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Repro > Week 3.0 - Puberty and menopause > Flashcards

Week 3.0 - Puberty and menopause Flashcards

1
Q

Define Puberache

A

-Development of axillary and pubic hair

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2
Q

Define menarche

A

-First menstrual period

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3
Q

Define adrenache

A

-onset of increased androgen secretion

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4
Q

What is puberty?

A

-Stage of human development when sexual maturation and growth are completed and results in the ability to reproduce

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5
Q

Who begins puberty first girls or boys?

A

-Girls

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6
Q

Define thelarche

A

-Development of breast

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7
Q

Describe the main features of puberty

A
  • Accelerated somatic growth
  • maturation of gonads and genitals
  • Development of secondary sexual characteristics
  • Menstruation and spermatogenesis begins (reproductive system inactive before this)
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8
Q

With what hormonal changes is the onset of puberty associated with?

A
  • Gradual activation of GnRH causing steady rise in FSH and LH
  • Increased secretion of oestrogens and androgens
  • Extragonadal hormonal changes -> elevation of adrenal steroids and IGF-1
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9
Q

Which hormones is the growth spurt dependent upon?

A
  • Growth Hormone

- Sex steroid hormones

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10
Q

What is the difference between the growth spurt in girls and boys?

A

-Earlier and shorter in girls

men are larger because growth spurt longer and slightly faster

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11
Q

What signifies the end of the growth spurt?

A

-Epiphyseal fusion

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12
Q

What causes the growth spurt to be shorter in girls?

A

-Oestrogen closes the epiphyseal plates earlier

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13
Q

What controls the rate of genital development in boys?

A

-Testosterone

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14
Q

When does puberty typically begin in girls?

A

-8-13 years (mean 11.5 years)

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15
Q

When does puberty typically begin in boys?

A

-10-14 years (mean 12.5 years)

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16
Q

What is the critical weight for menarche?

A

-47kg

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17
Q

What is the relationship between weight and menstruation?

A
  • If weight falls below ~47kgs then reproductive cycle will cease
  • Overweight tend to start period early
  • Obesity can also interfere with normal menstruation
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18
Q

Name one environmental factor thought to influence puberty?

A
  • Light/dark exposure ie day length

- Altitude

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19
Q

What happens to the LH pulses on lead upto puberty?

A

-Pulses are negligible and then increase in amplitude and frequency

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20
Q

What is the first phenotypic change in girls?

A

-Breast development

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21
Q

What is the first phenotypic change in boys?

A

-Testicular enlargement

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22
Q

What is the relationship between sleep and LH?

A

-LH secretion is associated with REM sleep and begins as nocturnal pulsatility which causes a noturnal increase in sex steroid secretion

23
Q

What initiates gonadal development in puberty?

A

-high levels of FSH and LH secretion

24
Q

What happens after the gonads have started to develop in males?

A
  • Spermatogenesis and androgen secretion begins

- Androgens initiate growth of sex accessory structures (eg prostate) and secondary sex characteristics

25
Q

The adrenal glands secrete androgens, why does this not initiate puberty?

A

-Level too low

26
Q

What is the relationship between TSH and puberty?

A

-As puberty starts TSH secretion from pituitary increases leading to increased metabolic rate and promotes tissue growth

27
Q

What effects do androgens have on growth?

A

-Cause retention of mineral to support bone and muscle growth

28
Q

Which sex steroid do sertoli cells secrete?

A

-Oestrogen

29
Q

Which secondary sex characteristics are driven by androgens in females?

A
  • Pubic hair growth
  • Bone growth
  • Sebaceous gland secretion
30
Q

Where are androgens released from in women?

A

-Adrenals

31
Q

State the order of pubertal changes in girls

A
  • Thelarche
  • Pubuc hair growth
  • Growth spurt
  • Menarche
  • Breast development and pubic hair development complete
32
Q

State the order of pubertal changes in males

A
  • Genital deveopment
  • Pubic hair growth
  • Spermatogenesis
  • Growth spurt
  • Genital development and pubic hair development complete
33
Q

What is tanner staging? explain it

A

-A method of staging pubertal development
-Different in girls and boys
-Each individual change has 5 stages
eg girls: Breast 1-5, Pubic hair 1-5, Axillary hair 1-5, menarche
boys: Testicular vol >4ml, Penis enlargment 1-5, pubic hair 1-5, axillary hair 1-5, spermache

34
Q

What initiates the 1st ovarian cycle?

A

-1st LH surge

35
Q

Define precocious puberty

A
  • Onset of puberty before the average age

- Before 8 in girls and 9 in boys

36
Q

How common is precocious puberty?

A

-1/5000-10,000

much more common in females

37
Q

What is the most common cause of precocious puberty?

A

-Idiopathic

38
Q

Besides idiopathic, what are the two types of causes of precocious puberty?

A
  • Gonadotrophin dependant

- Gonadotrophin independent

39
Q

Give an example of gonadotrophin dependant cause of precocious puberty

A
  • Tumour eg hcg secreting tumour
  • Trauma
  • Nutritional status ie obesity
40
Q

Give an example of gonadotrophin independent cause of precocious puberty

A
  • Choriocarcinoma of gonads/pineal gland
  • Meningitis
  • Congenital adrenal hyperplasia
41
Q

What is precocious pseudopuberty?

A
  • Development of secondary sex characteristics without activation of the reproductive system
  • Caused by an alternative source of androgen or oestrogen, independent of FSH/LH/GnRH
42
Q

What is testotoxicosis?

A
  • Familial male precocious puberty
  • Autosomal dominant condition where there is rapid skeletal growth, skeletal maturation and sexually aggressive behaviour in the first 2/3 years of life
43
Q

Define delayed puberty

A

Either:
-Initial physical changes of puberty are not present by age 13 in girls (or primary amenorrhea by 15.5/16) or 14 in males
or
-Pubertal development is inappropriate ie interval between first signs of puberty and menarche.complete genital growth is >5years

44
Q

What are the 2 major causes of delayed puberty?

A
  • Gonadal failure (hypergonadotrophic hypogonadism)

- Gonadal deficiency

45
Q

Give some causes of gonadal failure

A
  • Turners syndrome
  • Post-malignancy treatment
  • polyglandular autoimmune syndrome
46
Q

Give some causes of gonadal deficiency

A
  • Congenital hypogonadotrophic hypogonadism
  • Hypothalamic/pituitary lesions
  • Rare genetic mutations inactivating LH/FSH receptors
47
Q

Describe pre-menopause

A
  • typically from age 40
  • Follicular phase shortens
  • Ovulation becomes early/absent as primary follicles begin to run out-> reduced fertility
  • less oestrogen secreted
48
Q

Describe menopause

A
  • Cessation of menstrual cycle for at least 12months
  • Average age 49-50
  • No more follicles
  • Oestrogen levels fall dramatically thus FSH/LH rise dramatically (no inhibin)
49
Q

Describe the effects of the menopause on oestrogen sensitive tissues

A
  • Thinning of cervix
  • Regression of endometrium/myometrium of uterus
  • Vaginal rugae lost reducing vaginal tone
  • Involution of breast tissue
  • Urinary incontinence
50
Q

Describe the effects of the menopause on bone

A
  • Bone mass reduces by 2.5%/year for several years
  • Enhanced osteoclast ability to absorb bone and attentuated osteoblastic activity
  • Osteoporosis
51
Q

Describe the purpose of HRT

A

-Relieve symptoms of menopause and improve well-being
-Can limit osteoporosis
(-given orally or topically)

52
Q

Why might precocious puberty be stimulated by meningitis?

A

-Increased pressure due to swollen meninges causing activation of HPG axis

53
Q

Would you expect a female to be taller or shorter with precocious puberty? why?

A

-Shorter due to early closure of epiphyseal growth plates

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