phase 2a > puberty > Flashcards

puberty Flashcards

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1
Q

what do ovarian oestrogens do?

A

regulate the growth of breast and female genitalia

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2
Q

what do ovarian and adrenal androgens do?

A

control pubic and axillary hair

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3
Q

what occurs at puberty for girls?

A

ovarian oestrogens
ovarian and adrenal androgens

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4
Q

what occurs at puberty for boys?

A

testicular androgens

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5
Q

what do testicular androgens do?

A

External genitalia and pubic hair growth
–enlargement of larynx and laryngeal muscles
——-> voice deepening

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6
Q

describe the prepubertal hair for boys in stage 1

A

no pubic hair

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7
Q

what is the the testicular length and volume for stage 1 of boys?

A

testicular length <2.5 cm
testicular volume < 3.0 mL

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8
Q
A
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9
Q

describe stage 2 of the tanner stages in boys

A

Sparse growth of slightly curly pubic hair, mainly base of penis * Testes > 3 mL (>2.5 cm in longest diameter)
* Scrotum thinning and reddening

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10
Q

describe stage 3 of the tanner stages in boys

A

Thicker, curlier hair spread to mons pubis
* Growth of penis in width and length; further growth of testes

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11
Q

describe stage 4 of the tanner stages in boys

A
  • Adult-type hair, not yet spread to medial surface of thighs
  • Penis further enlarged; testes larger, darker scrotal skin colour
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12
Q

describe stage 5 of the tanner stages in boys

A
  • Adult-type hair spread to medial surface of thighs * Genitalia adult size and shape
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13
Q

describe stage 1 of the tanner stages in girls

A

Prepubertal: No pubic hair * Elevation of papilla only

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14
Q

describe stage 2 of the tanner stages in girls

A
  • Sparse growth of long, straight or slightly curly, minimally pigmented hair, mainly on labia
  • Breast bud noted/ palpable; enlargement of areola
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15
Q

describe stage 3 of the tanner stages in girls

A

*Darker, coarser hair spreading over mons pubis * Further enlargement of breast and areola,
with no separation of contours

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16
Q

describe stage 4 of the tanner stages in girls

A

Thick adult-type hair, not yet spread to medial surface of thighs
* Projection of areola and papilla to form secondary mound above level of breast

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17
Q

describe stage 5 of the tanner stages in girls

A
  • Hair adult-type and distributed in classic inverse triangle * Adult contour breast with projection of papilla only
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18
Q

what is thelarche

A

beginning of breast development - its the first visible change of puberty

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19
Q

what is thelarche induced by

A

estrogen

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20
Q

how long is thelarche

A

completed in around 3 years

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21
Q

what are the effects of estrogen on the breast

A
  • Hair adult-type and distributed in classic inverse triangle * Adult contour breast with projection of papilla only
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22
Q

what are the other hormones involved in breast development?

A

prolactin, glucocorticoids, insulin

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23
Q

what are the Definitive signs of puberty onset in girls

A

menarche - first menstrual bleeding

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24
Q

what are the Definitive signs of puberty onset in boys?

A

first ejaculation – often nocturnal

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25
what are the secondary sexual characteristics that occur at puberty with girls?
-Ovarian oestrogens regulate the growth of breast and female genitalia -Ovarian and adrenal androgens control pubic and axillary hair
26
what are the secondary sexual characteristics that occur at puberty with boys?
Testicular androgens – external genitalia and pubic hair growth, enlargement of larynx and laryngeal muscles (voice deepening)
27
define the ' tanner stages'
A scale that defines physical measurements of development based on external primary and secondary sex characteristics.
28
describe the prepubertal vagina
Reddish in colour * Thin atrophic columnar epithelium * pH neutral *Length 2.5-3.5 cm
29
describe the pubertal vagina
* Dulling of the reddish colour * Thickening of the epithelium * Cornification of the superficial layer stratified squamous epithelium * pH acidic 3.8-4.2 * Secretion of clear whitish discharge in the months before menarche * Length 5-8 (-12)cm
30
describe the maturation of the external genitals under the effect of oestrogens
-Labia majora & minora increase in size & thickness – Rugation & change in colour of the labia majora – Hymen thickens – Clitoris enlarge – Vestibular glands begin secretion
31
describe the maturation of the external genitals with adrenal androgens and ovarian androgens
– Growth of pubic & axillary hair
32
what is precocious puberty?
onset of secondary sexual characteristics before 8 yrs (girl), 9 yrs (boy)
33
early menarche at what age may lead to short stature?
before 9 years
34
what is delayed puberty?
absence of secondary sexual characteristics by 14 years (girls), 16 years (boy)
35
what does delayed puberty lead to?
leads to reduced peak bone mass and osteoporosis
36
what does the hypothalamic maturation hypothesis emphasise?
the direct link CNS and pituitary and hypothalamic GnRH neurone
37
what does puberty require in terms of hypothalamic maturation hypothesis?
increase
38
what is adrenarche?
Maturational process of the adrenal gland Developmental process where a specialized subset of cells arises forming the androgen- producing zona reticularis (ZR)
39
where is adrenarche observed?
in humans and in some old world primates
40
what can adrenarche physically show? ( signs/ symptoms)
Mild advanced bone age, axillary hair, oily skin, mild acne, body odour
41
who is adrenarhe more pronounced in?
obese children
42
what is pubarche?
Most pronounced clinical result of adrenarche
43
what is pubarche the result of?
Result of androgen action on the pilosebaceous unit transforming vellus hair into terminal hair in hair-growth prone parts of the skin
44
what are the indications for investigation of delayed puberty for girls?
- lack of breast development by 13 years - more than 5 years between breast development and menarche - lack of pubic hair by age 14 yrs - absent menarche by age 15-16
45
what are the indications for investigation of delayed puberty for boys?
- lack of testicular enlargement by age 14 years - lack of pubic hair by age 15 yrs - more than 5 years to complete genital enlargement
46
what are causes of “True” (Central) Precocious Puberty (GnRH dependent)?
* Idiopathic precocious puberty * CNS tumours – Optic glioma associated with NF1 – Hypothalamic astrocytoma * CNS disorders – Developmental abnormalities, hypothalamic harmartoma – Encephalitis, Brain abscess – Hydrocephalus, Myelomeningocele, Arachnoid cyst – Vascular lesion – Cranial irradiation * Secondary central precocious puberty * Psychosocial, i.e. adoption from abroad
47
what are causes of Precocious Pseudo-Puberty (GnRH independent
Increased androgen secretion – Congenital adrenal hyperplasia (21OHD, 11OHD) – Virilizing neoplasm – Leydig cell adenoma – Familial Male Precocious Puberty – Testotoxicosis * Gonadotropin secreting tumours – Chorioepitheliomas, germinoma, teratoma – Hepatoma, choriocarcinoma * McCune-Albright syndrome * Ovarian cyst * Oestrogen secreting neoplasm * (Hypothyroidism) * Iatrogenic or exogenous sex hormones
48
what is delayed puberty ?
Idiopathic (constitutional) delay in growth and puberty – delayed activation of the hypothalamic pulse generator
49
what is Hypogonadotrophic hypogonadism?
– sexual infantilism related to to gonadotrophin deficiency
50
what is Hypergonadotrophic hypogonadism?
– primary gonadal problems
51
what does a delay in puberty lead to?
leads to delay in acquisition of secondary sex characteristics, psychological problems, defects in reproduction and reduced peak bone mass.
52
what is CCDGP?
CONSTITUTIONAL DELAY OF GROWTH AND PUPERTY
52
53
what does CDGP cause?
* Delay in bone maturation, delay in adrenarche
54
when history taking what do you look for ?
Totally absent or started and then arrested * Family history – constitutional delay – Infertility – delayed puberty * Review of symptoms * Perinatal history * Prior medical illness * Medication * Psychosocial deprivation
55
what laboratory investigations take place ?
Complete red blood count U + E, renal, LFT LH, FSH Testosterone/ oestradiol Thyroid function, prolactin
56
functional causes of delayed puberty
Chronic renal disease Chronic lung disease Anorexia nervosa Psychosocial/ stress Drugs
57
what is hypogonadism ?
the reduction or absence of hormone secretion of the gonads
58
what is female primary hypogonadism?
the ovary fails => Oestrogen goes down => Lack of feedback => LH and FSH increase
59
what is female secondary hypogonadism?
Hypothalamus/Pituitary fail! => LH and FSH low => no response to feedback => oestrogen decreases
60
what is male primary hypogonadism?
The testis fails! => Testosterone goes down => Lack of feedback => LH and FSH increase
61
what is male secondary hypogonadism?
Hypothalamus/Pituitary fail! => LH and FSH low => no response to feedback => testosterone decreases
62
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