OnlineMedEd: Gynecology - "Puberty"

Question 1

In what order do girls go through puberty?

Answer 1

• Breast bud development: 8
• Axillary hair: 9
• Growth spurt: 10
• Menarche: 11

Question 2

Constitutional growth delay is a defect in which part of the hormonal axis?

Answer 2

Hypothalamus

Question 3

Sertoli-Leydig and Granulosa-Theca tumors generally arise in the _____________.

Answer 3

ovaries

Question 4

The first step in working up precocious puberty is ____________.

Answer 4

wrist x-ray

If the bones are ≥ 2 years older than the biologic age, then further workup is warranted.

Question 5

What test should you do after a positive bone x-ray?

Answer 5

GnRH stimulation test

If GnRH stimulates release of LH in the pubertal range, then you know it is a central disorder. If not, then it is at or below the level of the pituitary.

Question 6

You do a GnRH test and it is positive (meaning a central cause of precocious puberty). The brain MRI is negative. What is going on and what should you do?

Answer 6

Constitutional precocious puberty

Treat with continuous Leuprolide to suppress puberty until biologic age catches up.

Question 7

Review the adrenal hormone pathway, the menstrual hormone timeline.

Answer 7

Done!

Question 8

What do you order when the GnRH stimulation test is negative?

Answer 8

• US abdomen, adrenal, ovaries (looking for tumors and PCOS)
• DHEAS, 17-OH progesterone, testosterone (looking for CAH)

Question 9

CAH is treated with _________________.

Answer 9

mineralocorticoids and glucocorticoids

These turn off the overactive adrenals and reduce the virilization.

Question 10

Delayed puberty causes are divided into ________________.

Answer 10

hypogonadal and hypergonadal causes

Hypogonadal (low LH and FSH):

• Prolactinoma
• Craniopharyngioma
• Hypothyroidism
• Pregnancy

Hypergonadal (high LH and FSH):

• Turner
• Savage