Reproductive - Disorders of Puberty Flashcards
What is the normal age range for entering puberty in girls?
8 - 13 years
What is the normal age range for entering puberty in boys?
9 - 14 years
Is delayed puberty more common in boys or girls?
Boys
Is precocious puberty more common in boys or girls?
Girls
Define what is meant by delayed puberty in girls?
The lack of any breast development by the age of 13 years
Define what is meant by delayed puberty in boys?
A testicular volume < 4mls by 14 years
What is the most common cause of delayed puberty in both sexes?
Constitutional delay
Is a pathological cause for delayed puberty more likely in boys or girls?
Girls
What are some central causes of delayed puberty, with an intact hypothalamic-pituitary axis?
Constitutional delay, chronic disease, malnutrition
What are some central causes of delayed puberty, caused by secondary hypogonadism?
Pituitary disease, GnRH deficiency
What are some peripheral causes of delayed puberty?
Turner’s/Klinefelter’s syndrome, bilateral testicular damage
What physical sign may be seen in adolescents with constitutional pubertal delay?
Short stature
What investigation may be useful to support a diagnosis of constitutional pubertal delay?
Bone age radiograph
Why should TFTs be performed in individuals with delayed puberty?
Hypothyroidism can be a cause
How can puberty be induced in those with constitutional pubertal delay?
A short course of oestrogen or testosterone
Precocious puberty is defined as signs of puberty before what age in girls?
8 years
Precocious puberty is defined as signs of puberty before what age in boys?
9 years
What are some peripheral (gonadotrophin-independent) causes of precocious puberty?
Ovarian/testicular/adrenal tumours or CAH
Is the cause of central precocious puberty more likely to be pathological in boys or girls?
Boys
What will a bone radiograph show in children with precocious puberty?
Advanced bone age
What imaging investigation is indicated in all boys, and girls aged < 6 years, with precocious puberty?
Pituitary MRI
What blood test is a reliable indicator of whether a boy has entered puberty or not?
Early morning testosterone
In a child with precocious puberty, very high levels of either testosterone or oestrogen with suppressed gonadotrophin levels suggests what?
Peripheral precocious puberty
Which gonadotrophin is the most reliable indicator of whether a child’s gonadotrophins are at pubertal or pre-pubertal levels?
Serum LH
If the picture of precocious puberty is unclear, what stimulation test can be used?
GnRH stimulation test
In the GnRH stimulation test, what will happen if there is central precocious puberty?
Gonadotrophin levels will rise
In the GnRH stimulation test, what will happen if there is peripheral precocious puberty?
No change in gonadotrophin levels
What medication can be used to halt puberty in children with idiopathic precocious puberty?
Gonadotrophin agonists
What is the main complication of precocious puberty?
Diminished final adult height
How is androgen insensitivity syndrome inherited?
X linked
Explain the genotype and phenotype of a child with androgen insensitivity syndrome?
Genotypically male but phenotypically female
What are the two main features of androgen insensitivity syndrome?
Primary ‘amenorrhoea’ and bilateral undescended testes
How is a diagnosis of androgen insensitivity syndrome made?
Karyotyping
How is androgen insensitivity syndrome managed?
Counselling, oestrogen therapy and bilateral orchidectomy
