ , ____________ syndrome

Primary cause in adrenals(gonadotropin ________________ ) •_________________ (CongenitalAdrenalHyperplasia)
• Tumours

A

independent; Ovarian cysts

McCune-Albright

independent; Enzymedeficiencies

23
Q

Causes of Precocious Puberty (PP)

Others:Long-standing _________ ___________

Markedly elevated ______ secretion might stimulate the FSH receptor

A

primary hypothyroidism

TSH

24
Q

Management of PP 1/5

Detailed history
Physical Examination:
─______________
─ __________ staging
─ Dermatological [______________,
______________]
─ Neurological

A

─Anthropometry
─ Tanner staging
─ Dermatological [Mc-Cune-Albright,
Neurofibroma] ─ Neurological

25
Q

Management of PP 2/5
Investigations:
Baseline ____,_____
_____________(______ or _____)
Adrenal steroids/metabolites[if indicated]
____________ tests [if indicated]
_______ stimulation tests

A

FSH,LH

Gonadal steroids [E2 or T]

Thyroid function

GnRH

26
Q

Management of PP 3/5

Imaging:

___________ -provides indication of skeletal advancement from excess _______. Useful in calculation of final height.
Pelvic Ultrasound
CT Scan/MRI especially in boys or girls with neurological signs.

A

Bone Age; steroids

27
Q

Management of PP 4/5
Treatment:
Directed at the cause
Treatment of underlying disease conditions
CPP- Treatment with _________ (Leuprorelin,Goserelin, Triptorelin)
[pituitary gonadotrophs are subjected to prolonged rather than the physiological pulsatile GnRH levels.]

A

GnRH agonists

28
Q

DELAYED PUBERTY

Delayed onset :

Females: Breast bud does not appear till ___________ or
•Menarche does not occur till _________

Males: No testicular enlargement by __________of age

A

13 years; 16 years

14 years

29
Q

DELAYED PUBERTY

Delayed progression [Arrested ]:

Females: Menarche does not occur within _________ after breast bud

Males:

Incomplete development of the genitalia __________ after commencement.

A

5 years

5 years

30
Q

Management of PP 5/5
Peripheral PP:
Replacement therapy- CAH: _____________ , Hypothyroidism : ____________

Oversecretion of hormones
─Medroxyprogesterone (Antigonadotropic + inhibitor of biosynthesis of gonadal steroids)
─Cyproterone acetate (Antigonadotropic + antiandrogen)
─ _______________ (Antiandrogen)
─ ___________ (Inhibitor of several steps in the biosynthesis of adrenal and gonadal steroids)
─ Aromatase inhibitors (Non-selective, selective)
Surgery /Chemotherapy for tumours

A

Hydrocortisone; L-thyroxine

Spironolactone; Ketoconazole

31
Q

Management of PP 5/5
Peripheral PP:
Replacement therapy- CAH: Hydrocortisone, Hypothyroidism : L-thyroxine
Oversecretion of hormones
─Medroxyprogesterone (Antigonadotropic + inhibitor of biosynthesis of gonadal steroids)
─Cyproterone acetate (Antigonadotropic + antiandrogen)
─ Spironolactone (Antiandrogen)
─ Ketoconazole (Inhibitor of several steps in the biosynthesis of adrenal and gonadal steroids)
─ Aromatase inhibitors (Non-selective, selective) Surgery /Chemotherapy for tumours

A

Senoir paeds (15 decks)

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