Human development block > Puberty > Flashcards

Puberty Flashcards

(49 cards)

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1
Q

Which hormones control puberty?

A
  • GnRH
  • LH
  • FSH
  • Neuroendocrine hormones
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2
Q

Which female steroid hormones are involved in puberty

A
  • Oestradiol
  • Progesterone
  • Adrenal androgen precursors
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3
Q

Which male steroid hormones are involved in puberty?

A
  • Testosterone
  • Dihydrotestosterone( DHT)
  • Adrenal androgens
  • Oestradiol
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4
Q

What does testosterone get aromatised to?

A

Oestrogen—> This gives us our growth spurt( growth plates fuse together)

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5
Q

Define gonadarche

A

Activation of the gonads by the pituitary hormones FSH-LH

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6
Q

Define adrenarche

A

Increase in production of androgens by the adrenal cortex

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7
Q

Define Thelarche

A

Appearance of breast tissue—-> oestradiol(ovaries)

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8
Q

Define Menarche

A

First menstrual bleed-oestradiol on endometrial lining-non ovulatory

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9
Q

Define spermarche

A

First sperm production- nocturnal sperm emissions FSH,LH—> testosterone

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10
Q

Define pubarche

A
  • Appearance of pubic hair —> androgens from adrenal gland
  • First appearance of axillary hair, apocrine body odour& acne
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11
Q

What is estradiol responsible for?

A
  • Breast development
  • Growth acceleration
  • Skeletal maturation
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12
Q

What is estradiol together with progesterone responsible for?

A

-Menstruation

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13
Q

Outline the hypothalamic-pituitary-ovarian axis

A
  • Hypothalamus releases GnRH which stimulates the gonadotroph cell
  • The gonadotroph cell releases FSH&LH which stimulate folliculogenesis in the ovary
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14
Q

Which hormones inhibit the activity of the gonadotroph in females?

A
  • Inhibin
  • Progesterone
  • Estrogens ( primarily estradiol)
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15
Q

Outline the hypothalamic-pituitary-testicular axis

A
  • Hypothalamus releases GnRH which stimulates the gonadotroph cell
  • The gonadotroph cell releases FSH&LH which stimulate spermatogenesis in the testis
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16
Q

Which cells produce testosterone?

A

The Leydig cells of the testis

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17
Q

Which hormones inhibit the activity of the gonadotroph in males?

A

-Inhibin B

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18
Q

Which hormones inhibit the activity of the hypothalamus in females?

A
  • Progesterone

- Estogens (primarily estradiol)

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19
Q

Which hormones inhibit the activity of the hypothalamus in males?

A

-testosterone

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20
Q

Describe the pattern of testosterone conc on a graph

Study These Flashcards
A
  • Spikes
  • As you go on in puberty, the spikes become higher& bigger and they become diurnal
  • Girls also get oestrogen which also spikes but not to the same extent
21
Q

Outline the tanner stages for genitalia

Study These Flashcards
A
  1. ) Pre-pubertal
  2. ) Beginning of onset of puberty; testes enlarges from 3ml–>4ml
  3. ) darker colour-redness
  4. ) even darker and larger,scrotal sac comes down more
  5. ) darkest and largest
22
Q

Outline the tanner stages for pubic hair in boys

Study These Flashcards
A
  • 5 stages
  • 5 has the most pubic hair
  • Pubic hair starts at the base of the penis
23
Q

Outline the mammary/breast tanner stages

Study These Flashcards
A
  • 5 stages
  • gradual growth of breast tissue
  • areolar+ nipple increase in size
  • 5th stage: theres is a smooth contour of the breast; the growth is complete
24
Q

What is one of the first testicular difference in puberty for boys

Study These Flashcards
A

Testicular stages increases from 3ml to 4ml

25
Outline the tanner stages for pubic hair in females
- 6 stages - gradual increase in amount of pubic hair - Starts along the labial line - If it starts elsewhere it isnt true puberty
26
What pubertal tanner stages exist for boys?
- (A) Axillary hair( A1-A3) - (P) Pubic hair (P1-P5) - (G) Genitalia (G1-G3)
27
Which pubertal tanner stages exist for girls?
- (A) Axillary hair (A1-A3) - (P) Pubic hair (P1-P6) - (B) Breast development (B1-B5) - (M) Monarche; menstrual, the onset of the menses (M1-M2)
28
What determines pubertal timing ?
- Genetics eg mum& daughter have their period around the same time - Environment eg insectides, pesticides, hormone disrupters, phytooestrogens found in soya milk - Nutritional status eg anorexia delays it - Health status eg immunocomprimisation
29
What other changes apart from those outlined by the tanner stages, are associated with puberty?
1. ) Anaemia - more likely in girls 2. ) Gynecomastia 3. ) Acne - caused by androgenic stimulation - Higher serum levels of dehydroepiandrosterone sulfate( DHEAS)
30
What is precocious puberty?
- 2 or 2.5 SD earlier than the population norms - May range from variants of normal development to pathologic conditions; may be genetics - BOYS: before 9yrs - GIRLS: before 8yrs
31
What is true central precocious puberty (TCPP)?
- Gonadotrophin dependent - Early maturation of the HPG axis - Sequential maturation - Pathologic 40-75% of boys - Pathologic in 10-20% of girls - Sexual characteristics are appropriate for the child's gender
32
What is peripheral precocity?
- Gonadotrophin independent - Excess of secretion of sex hormones-gonads,adrenal glands, exogenous sources of sex steroids, ectopic production of gonadotropin from a germ cell tumor - Non sequential maturation - Isosexual or contrasexual
33
What are benign pubertal variants?
-Premature thelarche -Isolated androgen-mediated sexual characteristics ( precocious adrenarche) -Can be a variant of normal puberty
34
What are the characteristics of central precocious puberty
- Accelerated linear growth - Advanced bone age - Pubertal levels of LH - Pubertal levels of FSH
35
What causes TCPP
1. )Idiopathic 2. )CNS lesions- neurogenic TCPP - Hamartomas - other cns tumours: astrocytomas,ependyomas, pinealomas, optic& hypothalamic gliomas - CNS irradiation - other CNS lesions: hydrocephalus, cysts, trauma, CNS inflammatory disease, congenital midline defects 3. ) Genetics - Gain of function mutation in the KISS1 &KISS1R 4. ) Previous excess sex steroid exposure/miscellaneous - Priming from adrenarche - Mc cune albright - Extreme prematurity 5. )Pituitary gonadotrophin-secreting tumours - Elevated levels of LH& FSH
36
What causes peripheral precocity in girls?
1. ) Ovarian cysts - most common - breast development, vaginal bleeding-Ovarian torsion 2. ) Ovarian tumours - Rare cause - Granulosa cell tumors---> isosexual precocity - Sertoli/leydig cell tumours, pure leydig cell tumours, gonadoblastoma---> contrasexual precocity( virilisation)
37
What causes peripheral precocity in boys?
1. ) Leydig cell tumors - asymmetric testicular enlargment - Testosterone secreting tumor, benign - Rx usually radical orchiectomy 2. )Germ cell tumours - they secrete hCG - hCG secretion activates LH receptors on Leydig cells---> testosterone production - located in gonads,brain,liver,retroperitoneum, anterior mediastinum 3. ) Familial male-limited precocious puberty (testotoxicosis): - Activating mutation in the LH receptor gene---> premature Leydig cell maturation& testosterone secretion
38
What consequences can primary hypothyroidism have on puberty?
- Early breast development, galactorrhoea, recurrent vaginal bleeding-premature testicular enlargement - Cross-reactivity & stimulation of the FSH receptor by high serum TSH levels -common alpha subunit
39
Outline McCune Albright syndrome
- Triad of peripheral precocious puberty, irregular cafe au lait spots, fibrous dysplasia of bone - Sequence of pubertal progression may be abnormal often presenting with vaginal bleeding - Tends to be within the midline, not crossing over
40
What is premature thelarche?
- A benign pubertal variant - Idiopathic - Arounds 2yrs of age - waxes and wanes, doesn't progress - Isolated breast development/ Not beyond tanner stage 3 - Absence of other secondary sexual characteristics - Normal height velocity for age - Normal or near normal bone age - LH& FSH between normal range
41
What is premature adrenarche?
- Pubic &/or axillary hair---> pubarche - Acne, BO, greasy skin - Mild increase in growth velocity& advanced bone age - Mild elevation in serum DHEAS for age - More common in girls, Afro caribbean & hispanic females - In patients with obesity & insulin resistance - Risk factor for later development of PCOS in girls - Can cause priming resulting in TCPP
42
How can we treat premature preocity
- Depends on cause - Reasurrance if it's normal benign variation - Gonadotrophin independent: Anti-androgens/aromatase inhibitors - Gonadotrophin dependent : block with GnRH analogues
43
Outline delayed puberty in girls
- 13 yrs old and no breast development - No pubic hair by 14 yrs - More than 5 years between thelarche& menarche - No menarche by 16 years old without secondary sexual characteristics
44
Outline delayed puberty in boys
- Testicular volume less than 4ml by age 14 - No pubic hair by 15 yrs old - More than 5 yrs to finish penile and testicular growth
45
What are the different forms of gonadal failure
1. ) Primary failure - hypergonadotrophic hypogonadism - increased levels of FSH&LH stimilating the gonads - Gonads not working; increased LH& FSH levels due to hypothalamus and pituitary still working 2. ) Secondary failure: - hypogonadotrophic hypogonadism - hypothalamus/pituitary stops working so no testosterone release---> no stimulation of gonads - May stop due to trauma to the brain or craniofacial anomalies
46
Explain the different types of secondary hypogonadism
- Normal/low gonadotrophins - hypogonadotropic hypogonadism 1. ) Congenital: - craniofacial anomalies/midline defects - GnRH deficit (eg Kallman, Prader Willi, Alteration of GnRH receptor) 2. ) Acquired: - function loss: Eating disorders/athletes; chronic illness; Cushing;diabetes;hyperprolactinaemia;hypothyroidism - Physical: CNS tumors; Infiltrative disease; head trauma; head radiation
47
What are the hypogonadotrophic hormones?
GnRH FSH LH
48
Explain the different types of primary hypogonadism
- High gonadotrophins - hypergonadotrophic hypergonadism 1. ) Congenital: - Chromosome anomalies: Turner syndrome; Klinefelter syndrome - Testicular regression syndrome - Synthesis & action of sexual steroids 2. ) Acquired: - surgery/trauma - chemo/radiotherapy - Autoimmune - Post infection - Metabolic galactosemia
49
How can we diagnose delayed/early puberty?
- Clinical history - growth charts - family history - Exercise,chronic illness, food habits - LH, FSH, testosterone, oestrogens, prolactin, TSH, karyotype - Bone age, brain MRI, pelvic Ultrasounds
Human development block
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