Puberty

Question 1

Precocious Puberty

Answer 1

Boys more likely to be serious
Causes:
- Central: CNS lesion hypothalamis/pituitary e.g. harmatoma, cyst, tumour, neoplasm, trauma
- Peripheral: adrenal/gonadal tumours, exogenous sex steroids, CAH, McCune Albright

Investigations:

• DHEA, testosterone, 17-OHP
• Bone age X-ray
• FSH, LH, estrodial
• Adrenal USS
• MRI B
• GnRH / ACTH stimulation test

Management:
- Pubertal suppression - GnRH agonist

Question 2

Delayed Puberty

Answer 2

Causes:
- Constitutional delay, chronic illness, GH deficiency/hypopit or hypothyroid, Turner’s/Kallman, eating disorder

Investigations:

• FSH, LH, testosterone, estradiol
• TSH
• MPH
• Karyotype
• GnRH
• Pelvic US
• MRI

Management:
- Give hormone to induce puberty