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CMN572 > U4: puberty > Flashcards

U4: puberty Flashcards

1
Q

puberty patho in girls: hypothalamus releases _____ which stimulates the AP glad to produce ______ which stimulates the ovarian follices to release ______ which has a negative feedback on hypothalamus & AP

A
  • gonadotrophin releasing hormones (GnRH)
  • LH/FSH
  • estrogen
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2
Q

puberty patho in boys: hypothalamus releases ______ which stimulates the AP glad to produce ______ which stimulates the testicles to release _______ which has a negative effect on the hypothalamus & AP

A
  • gonadotrophin releasing hormones (GnRH)
  • LH
  • testosterone
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3
Q

what lab should also be checked in children with precocious/delayed puberty?

A

thyroid studies

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4
Q

puberty is considered precocious under what age in boys and girls?

A

<8y girls

<9y boys

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5
Q

puberty is considered delayed in girls with no signs by age _____ or no menarche by age _______

A
  • 13y with no signs

* 16y with no period

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6
Q

puberty is considered delayed in boys with no signs by age _____ or over ______y elapsed since _______

A
  • 14y with no signs

* 5y since first sign of puberty

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7
Q

precocious puberty can be classified as: (2)

A
  • central

* peripheral

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8
Q

central PP is an issue at what organ on the HPO axis?

A

*brain/pituitary

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9
Q

what labs correlate with central PP?

A
  • increased LH/FSH

* increased estradiol & testosterone

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10
Q

peripheral PP is an issue at what organ on the HPO axis?

A

*adrenal gland/ovaries/testes

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11
Q

how do GnRH analogues work?

A

*GnRH agonist acts EXACTLY like GnRH hormones and stimulate LARGE amount of LH/FSH&raquo_space; flair of sex hormones

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12
Q

what are GnRH analgoues used for?

A

endometriosis

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13
Q

GnRH analogue meds (2)

A
  • Goserelin/Zoladex

* Leuprorelin/Prostap

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14
Q

central PP is missing what hormone which therefore must be supplemented

A
  • GnRH
  • “leuprolide” IM QM
  • “histrelin implant QY
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15
Q

in central PP the ________ is not stimulated to to release _______

A
  • hypothalamus

* GnRH

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16
Q

without GnRH the anterior pituitary still produces ______ & ______ which signal the gonads to release ________… this leads to high levels in the blood- a diagnostic feature of ______

A
  • FH
  • LSH
  • sex hormones
  • central PP
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17
Q

basically…. in central PP which HPO axis organs are on and which are off?

A
  • ON = anterior pituitary and gonads

* OFF = hypothalamus

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18
Q

basically in peripheral PP which HPO axis organs are on and which are off?

A
  • ON = gonads (and adrenals)

* OFF = hypothalamus & anterior pituitary

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19
Q

in peripheral PP the _____ are stimulated by the _______ to release ______

A
  • gonads
  • adrenal glands
  • sex hormones
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20
Q

boys with central PP must obtain what imaging? to eval for what? bc why?

A
  • MRI
  • CNS lesions
  • less common in boys
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21
Q

what diagnostic test will help you differentiate between abnormal pubertal processes?

A

*bone xray to assess bone age

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22
Q

if bone age is 2y older than actual age, expect?

A

PP

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23
Q

if bone age is delayed but child has a normal growth chart, what do you expect?

A

constitutional growth delay

24
Q

causes of peripheral PP can include?

A
  • adrenal tumor
  • genetic abnormality
  • exposure to meds
  • ovarian cysts/tumors
  • tumors of testes
25
Q

if bone age is >12y with no signs of puberty, what do you expect?

A

*delayed puberty

26
Q

sexual differentiation is completed at ______w gestation

A

*12

27
Q

PP is more common in boys or girls?

A

*girls

28
Q

T or F: obesity is a cause of PP

A

True

29
Q

PP: girls who present WITH pubic or armpit hair BUT NO BREAST DEVELOPMENT. obtain what 2 labs?

A
  • androgen

* 17-hydroxyprogesterone

30
Q

female presents with PP. what lab do you draw and why?

A
  • estradiol

* r/o ovarian tumor/cyst

31
Q

for PP obtain an xray of?

A

left hand and wrist

32
Q

treat central PP with what?

A

*GnRH analogues until time to resume puberty

33
Q

treat peripheral PP with what?

A

*treat underlying cause

34
Q

benign premature adrenarche is described as

A

*early development of pubic hair, axillary hair, body odor, acne

35
Q

pt has benign premature adrenarch (BPA), what labs do you draw and why?

A
  • prob LH/FSH, sex hormones, and GnRH to see where the issue is.
  • to r/o late onset CAH or adrenal tumors
36
Q

benign premature thelarche is?

A

isolated breast development wihtout other signs of puberty.

  • most common in girls under 2
  • if onset >36m OR AW other signs of puberty REFER
37
Q

PP In boys: testes enlarged >2cm indicates what?

A

central PP

38
Q

PP in boys: testes remain small indicates what?

A

Gonadotropin-independent causes

39
Q

PP in boys: testes asymmetric or unilaterally enlarged

A

*tumors

40
Q

peripheral PP In boys but labs are negative for CAH. what next?

A

get imaging of liver, adrenals, testicles to look for tumors

41
Q

familial male PP or McCune Albright Syndrome (GNAS mutation) will be treated with what?

A
  • agents that block steroid synthesis = ketoconazole

* antiandrogens = sprionolactone + aromatase inhibitors [anastrazole or letrozole]

42
Q

symmetric testes >2.5cm or >4ml indicate onset of puberty. T or F?

A

true

43
Q

girls SMR 2:

A

breast buds; straight/fine hair

44
Q

girls SMR 3:

A

breast & areola grow; coarse/dark hair spreads

45
Q

girls SMR 4:

A

nipple & areola form separate mound; adult-like hair sparing thighs

46
Q

girls SMR 5:

A

areola rejoins breast contour; hair inverted triangle (adult)

47
Q

boys SMR 2:

A
  • testes increase in size
  • scrotum reddens
  • straight hair at base
48
Q

boys SMR 3:

A
  • penis grows LONGER

* curly/coarse hair

49
Q

boys SMR 4:

A
  • penis grows WIDER

* adult-like hair sparing thighs

50
Q

boys SMR 5:

A

*penis and pubic hair fully developed

51
Q

gynecomastia occurs btwn ages _______ and usually disappears in ____y

A
  • 14-15

* 2y

52
Q

girls growth spurt onset, peak, end

A
  • 9
  • 11.5 (SMR 3-4)
  • 16y
53
Q

boys growth spurt onset, peak, end

A
  • 11
  • 13.5
  • 18y
54
Q

central delayed puberty labs

A

LOW FH/LSH

55
Q

primary gonadal failure labs

A

HIGH LH/FSH

56
Q

delayed puberty ST primary gonadal failure is usually secondary to what 2 dx in girls?

A
  • turners

* PCOS

57
Q

delayed puberty ST primary gonadal failure is usually secondary to what DX in boys?

A

*Klinefelter

CMN572 (13 decks)

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