Physical changes during puberty
Given by tanner marshall
Growth spurt
Thelarche
Pubearche adrenarche
Peak growth in height
Menarche
These changes completed b/w 10 to 16 years
Factor controlling onset of puberty
Genetic
Nutrition
Body weight
Psychological state
Social background
Exposure to light 🚨
Endocrinology of puberty
1) GnRH ➡️ FSH LH ➡️ estradiol
At start pulsatile secretion gradually changed to only nyt after that
throughout day
2)adrenal glands produce androgen helps in axillary pubic hair
3) FSH LH acts on ovaries produce estrogen develops uterus vagina vulva breast also
4) leptin helps in pubertal changes
Tanner breast changes
1- prepubertal elevation of papilla.
2- breast buds papilla slight elevation areola begins to enlarge
3- further enlargement
4- 2° mound of areola begins papilla projects above breast
5- areola recessed to general contour of breast
Pubic hair development
1-no pubic hair
2- spares hair on both labia
3- dark coarse curly hair on mons
4- adult type mons
5- hair © triangle distribution covering tighs
First menstruation tells about
1)Intact hypothalamo-pituitary ovarian axis
2)Functional ovaries
3)Responsive endometrium to endogenous ovarian steroids
4)Patent uterovaginal canal
Precocious puberty
For girls who exhibit 2°sexual characters before age of 8 or menstruate before age of 10
Causes of precocious puberty
GnRH dependent or central
GnRH dependent or central
Constitutional premature activation
1°hypothyroidism
Intracranial lesions - meningitis encephalitis neurofibroma
Incomplete - premature thelarche , premature puberche ,menarche
Causes of precocious puberty
GnRH independent or peripheral
Due to excess estrogen
Ovary -
gransulosa cell tumors
Theca cell tumors
leydig cell tumors
Mc cune albright syndrome
Adrenal
hyperplasia, tumour
Liver- Hepatoblastoma
Mc cune alright syndrome
Sexual precocity - excess estrogen
multiple cystic bone lesions ,
endocrinopathies ,
Cafe au lait spots of skin
Delayed puberty
Puberty said to be delayed when breast tissue ,pubic hair have not appeared by 13-14 yrs
Menarche appears as late as 16 yrs
Upper limit - 15 yrs
Causes of delayed puberty
Hypergonadotro hypogonadism
Gonadal dysgenesis
Ovarian failure
#Hypogonad hypogonadism
Constitutional delay
Chronic illness malnutrition
1°hypothyroidism
Kallmanns syndrome
#Anatomical causes
Mullerian agenesis ,imperforate hymen , transverse vaginal septum
