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Sydney Child Health Program > 11.1 Puberty > Flashcards

11.1 Puberty Flashcards

1
Q

what is thelarche?

A

onset of breast development

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2
Q

what is pubarche?

A

onset of sexual hair development

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3
Q

how are pituitary gonadotropins secreted?

A
  • pulsatile
  • oestrogens
  • androgens
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4
Q

puberty control centres in order?

A
  • higher centres
  • hypothalamus (GnRH)
  • pituitary (LH, FSH)
  • gonads
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5
Q

what is adrenarche?

A
  • increased adrenal androgen production in both sexes
  • happens before gonadarche
  • not true puberty
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6
Q

growth spurt for girls v boys?

A
  1. 5 years - girls

13. 5 years - boys

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7
Q

what to think about in early sexual development?

A
  • central v peripheral causes
  • complete v incomplete
  • pathological v normal
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8
Q

what is true precocious puberty?

A
  • problem with central activation
  • check LH, FSH, sex steroid levels
  • can be neuro tumours
  • mostly idiopathic
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9
Q

precocious pseudo-puberty is?

A
  • peripheral activation
  • congenital adrenal hyperplasia
  • tumours
  • iatrogenic
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10
Q

what are normal variants in early sexual development?

A
  • premature thelarche

- premature adrenarche

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11
Q

lower limits of normal for development for girls?

A

<8 thelarche, pubarche

<10menarche

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12
Q

lower limits of normal for development for boys?

A
  • testicular enlargement 9 years

- pubic hair 9years

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13
Q

early puberty, what bloods?

A
  • LH, FSH, testosterone, oestradiol, prolactin, hCG

- DHEAS, androtenediaon, 17-OH progesterone

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14
Q

what causes precocious puberty?

A

girls: 90% idiopathic
boys: 75% HAVE a pathological CNS lesion

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15
Q

how to treat central precocious puberty?

A
  • treat CNS tumour

- pubertal suppression

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16
Q

how to suppress puberty?

A

GnRH agonists

-depot injections 4-12 weeks

17
Q

what is McCune-Albright syndrome?

A
  • peripheral, not central
  • more in girls than boys
  • low LH and FSH but high pubertal sex steroids
  • has skin lesions
  • x-ray have polyostotic lesions
18
Q

how to treat McCune-Albright syndrome?

A

peripheral hormone blockade: aromatase inhibitors

19
Q

thelarche normal variant?

A
  • common first 2 years of life
  • fluctuates
  • ?exogenous oestrogen exposure
  • usually bone age is normal
20
Q

what to look out for in premature adrenarche?

A

early pubic hair:
<8 girls, <9boys
-oily skin, mild acne, axillary hair, adult body odour

21
Q

when are ovarian cysts abnormal?

A

> 10mm, exaggerated follicular, sometimes with haemorrhage

-monitor with U/S

22
Q

pubertal gynaecomastia common in boys?

A

~50% in boys peak age 14

  • investigate if
  • exaggerated
  • abnormal progression
  • associated signs
23
Q

pathological gynaecomastia?

A

drugs - marijuana

  • sex-steroid tumours
  • klinefelter
  • systemic illness
24
Q

when is delayed puberty?

A

13 for girls

14 boys

25
Q

when is puberty delayed in terms of menarche?

A

15.5-16y

26
Q

what is arrested puberty?

A

> 5yrs with incomplete progression

27
Q

causes of delayed puberty?

A

gonadal (primary)
pituitary (secondary)
hypothalamic (tertiary)

28
Q

Primary hypogonadism causes?

A
  • chromosomal
  • trauma/torsion
  • radiation, chemo
  • cryptorchidism
29
Q

Primary hypogonadism Ix features?

A
  • high LH, LSH

- low testosterone/oestradiol

30
Q

secondary hypogonadism causes?

A
  • craniopharyngioma
  • trauma
  • radiotherapy
  • genetic pituitary
31
Q

secondary hypogonadism Ix features?

A
  • low LH, LSH - evena fter GnRH

- low testosterone/oestradiol

32
Q

tertiary hypogonadism causes?

A

familial (normal variant)

  • lesions
  • genetic GnRH neurone migration
  • Kallmann syndrome (anosmia)
33
Q

tertiary hypogonadism Ix features?

A
  • low LH, LSH -
  • BUT rise after GnRH stim
  • low testosterone/oestradiol
34
Q

what is constitutional delay?

A

most common: boys >girls

  • slow growth
  • delayed bone age: >2yr
  • no pathological
  • often FHx
  • reassure

Sydney Child Health Program (113 decks)

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