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Revision Cards > Week 203 - Puberty > Flashcards

Week 203 - Puberty Flashcards

1
Q

Week 203 - Puberty: Give a definition of puberty.

A

Puberty a series of physiological events that begin in late childhood, including the development of secondary sexual characteristics, somatic growth, bone maturation as well as psychological and behavioural changes.

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2
Q

Week 203 - Puberty: Give a definition of adolescence.

A

Adolescence is classed as the period between the ages of 10-24, and is when the person adapts neurologically and psychologically to physical changes of puberty, and to their changing social position.

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3
Q

Week 203 - Puberty: What is the basic endocrine system at the start of puberty?

A
  • The hypothalamus stimulates the anterior pituitary gland to first release LH (leutinising hormone) and later FSH (Folicle stimulating hormone).
  • LH acts on the gonads to produce the respective sex hormones, which in turn act on growth tissues.
  • FSH acts on the gonads to produce either sperm or ova.
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4
Q

Week 203 - Puberty: What are the two main cell types in the testes, involved in puberty?

A
  • Sertoli cells

* Leydig cells

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5
Q

Week 203 - Puberty: Which hormone acts on the Sertoli cells of the testes? What does it stimulate the release of?

A
  • FSH leading to a release of inhibin and oestradiol.

* Testosterone also stimulates the sertoli cells.

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6
Q

Week 203 - Puberty: Which hormone acts on the Leydig cells of the testes?

A

• LH leading to the release of testosterone.

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7
Q

Week 203 - Puberty: What is the first stage of puberty in boys?

A

• Enlargement of the testes, puberty is said to have begun when they reach a volume <4ml.

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8
Q

Week 203 - Puberty: Explain the endocrine pathway that occurs during female puberty.

A
  • The hypothalamus stimulates the anterior pituitary gland to release LH+FSH.
  • These act on the ovary to produce oestradiol which causes the development of antral follicle.
  • This directly releases oestrogen and causes the development of corpus luteum which releases progesterone.
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9
Q

Week 203 - Puberty: Which set of hormones cause the development of female pubic and axillary hair?

A

Androgens.

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10
Q

Week 203 - Puberty: Oestradiols produced by the ovary cause the development of which structure within the ovary?

A

Antral follicle.

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11
Q

Week 203 - Puberty: The two female sex hormones are oestrogen and progesterone, which two structures in the ovary produce them?

A
  • Antral follicle - Oestrogen

* Corpus Luteum - Progesterone

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12
Q

Week 203 - Puberty: What is the first sign of puberty in females?

A

Breast development, deposition of fat on the hips and enlargement of uterus and vagina.

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13
Q

Week 203 - Puberty: What is the difference between growth of height in the patterns of female and male puberty?

A

In female puberty growth begins at the start of puberty, where as in males it does not develop until later when the testes of 10-12ml.

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14
Q

Week 203 - Puberty: The sex hormones stimulate the release of which hormones needed for growth? Where are they secreted from?

A
  • GH (Growth hormone) - Anterior pituitary gland.

* IGF (Insulin-like growth factor) - Liver.

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15
Q

Week 203 - Puberty: There are two other hormones needed for the production and effect of GH and IGF, what are they and what is their effect?

A
  • Thyroid hormone - Production and action of GH

* Insulin - Secretion of IGF and promotes protein synthesis.

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16
Q

Week 203 - Puberty: How much growth do males and females experience during puberty?

A
  • Females - 25cm approx.
  • Males - 28cm approx. (But since they start pubertal growth on average 2 years later, they have a further 10cm of normal growth)
17
Q

Week 203 - Puberty: What causes the end of growth?

A

• Fusion of the epiphyseal plates, in response to oestrogen.

18
Q

Week 203 - Puberty: What is consonance?

A
  • This is the normal pattern that puberty follows, ie, testicular growth> penile growth> pubic hair> growth spurt.
  • If someone is developing along with consonance, it suggests that the hypothalamus-pituitary-gonadal axis is working correctly.
19
Q

Week 203 - Puberty: What is non-consonance?

A
  • This is deviation from the normal pattern of puberty and suggests that there is production of sex hormones/androgens from a peripheral source (out of the hypo-pit-gonadal axis).
  • The order of development can suggest the site that is driving puberty.
20
Q

Week 203 - Puberty: The exact cause for the initiation of puberty is unknown, but what are the three main factors?

A
  • Genetics
  • Nutrition
  • Environment
21
Q

Week 203 - Puberty: What is adrenarche and what does it cause?

A
  • Adrenarche is the normal maturation of adrenal glands causing increased secretion of the androgens (androstenedione and dehydroepiandrosterone (DHEA))
  • The androgens cause the development of axillary and pubic hair.
  • It normally coincides with the start of puberty but can start earlier or be delayed.
22
Q

Week 203 - Puberty: The nocturnal secretion of which hormone at the end of the 1st decade of life heralds the start of gonadarche?

A

GnRH - Gonadtrophin releasing hormone.

23
Q

Week 203 - Puberty: What is Thelarche?

A

Development of breast tissue, during puberty. (Females)

24
Q

Week 203 - Puberty: What is the definition of delayed puberty and how can the diagnosis be confirmed?

A
  • Complete absence of physical signs of puberty in girls after the age of 13 and aged 14 in boys.
  • Bone age scan of hand and wrist.
25
Q

Week 203 - Puberty: What are the two types of delayed puberty and what are the levels of FSH/LH in these?

A
  • Central failure - Hypogonadtrophic failure - Low FSH/LH

* Primary gonadal failure - Hypergonadotrophic failure - High FSH/LH

26
Q

Week 203 - Puberty: What are some of the causes of hypergonadotrophic failure?

A

Primary Gonadal Failure

  • Genetic (Turner’s, Klinefelter’s XXY)
  • Autoimmune
  • Enzyme defects
  • Androgen insensitivity
  • Chemotherapy
  • Pelvic radiation
  • Bilateral cryptoorchidism in males. (Uncorrected before age 8)
27
Q

Week 203 - Puberty: What are some of the causes of hypogonadotrophic failure?

A

Central Failure

  • Constitutional
  • Eating disorder
  • Excessive physical activity
  • Hypothyroidism
  • Intracranial tumour
  • Isolated GH or GnRF deficiency
28
Q

Week 203 - Puberty: What is the system of staging for puberty?

A

Tanner staging 1-5 (5 being fully developed)

29
Q

Week 203 - Puberty: What is precocious puberty?

A

This is the early onset of secondary sexual characteristics.

- <9yrs in boys

30
Q

Week 203 - Puberty: Explain the two types of precocious puberty.

A

• True central precocious puberty

  • Gonadotrophin dependant
  • Consonant puberty occurring early, resulting from initiation of the hypothalamus.

• Peripheral precocious puberty

  • Precocious pseudopuberty / Independent of gonadotrophin.
  • Caused by abnormal secretion of sex-hormones independent of hypothalamus.
  • May be non-concordant.
31
Q

Week 203 - Puberty: What three themes of impact does precocious puberty have on the child?

A
  • Low final height. (Early fusing of epiphyseal plates)
  • Impact on fertility and age of menopause.
  • Psychological impact.
32
Q

Week 203 - Puberty: What are the causes of true central precocious puberty?

A

• Idiopathic
• Secondary;
- CP/Hydrocephalus, Tumours/Masses, Trauma, Chronic inflammatory conditions, Radiotherapy, Sexual abuse, Adoption.

33
Q

Week 203 - Puberty: What are the causes of peripheral precocious puberty?

A
  • Genetic
  • Precocious breast development - Thelarche, ovarian cyst, hypothyroidism.
  • Virilisation - Adrenarche, Cushings Disease, Adrenal Tumours
  • Gonadotrophin/sex-hormone secreting tumours
  • Exogenous steroids
34
Q

Week 203 - Puberty: What investigations should be performed for precocious puberty?

A
  • Auxology - multi-disciplinary approach.
  • Parental heights
  • LH/FSH tests
  • Oestradiol/Testosterone
  • Androgens
  • Bone age
  • Pelvic USS -Girls
35
Q

Week 203 - Puberty: What is the treatment of central precocious puberty?

A

• An analogue of GnRH can be given which inhibits the secretion of LH/FSH, so delays puberty, this can then be stopped at a later age so puberty can resume.

36
Q

Week 203 - Puberty: What is the treatment of peripheral precocious puberty?

A

Address the cause.

37
Q

Week 203 - Puberty: What enzyme is responsible for breaking 17-OH-progesterone into cortisol? What effect can deficiency of this enzyme cause?

A
  • 21-hydroxylase
  • Deficiency of this enzyme pushes the pathway towards the sex-steroid pathway, commonly resulting in congenital adrenal hyperplasia (CAH).

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