Session 3 - Group work Flashcards
When is thelarche?
8-11 years
When is Adrenarche?
11-12 years
When is growth spurt in the ladies?
10-14 years
When is the menarche?
11-15 years
Precocious puberty is defined as physical signs of sexual maturation before 8 years or
menarche before 10 years old. Why might precocious puberty be stimulated by meningitis?
Irritation and inflammation stimulating early rises in GnRH secretion
True precocious puberty is caused by premature secretion of gonadotrophins - mostly
idiopathic, but can be caused by CNS lesions (hypothalamic tumours, post-encephalitis
neurofibromas etc.). Hence, irritation and inflammation such as meningitis can stimulate early
rises in GnRH secretion.
What are the effects of precocious puberty on a bone growth? Would you expect a girl
to be shorter or taller as an adult because of precocious puberty?
The growth spurt begins earlier and is terminated earlier, so that epiphyses may close at an
earlier stage of growth, making the individual shorter.
Delayed puberty commonly present as primary amenorrhoea, which is failure to
menstruate by the age of 16 years. What possible explanations might you consider if:
(i) plasma LH and FSH levels are in the normal range?
If gonadotrophin levels are normal, then either the ovary is not responding to them so no steroids are produced, or if the tissues are not responding to the steroids that are produced. If no steroids are produced, however FSH & LH levels should be raised. Another possibility is
that menstruation is occurring, but the products are not shed because of a vaginal or cervical problem
Delayed puberty commonly present as primary amenorrhoea, which is failure to
menstruate by the age of 16 years. What possible explanations might you consider if:
plasma LH and FSH levels are very low?
(ii) plasma LH and FSH levels are very low?
If gonadotrophin levels are low, then the problem is likely of pituitary or hypothalamic origin.
Some examples are pituitary tumours. Anorexia nervosa, malnutrition and psychogenic causes
also lead to hypo gonadotropic hypogonadism. Check serum prolactin and consider imaging for
a cranial lesion.
What would you examine to assess the stage of puberty of a boy behind his classmates?
To assess stage of puberty check height, weight, body hair, genitalia, bone age. Also ask
about medical history and medications. Delayed puberty is lack of sexual maturation by age 15 -
majority have constitutional delay - which is quite benign - and which represents normal
variation - often familial. Such boys will eventually undergo a normal puberty and attain normal
height. Constitutional delay is most probable in a healthy boy with delayed growth and bone
age.
Consider that he is 14 years old. What proportion of normal 14 year olds would be
expected not yet to be exhibiting signs of puberty? What factors in his history might
make you feel that he is in this group?
The proportion would be very low (3-5%) since puberty in boys visibly begins between 9 and 14
years with scrotum and testicular development, however, full maturity may not be complete until
early 20’s (e.g., facial hair).
If he has good general health and nutrition, also if a brother was a “late developer”, you would
suspect constitutional delay of puberty and would give reassurance. Serious systemic illness
(e.g. diabetes, malabsorption can delay puberty).
Explain what is meant by ‘bone age’. How will this help in this boys case?
Accelerated growth is one of the earliest signs of precocious puberty and bone age can be
determined with hand-wrist films and compared with standards for the patient’s chronologic age.
If his bone age is inconsistent with (behind) his chronologic age then constitutional delay is
likely.
You will want to assess where he is in his pubertal growth spurt. How will you do so?
Growth spurt in boys is approx 10cm/year-so height comparisons over time are useful.
When does the growth spurt occur in relation to the other events of puberty in boys?
The growth spurt starts about 12 months after the first signs of puberty (increase in testicle size
due to FSH induced increase in seminiferous tubules)
Could it be that the boy is starting puberty, but his parents have not noticed it? Why may
they not have noticed the early stages?
Early signs of puberty in boys are the increase size of testes followed by reddening of scrotal
skin and elongation of penis-his parents may not be aware that these changes are occurring.
Might he be producing sperm?
High intra-testicular levels of testosterone are needed for spermatogenesis-so it is doubtful
