11.1 Puberty

Question 1

what is thelarche?

Answer 1

onset of breast development

Question 2

what is pubarche?

Answer 2

onset of sexual hair development

Question 3

how are pituitary gonadotropins secreted?

Answer 3

• pulsatile
• oestrogens
• androgens

Question 4

puberty control centres in order?

Answer 4

• higher centres
• hypothalamus (GnRH)
• pituitary (LH, FSH)
• gonads

Question 5

what is adrenarche?

Answer 5

• increased adrenal androgen production in both sexes
• happens before gonadarche
• not true puberty

Question 6

growth spurt for girls v boys?

Answer 6

11. 5 years - girls

13. 5 years - boys

Question 7

what to think about in early sexual development?

Answer 7

• central v peripheral causes
• complete v incomplete
• pathological v normal

Question 8

what is true precocious puberty?

Answer 8

• problem with central activation
• check LH, FSH, sex steroid levels
• can be neuro tumours
• mostly idiopathic

Question 9

precocious pseudo-puberty is?

Answer 9

• peripheral activation
• congenital adrenal hyperplasia
• tumours
• iatrogenic

Question 10

what are normal variants in early sexual development?

Answer 10

• premature thelarche

- premature adrenarche

Question 11

lower limits of normal for development for girls?

Answer 11

<8 thelarche, pubarche

<10menarche

Question 12

lower limits of normal for development for boys?

Answer 12

• testicular enlargement 9 years

- pubic hair 9years

Question 13

early puberty, what bloods?

Answer 13

• LH, FSH, testosterone, oestradiol, prolactin, hCG

- DHEAS, androtenediaon, 17-OH progesterone

Question 14

what causes precocious puberty?

Answer 14

girls: 90% idiopathic
boys: 75% HAVE a pathological CNS lesion

Question 15

how to treat central precocious puberty?

Answer 15

• treat CNS tumour

- pubertal suppression

Question 16

how to suppress puberty?

Answer 16

GnRH agonists

-depot injections 4-12 weeks

Question 17

what is McCune-Albright syndrome?

Answer 17

• peripheral, not central
• more in girls than boys
• low LH and FSH but high pubertal sex steroids
• has skin lesions
• x-ray have polyostotic lesions

Question 18

how to treat McCune-Albright syndrome?

Answer 18

peripheral hormone blockade: aromatase inhibitors

Question 19

thelarche normal variant?

Answer 19

• common first 2 years of life
• fluctuates
• ?exogenous oestrogen exposure
• usually bone age is normal

Question 20

what to look out for in premature adrenarche?

Answer 20

early pubic hair:
<8 girls, <9boys
-oily skin, mild acne, axillary hair, adult body odour

Question 21

when are ovarian cysts abnormal?

Answer 21

> 10mm, exaggerated follicular, sometimes with haemorrhage

-monitor with U/S

Question 22

pubertal gynaecomastia common in boys?

Answer 22

~50% in boys peak age 14

• investigate if
• exaggerated
• abnormal progression
• associated signs

Question 23

pathological gynaecomastia?

Answer 23

drugs - marijuana

• sex-steroid tumours
• klinefelter
• systemic illness

Question 24

when is delayed puberty?

Answer 24

13 for girls

14 boys

Question 25

when is puberty delayed in terms of menarche?

Answer 25

15.5-16y

Question 26

what is arrested puberty?

Answer 26

>5yrs with incomplete progression

Question 27

causes of delayed puberty?

Answer 27

gonadal (primary) pituitary (secondary) hypothalamic (tertiary)

Question 28

Primary hypogonadism causes?

Answer 28

- chromosomal - trauma/torsion - radiation, chemo - cryptorchidism

Question 29

Primary hypogonadism Ix features?

Answer 29

- high LH, LSH | - low testosterone/oestradiol

Question 30

secondary hypogonadism causes?

Answer 30

- craniopharyngioma - trauma - radiotherapy - genetic pituitary

Question 31

secondary hypogonadism Ix features?

Answer 31

- low LH, LSH - evena fter GnRH | - low testosterone/oestradiol

Question 32

tertiary hypogonadism causes?

Answer 32

familial (normal variant) - lesions - genetic GnRH neurone migration - Kallmann syndrome (anosmia)

Question 33

tertiary hypogonadism Ix features?

Answer 33

- low LH, LSH - - BUT rise after GnRH stim - low testosterone/oestradiol

Question 34

what is constitutional delay?

Answer 34

most common: boys >girls - slow growth - delayed bone age: >2yr - no pathological - often FHx - reassure