Adolescent Medicine Flashcards
when is the adolescent period
what are the four “Tasks” of adolescents
Adolescents
- defined as the ages between 10 afn 19
- transition to adulthood:can be seen into early 20s
Tasks
- complete puberty and somatic growth
- develop socailly, emotionally and cognitvietly
- move from concrete to abstract thinkinig
- establish seperate identity from fmily
- prepare for career
define the following
thelarche
pubarche
menarche
adrenache
Thelarche
- development of the breast tissue: usually first sign of puberty in females
Pubarche
- pubic hair development with OUT breast development in females
menarche
- onset of menstruation
adrenarche
- adrenal glad “awakens” & leads to increads adrogen production in men and women
- develop pubic hair, oily hair/skin and body odor
Physiology of Puberty male & female
Male
- at puberty = inhibition of GnRH is removed: allows for pusatile release of the hormone
- GnRH triggers FSH and LH
- LH: to the lydig cells: makes testosterone
- FSH: to the sartoli cells to make sperm
female
- GnRH inhibition release at puberty: increase in pusatile release
- GnRH triggers FSH and LH
- FSH: stimulates ovarian maturation, granuolsa cell function & therefore estradiol production
- LH: stimulates ovulation, corpus leutem creation & progesteron release
- estradiol: initially inhibits FSH and LH release as its bein produced
- then later: the estradiol becomes stiulatory and teh cyclic pattern begins
Abnormal Puberty
Delay v Percious definitions
Abnormal Puberty
- variable onset based on ethnicity: black chidlren tend to have puberty happen earlier
Delayed PUberty
- female: no breast tissue development by age 13; or no menarche within 4-5 years after puberty (breast tissue) arises
- males: no onset of testicular enlargement by age 14; maturational arrest
Precious Puberty
- onset of puberty at least 2 SD before the expected (calculated with ethinictiy)
- this generally triggers endocrine referral
- onset of puberty: less than 8 in females
- onset of puberty: less than 9 in males
reasons for Delayed Puberty & Precious Puberty
Delayed Puberty
- constitutional delay
- anatomic abnormalities
- hypogonadism: turner syndrome, premature ovarian failure, galctosemia
- central hypogonadism: hypothalmic/pituitary issues, cushings’, hypothyroidism
Precious Puberty
- centeral reasons: CNS tumore, hydrocephalus, radiation, trauma, mcCune Albright, hypothyroidism (decreased FSH,LH)
- peripheraly: (increased FSH, LH) : adrneal tumor, pituitary tumor, exposure to exogenous hormones, ovarian cysts, testicauarl tumor
- COVID-19 or idopathic!
Somatic Growth for Male and Female in adolscence
Females
- weight can double during puberty
- height increases by 15-20%
- muscle mass and stregth increases
- lean body mass decreased to 75% of total body weight
Males
- weight doubles
- height increases 15-20%
- muscle mass and stregnth increase
- lean body mass INCREASES to 90%
reasons for adolsecent mortality
and morbidity
Mortality
- leading cause of death in 2022: GUN VIOLENCE
- in 2019 it was unintentional death
Morbidity
- most adolescents in good or excellent health: so they unfortunately dont come to yeraly checks and we cant provide preventitive and primary interventions!
major morbidities include
- unintended pregnancy
- STIs
- substance use
- depression
- smoking
- violence
-
clinical facotrs: only a few locations iwthin training specifically for adolescnt medicine
approach to the visit with adolescent pt.
when to interview alone
remember they are the primary pt. introduce self and engage wtih them first before asking them who is in the room with them
- take time to listen, show genuine insterest
- pay close attention to body language
- use open ended wuestions, allow long periods of silence (12 seconds or more!!) to answer
when to interview alone
- begin introducing the idea at age 11
- should begin to occur at 12-13 years old
- get parent out of room: while child is changing into gown and explain what will happen, also time for parent to voice concerns
Confidentialtiy in the adolescent exam
what to speak about
when and what would be told to parents
Confidentiality
- basic right and importatnf or relationship!
- address this at beginning o visits
Discussion
- ANYTHING!!!
- Sexualatiy: testing, activity, contraception, LGBT,
- sexual victim : most states require this to be reported to law or parents or botH
- drinking/drugs/tobacco use
limitations to confidentiality: when it needs to be shared
- life-threatening concerns
- hurting self or others
- intention to hurt self or others
- these should be shared with others
Factors permitting health care for minors withOUT parental consent
this varies by state but on average
- married
- miliarty
- bearing a child of their own
- reporductive care services (activity, STIs, abortion, contraception)
- independtly living (emancipated)
- reproductive care
- mental health care
- substance abuse evaluation
- life-threatening care: treat then contact pt.
this can be challenging becuase of EMR…
- if getting STI testing; this can come up on paretns insurance and EMRs/portol access
Questions to be asked in the psychosocial history for the adolsecent
HEEEADDSSS(S)
H: home
E: education
E: employement
E: eating
A: activities
D: drugs/alcohol
D: depression/suicide
S: sexuality
S: safety
S: spirituality
(S): Screens and social media!
ask these questions with open-ended ones, “tell me about your home life, what do you enjoy or dislike about school”
Home Assessment Questions
Education Questions
Employment Questinos
Home
- who do you live with
- where (house v apt)
- share room
- relationship with parents/sibilins
Education
- what school and grade
- class types
- worst and best subeject & grades
- days missed
Employment
- do you work ? how often and what type
- what do you want to do when older?
Eating Questions
disorders to be aware of
Eating
- how do you feel about your weight? wish you weighed more or less?
- what do you eat in a typical day?
- “perfect weight”
watch meal skipping!! and controlling behaviors
Disorders to be aware of
- anorexia nervosa and bulimia are seen most commonly in teens (F>M) (think of gymnasts and wrestlers)
- relative energy deficiency syndrome (female athlete triad) : OP, disordered eating, menstrual irreg.
- binge eating disorder on the rise
Adolsecent Obesity
Obesity
- consider to be 120% of the 95th percentile BMI curve OR
- BMI > 40 (class III obseity)
rising: 21% prevelence in those 15-19
- adolsecents have increased autonomy over what they eat
Treatment
- lifestyle interventions!! early and start them
pharmacotherapy :
- semaglutide or liraglutide for 12+
- metformin 6+
- phentermine 12+ short term only
- phentermine/topier. 12+ short term
bariatric surgery
- watch with consent to lifelong adhearnace to changes
Activity Questions
Activity
- spend free time, do for fun
- excel at? sports? how often
