15.10.3

Question 1

Precocious Puberty
Def
Problems associated

Answer 1

Puberty = complex temporal sequence of biological events leading to the maturation of secondary sexual characteristics, the attainment of final adult height and the capacity for reproduction

Precocious Puberty
- ♀: 2˚ sexual characteristics < 8 yrs (B2)
- ♂: 2˚ sexual characteristics < 9 yrs (G2)

Problem associated
- short adult height
- psychological
- practical

Question 2

Varying presentation

Answer 2

• Consonant (central) precocious puberty - normal breast development
• Non-consonant (peripheral)precocious puberty - abnormal breast development
• Variants of normal

Clinical signs
- Cafe-au-lait (slide 21) {traid: spots, bones, ovaries}
- Thelarche - early breast development; being/malignant
- Adrenarche

Question 3

Approach to early puberty

Answer 3

1. Consonant CPP (GDPP)
-♀: Idiopathic*
-♂: Central

2. Not Consonant
- GIPP
➡️McC Albright
➡️Ovarian cysts
➡️Testotoxicosis
- Breast
➡️P Thelarche
➡️Thelarche V
➡️Hypothyroid
- P/A hair Acne
➡️Adrenache
➡️CAH
➡️PCOS
➡️Cushing dis
➡️Thelarche V
- Andr XS Viriliz
➡️CAH
➡️A/G tumor
➡️Pers F andr

Question 4

Secondary causes of GDPP
CNS
Other

Answer 4

CNS
- Cong: SOD
- Neoplasms: Hamartoma, glioma
- Post inf (Tb meningitis)
- Post trauma
- Post CRT
- Hydroceph/CP
- Adoption, sexual abuse

Other
- HCG prod tumours (heoatoblastoma, germ cell t, teratoma)

Question 5

Adrenarche

Answer 5

DHEAS, ∆4 increase @ 6-8yrs:
➡️Mid childhood growth spurt
➡️Sweat
➡️PH & AH

Premat Adrenarche:
- Signs <8yrs ♀; <9yrs ♂
- LBW (some pop: PCOS in teens), Asian, Med, Afro-Car

Pers Foetal adrenal steroids: PH, cliteromegaly
- Prem babies
- Exclude CAH, adrenal & ovarian tumours