Puberty- Teresa

Question 1

What are underlying endocrinology of puberty?

Answer 1

Increase in activity of adrenal gland- steroidogenesis
Increase pulsatile GnRH–>increase LH/FSH release–>increase circulating estrogen (females) and testosterone (males)
Mitosis of 1’ spermatogonia
Correlated onset of gamete maturation

Question 2

What causes start of puberty?

Answer 2

Discontinuation of suppression of HPG

Question 3

Phenotypic changes of puberty?

Answer 3

axial growth
growth of 2’ sex organs
gender specific and nongender specific hair growth
central processing alterations d/t pathway remodeling (impaired judgement)
vocal cord thickening
menarche
libido increase

Question 4

Adrenarche:

Answer 4

Pubarche (pubic hair growth)

Question 5

Thelarche

Answer 5

breast development

Question 6

gonadarche

Answer 6

production of ovarian hormones and mature gametes

Question 7

menarche

Answer 7

uterine responses to ovarian hormones

Question 8

Age definition of precocious puberty?

Answer 8

<8 for girls

<9 for males

Question 9

Types of precocious puberty?

Answer 9

GDPP: gonadotropin dependent precocious puberty
GIPP: gonadotropin independent precocious puberty

Question 10

What defines GDPP?

Answer 10

Events that would remove inhibition on the HPG axis:
early activation of pulsatile activity of gonadotropic axis so that all puberty signs are stage matched but occur earlier than expected

Question 11

What defines GIPP?

Answer 11

Events that provide peripheral hormones to carry out puberty

Staging is not matched

Question 12

Causes of GDPP??

Answer 12

idiopathic (80%)

central causes: hypothalamic hamartomas, CNS tumors, cranial irradiation, hydrocephalus, and trauma

Question 13

Causes of GIPP?

Answer 13

Girls: ovarian cysts, ovarian tumors
Boys: leydig cell tumors, HCG secreting germ cell tumors
Both sexes: exogenous estrogen, adrenal pathology with excess androgen, pituitary hormones

Question 14

In GIPP what are causes of adrenarche?

Answer 14

Tumors of adrenal gland

congenital adrenal hyperplasia (CAH, 21 hydroxylase deficiency)

Question 15

What are causes of bone age older than chronological age along with adrenarche in boys and thelarche in girls (GIPP)?

Answer 15

HCG secreting tumors

gonadal tumors

Question 16

Why are kids with precocious puberty shorter?

Answer 16

Prepubertal bone plates are very sensitive to estradiol E2.
Low levels stimulate pubertal growth spurt
higher levels cause fusion of epiphyseal plates

Question 17

How to dx GDPP?

Answer 17

GnRH analog stimulation test
–if gonadotropin levels are induced by GnRH stimulation–GDPP (if not: GIPP)
Random LH screening test
–LH of <0.1 is prepubertal. If >0.3= pubertal

Question 18

Tx for GDPP or GIPP?

Answer 18

Medical castration: GnRH agonists given constantly or antagonists; anti-estrogen/androgen
Give glucocorticoids if congenital adrenal hyperplasia

Question 19

SRY protein?

Answer 19

Causes medulla of bipotential gonad to develop into testis

Question 20

What causes wolffian duct to degenerate in females? What does it form in males?

Answer 20

Absence of testosterone–degeneration wolffian duct

Testosterone from testis causes wolffian duct to form seminal vesicle, vas deferens, and epididymis.

Question 21

What controls prostate development?

Answer 21

DHT

Question 22

What is the Anti-mullerian hormone?

Answer 22

From testes; causes mullerian ducts to degenerate

Question 23

what do mullerian ducts form?

Answer 23

fallopian tube, uterus, and upper part of vagina

Question 24

What is the fxn of aromatase?

Answer 24

Converts testosterone to E2

Question 25

Fxn of 5alpha reductase?

Answer 25

convert testosterone to DHT

Question 26

What do leydig cells secrete? Sertoli cells?

Answer 26

Leydig- testosterone

Sertoli–mullerian inhibiting substance