Session 5: Group Work

Question 1

Usual age range of Thelarche in women.

Answer 1

9-13

Question 2

Usualy age range of adrenarche in women.

Answer 2

11-13

Question 3

Usual age range of growth spurt in women.

Answer 3

10-14

Question 4

Usual age of menarche in women.

Answer 4

14

Question 5

Why might precocious puberty be stimulated by intracranial pathology such as meningitis?

Answer 5

Infection can cause premature problems with GnRH as the infection can spread or affect the hypothalamus/anterior pituitary.

Question 6

What are the effects of precocious puberty on a bone growth?

Would you expect a girl to be shorter or taller as an adult because of precocious puberty?

Answer 6

Oestrogen causes the epiphyseal growth plates to fuse. Higher levels of oestrogen leads to faster fusing.

Also if precocious puberty hits early girls won’t grow during the prepubescent years as much.

Question 7

What is the lower age limit of normal puberty in boys?

Answer 7

9-10 years

Question 8

How would you assess a boy’s stage of puberty if they are in their early stages?

Answer 8

Tanner scale

Increasing testicular volume and pubic hair

Question 9

What are common causes of early puberty in boys?

Answer 9

Pineal gland tumour

Congenital adrenal hyperplasia

Hypothalamus disorders like tumours or meningitis

Anterior pituitary disorders

Testes

Question 10

What might you do to delya puberty in guys?

What other help might he need?

Answer 10

Treat underlying cause

Give LHRH antagonist

(Give GnRH???)

Give growth hormones?

Question 11

What proportion of normal 14 years olds would be expected to not be exhibiting signs of puberty?

What factors might make you feel that he is in this group?

(A 14 year old boy is brought to his GP by his parents, concerned that he is behind his classmates in pubertal development)

Answer 11

5%

Short

Low testicular volume

Pubic hair

Size of external genitalia

Thin

Question 12

Explain what is meant by bone age.

How will this help in this boy’s case?

Answer 12

Degree of maturation of a child’s bone.

Are they as developed as they should be? What do the epiphyseal growth plates look like?

Comparison chart

Question 13

You will want to assess where he is in his pubertal growth spurt. How will you do so?

Answer 13

Growth chart measure height over a period of time

Question 14

When does growth spurt in boys generally?

Answer 14

12-16 yrs old

Question 15

Could it be that the boy is starting puberty, but his parents have not noticed it? Why may they not have noticed the early stages?

Answer 15

Yes because the first signs are increased testicular volume and pubic hair which the parents might not be aware of.

Question 16

If he did have a problem of delayed puberty, what test would you use to distinguish between defects in the gonads and defects primarily in the hypothalamus/pituitary?

Answer 16

Test testosterone levels

Test GnRH levels

Test LH/FSH levels