Puberty

Question 1

Pubertal Timing

Answer 1

• 50% has to do with genetics and ethnicity

Question 2

Puberty MOA

Females

Answer 2

• Estradiol levels progressively increase -> Maturation of female genital tract and breast development

Question 3

Puberty MOA

Males

Answer 3

• Testosterone level increases x20 -> Correlates with physical stages of puberty and degrees of skeletal maturation

Question 4

Physical Growth

Females

Answer 4

• Growth spurt begins nearly 2 years earlier in girls
• Peak height: between 11.5-12 years old
• 83-89% of total height attained: age 11

Question 5

Physical Growth

Males

Answer 5

• Growth spurt lasts longer in boys than girls
• Peak height: between 13.5-14 years old
• Mass double between 10-17 years old
• 83-89% of total height attained: age 12

Question 6

Psychosocial Development
Early Adolescence (10-13 yo)

Answer 6

• Development of secondary sex characteristics
• Feel more comfortable with same sex
• Concrete thinking

Question 7

Psychosocial Development
Middle Adolescence (14-16 yo)

Answer 7

• Rapid pubertal growth/development subsides
• Emotions and wide mood swings
• Formal operations
• Abstract thinking
• Self-centered
• Peers determine standards for identification

Question 8

Psychosocial Development
Late Adolescence (17+ yo)

Answer 8

• Dating becomes intimate
• Abstract thinking
• Period of idealism

Question 9

1st measurable sign of puberty in girls

Answer 9

• Height spurt

- 1st conspicuous sign is breast buds (8-11 yo)

Question 10

1st measurable sign of puberty in boys

Answer 10

• Scrotal and testicular growth

Question 11

Tanner Stages
Boys
Stage 1

Answer 11

• Infantile until puberty
• No true pubic hair, fine velus over the pubes
• Genitalia increase slightly in size over time, but little change to general appearance

Question 12

Tanner Stages
Boys
Stage 2

Answer 12

• Scrotum begins to enlarge, reddening and change in skin texture
• Sparse growth of slightly pigmented hair, usually straight and only slightly curly, begins at either side of base of penis

Question 13

Tanner Stages
Boys
Stage 3

Answer 13

• Penis increases in length, small increase in breadth
• Further growth of scrotum
• Hair spreads over pubis symphysis, considerably darker, coarse, and more curly

Question 14

Tanner Stages
Boys
Stage 4

Answer 14

• Length and breadth of penis increase more, glans has developed
• Scrotum is further enlarged and scrotal skin becomes darker
• Hair is adult in character, covers area considerably smaller than most adults, no spread to medial surface of thighs

Question 15

Tanner Stages
Boys
Stage 5

Answer 15

• Genitalia are adult in size/shape

- Hair is distributed in inverse triangle, spread to the top of medial thigh, but not above base of triangle

Question 16

Tanner Stages
Girls
Stage 1

Answer 16

• No breast development

- No pubic hair

Question 17

Tanner Stages
Girls
Stage 2

Answer 17

• Breast budding appears, some palpable breast tissue under nipple, areola is slightly enlarged
• Small amount of long pubic hair along vaginal lips

Question 18

Tanner Stages
Girls
Stage 3

Answer 18

• Breast is more distinct, no separation between contours of two breasts
• Hair is darker, coarser, curlier, and spreads sparsely over pubic symphysis

Question 19

Tanner Stages
Girls
Stage 4

Answer 19

• Breast further enlarged and greater contour distinction, nipple including areola forms a secondary mound on breast
• Hair is adult in type, area covered is smaller than most adults, no pubic hair on inside of thighs

Question 20

Tanner Stages
Girls
Stage 5

Answer 20

• Breast is fully developed, distinct contours, areola has receded into general contour of breast
• Inverted triangle pattern of pubic hair

Question 21

Adolescent Lipid Panels

Answer 21

• 9-11 yrs: Universal screen w/nonfasting non-HDL chol or fasting lipid screen
• 12-17 yrs: fasting lipid profile if FH newly positive, parent with dyslipidemia, any other RF
• 18-21 yrs: nonfasting non-HDL chol or fasting lipid profile

Question 22

PP in genders

Answer 22

Male < age 9

Female < age 8

Question 23

Diagnosing PP

Answer 23

• X-ray L hand to determine bone age
• Labs: LH, FSH, Estradiol/Testosterone levels
• If Central PP is Dx, get MRI of brain to r/o abnormalities of pituitary gland

Question 24

Risks if Cryptorchidism is untreated

Answer 24

• Infertility

- Testicular malignancy

Question 25

Cryptorchidism labs

Answer 25

- Infants between 2-6 months: measure LH, FSH, Inhibin B, and Test to determine if testes are present - After 6 months: HCG stimulation test to confirm absence or presence of functional abdominal testes

Question 26

Gynecomastia

Answer 26

- Occurs in 75% of normal pubertal boys, self-limiting - More common in obese boys - Typically resolves in 2 years

Question 27

Turner Syndrome | Girls

Answer 27

- Short stature - Infertile - Webbed (extra skin) neck - Swelling (lymphema) in hands/feet - Heart Defects - Kidney Problems - Widely spaced nipples - Brown spots on skin

Question 28

Klinefelter Syndrome | Boys

Answer 28

- Tall stature - Narrow chest - Wider hips - Female-type pubic hair pattern - Breast development - Osteoporosis - Testicular atrophy