session 3 Flashcards
Changes in the Male at Puberty
Genital development begins
- Pubic hair growth (Adrenarche)
- Spermatogenesis begins
- Growth spurt (10cm/year)
- Genitalia adult
- Pubic hair adult
the change of puberty the male starts at age?
9
Changes in the Female at Puberty
* Breast bud (Thelarche) – the first sign that puberty has begun. * Pubic hair growth (Adrenarche) * Growth spurt (9cm/year) * Onset of menstrual cycles (Menarche) * Pubic hair adult * Breasts adul
the change of the puberty at the female start at the age —–?
8
the physiological changes at puberty ?
Pulsatile GnRH secretion leads to rise in FSH and
LH
the start ofpuberty is associated with a steady rise in FSH and LH secretion.
-Rise in GnRH could be reduction in sensitivity to
–‘ve feedback by steroids, or (more likely) due
to ‘maturation’ of central mechanisms
why the GnRH hormone increase at the puberty
-Rise in GnRH could be reduction in sensitivity to
–‘ve feedback by steroids, or (more likely) due
to ‘maturation’ of central mechanisms
Critical weight is———- for menarche
47kg
Growth spurt start weight is——- for girls and—–for boys
30kg , 55kg
what is the important hormone release by the adipose tissue initiate secretion of the GrRH AND important for puberty
leptain
Adrenarche (Pubic and Axillary hair) occur dueto the effect of
adernogen in both sexs
the female are shorter than man why?
Oestrogen closes epiphyses earlier in girls.
Oestrogen is needed to initiate the growth spurt,
but once levels reach a certain point it causes the
epiphyses to fuse.
Growth Spurt depend on
growth hormones and steroids
Thelarche (Breast Development depend on
estrogen
the development of male genitalia in puberty depend on
testosterone
the tanner staging measure the puberty according to
breast,
genitals
and pubic hair development
Precocious Puberty
The development of the signs of
puberty before the age of 8 in Girls or 9 in Boys
there are two types of precocious puberty?
central (true ) and peripheral (pseud) precocious puberty
what is the True (central) precocious puberty
due to neurological causes. Early
stimulation of central maturation giving early, inappropriate
GnRH secretion. The cause of the majority is unknown, but
they can be due to neurological causes:
1-CNS tumors
meningitis
trauma
late treatment of CAH ( ACT AS trigger )
what is the peripheral precocious puberty
uncontrolled Gonadotrophin or steroid secretion like * Hormone secreting tumours or hormonal ingestion
-mc- cune - testotoxcosis adreanl tumors CAH IN male gonadal tumors HCG secreting Hepatoplastoma ]sex hormones ingestions (oral contraceptive )
Treatment for the precocious puberity
Explanation & reassurance n idiopathic causes
i
Stop the causative
drug——GnRH agonist
removalof tumor
what is the Pre-Menopause
it is the period after the 40 years and before the menopause
in the pre-menopause there is —–
- decrease in fertility
- increase in fertility
- absence of fertility
decrease in fertlity
The Menopause
Cessation of menstrual cycles
in menopause the increase of FSH more than LH due to the effect of ——
decreae of the inhibin hormone
Effects of Menopause
( I ) Vascular
Hot flushes affect ~80% to some degree
Transient rises in skin temperature and flushes
II ) Oestrogen Sensitive Tissues
Uterus
Regression of endometrium
Shrinkage of myometrium
Shrinks away into a very small organ
cervix thinning of cervix
Vagina rugae lost
Thinner, less distensible
Breast Involution of some breast tissue
Changes in skin
Bladder Reduction in bladder tone
Bone mass reduces by 2.5% per year for several
years. Increased resorption relative to production
Osteoporosis
Advantiges=of the hormonal replacement therapy
Relieves symptoms of the menopause
_Easy administration Orally or topically by patch or gel
_Can limit osteoporosis, but no longer recommended
for first line protection (Biphosphonates now recommended)
_Not advised for cardio-protection
Disadvantages of HRT
HRT increases the risk of malignancy due to effect of estrogen specially
endometrial and breast malignancies
also cardiovascular diseases such as coronary artery diseases and thromboembolism (DVT)
Menorrhagia
excessive (>80 ml) & /or prolonged
bleeding at regular intervals.
Metrorrhagia
irregular menstrual bleeding.
Menometrorrhagia
excessive, prolonged & irregular
bleeding.
Oligomenorrhoea
infrequent menses occurring at >
35 days interval.
Polymenorrhoea
frequent menses occurring at < 21
days interval.
Intermenstrual bleeding
bleeding between normal
menstrual periods.
Dysmenorrhoea
Painful menstruation
Postmenopausal bleeding
bleeding that occurs > 1 yr after
menopause, or at irregular intervals while on HRT.
Cryptomenorrhoea
menstruation occurs but not visible due
to obstruction in outflow tract
Dysfunctional Uterine Bleeding(DUB)
Abnormal bleeding,
no obvious organic cause
Amenorrhoea–
Absence of periods for at least 6 months
Anovulatory Cycles
No ovulation/ Oligo/Amenorrhoea +/-
Menorrhagia
Ovulatory Cycles
usually regular menstrual cycles +/-
Menorrhagia
+ dysmenorrhea/mastalgia (sore breasts)
what actually occut imHypothalamic/Pituitary Amenorrhoea?
inadequate FSH hormones secretion leaf to inadequate ovaries stimulation which then fail to produce enough oestrogen to
stimulate the endometrium of the uterus
Primary Hypothalamic Amenorrhoea causes
- Constitutional delay: exclude other causes.
- Kallmann Syndrome – Inability to produce GnRH ( LH & FSH
subsequently
Secondary Hypothalamic Amenorrhoea causes
- Exercise or stress-related amenorrhoea
- Eating disorders and weight loss ( anorexia or bulimia).
CNS neoplasm, trauma or infilterating disease such as TB or sarcoidosis .
* Drugs affecting HPG axis.
what the drugs affect the HAG AXIS
progesterone , HRT and the dopamine antagonist
Secondary Pituitary Amenorrhoea causes
Sheehan syndrome – –necrosis of piutary gland due to severe obstetric bleeding ——- Hypopituitarism
- Hyperprolactinaemia (adenoma)(inhbiti release of FSH and LH )
- Haemochromatosis – ‘Iron overload
how hypothyroidism cause amenorrhea
thyroxine is important for the stimulation for the progesterone’s to release by the granulosa cells
the decrease of thyroxine lead to adverse effects
the decrease of thyroxine lead to to stimulate relase of TRH which increase level of the prolactin and cause decrease in the FSH and LH secretion
how the hyperthyrodism lead to amenorrhea
it lead to trigger high sex -binding proteins production lead to decrease active estrogen that can act on endometrium of uterus .
Gonadal/End-Organ Amenorrhoea
primary type causes
Primary Gonadal/End-Organ
Gonadal dysgenesis – e.g. Turner Syndrome (45, Xo)
Androgen Insensitivity Syndrome
Receptor abnormalities for FSH and LH
Secondary Gonadal/End-Organ
causes of gonadal amenorrhea
premature menopause (ovarian failure) Polycystic Ovarian Syndrome
IV. Outflow Tract Amenorrhoea
Primary Outflow Tract Obstruction
- Uterine – Mullerian agenesis i.e. absent vagina & uterus
(Rokitansky syndrome)=15% of primary amenorrhoea - Vaginal – Vaginal atresia or transverse septum, imperforate hymen
Secondary Outflow Tract Obstruction
- Cervical stenosis as in case of conization of the cervix
- severe vaginal adhesion following vaginal surgery
- uterine causes
- Intrauterine Adhesions (Asherman’s syndrome)
- Endometrial TB
Rokitansky syndrome
Mullerian agenesis i.e. absent vagina & uterus
(Rokitansky syndrome)=15% of primary amenorrhoea
(Asherman’s syndrome)
Intrauterine Adhesions
Menorrhagia occur secondary to the
It isusually secondary to distortion of the uterine cavity,
leaving the uterus unable to contract down on open
venous sinuses in the zona basalis.
causes of the menorrhagia
It may may be due
to dysfunctional uterine bleeding (DUB) & usually
ovulatory.
Other causes include organic, endocrine,
haemostatic
Causes of the menorrhagia
1-DUB / (Bleeding of Endometrial Origion) 2-Fibriod 3-adenomyosis 4-Endometrial polyp 5-Coagulation disorder (von Willebrands disease ) 6-Pellvic inflammatory disease ( PID ) 7-Thyriod disease 8- Drug therapy ( warfarin ) 9-intrauterine contraceptive device 10-Endometrial /Cervical carcinom
Anovulatory DUB
There is no corpus luteum formation & Progesterone
production. As a result E2 is produced continuously,
causing overgrowth of the uterine endometrium &
subsequent bleeding .
difference in the causes between the perimenarchal adolescents,
vs
perimenopause
IN THE aovlatory DOB
it is due to immaturity ofHPG axis(unable to respond to E2 with an LH surge
In perimenopausal women it is due to declining
ovarian function.
Ovulatory DUB causes
altered life span of corpus luteum
or abnormal progesterone production
Disordered endometrial prostaglandin
production also has been implicated, as have
abnormalities of endometrial vascular
development
DIGNOSIS OF THE DOB
BHCG, TSH – Exclude pregnancy, thyroid
Coagulation workup
Smear if appropriate – Exclude cancer ( Cervical )
Sample endometrium ( D & C )
Dysmenorrhea (painful periods)
ATEOLOGIES
endometriosis and adenomyosis;
• pelvic inflammatory disease;
• cervical stenosis and haematometra (rare).
