PAEDS 203 - Puberty and Adolescence Flashcards
(39 cards)
What is consonance (in puberty)?
Smooth ordered progression of changes that happen throughout puberty in a somewhat uniform way
What does non-consonance in puberty suggest?
Over-activity of the sex hormones peripherally and usually present with virilizartion
What age does puberty occur in males and females?
males 10-11
females 8-9
How does puberty start?
Pulsatile release of GnRH which stimulates LH and FSH secretion from the anterior pituitary
What actions does LH have in the male and female?
Male: acts on Leydig cells to stimulate testosterone production
Female: acts on Theca cells to stimulate androgen production
What actions does FSH have in the male and female?
Male: stimulates Sertoli cells in the seminiferous tubules to produce mature spermatozoa
Female: stimulates follicular development and aromatase activity by acting on granulosa cells (therefore oestrogen production)
What are the main consequences of testosterone in male puberty?
Development of male secondary sexual characteristics : axilliary and pubic hair, enlargement of external genitalia, deepening voice, sebum secretion, muscle growth, libid and spermatogenesis
What are the main consequences of oestrogen in female puberty?
Breast and nipple development, vaginal and vulval growth, pubic hair, growth and maturation of uterus and fallopian tubes
What is the order of consonance for puberty in girls?
breast development, pubic hair, growth spurt, axillary hair
What is the order of consonance for puberty in boys?
Testicular/scrotal growth, pubic hair, growth spurt, increase in penis size, voice change, facial/axillary hair
How much do girls and boys grow approximately in puberty? What accounts for boys being taller than girls?
Boys 28cm Girls 25cm
Boys have an extra two years of growth as a child before puberty
What finishes bone growth?
Oestrogen causing fusion of epiphyseal plates
What defines delayed puberty?
Complete absence of physical signs of puberty after age 13 in girls and age 14 in boys
What are the two divisions that causes of delayed puberty can be split into?
Primary gonadal failure = hypergonadotrophic (high FSH and LH) and central failure = hypogonadotrophic (low FSH and LH)
What are some of the causes of primary gonadal failure ?
Turners syndrome Klinefelters syndrome Androgen insensitivity syndrome 5 alpha reductase deficiency Pelvic radiotherapy or chemotherapy
Describe Turners syndrome?
Often first manifestation in short stature and primary ammenorhoea - infertility or subfertility
Results from an XO chromosome but can have moasicism
Associated with diabetes, congenital heart defects, neck webbing and renal malformations
Describe Klinefelters syndrome?
XXY chromosomes and also have varying degrees of severity due to different mosaicisms.
Many men go undiagnosed until present with infertility later in life. In childhood there may be unusual rapid growth and failure of sexual maturation
Small firm tests and gynaecomastia
Treat with testosterone treatment during puberty
Describe androgen insensitivity syndrome
X linked recessive condition leading to failure of normal masculinization of the external genitalia in genetically male patient. Insufficient post receptor response after androgen stimulation. Can be complete or partial leading to a spectrum of presentations: infertility, gynaecomastia, vagina and clitoris or just clitomegaly or hypospadias
Describe 5 alpha reductase deficiency
AR sex limited condition
Inability to convert testosterone to DHT
therefore may be more with ambiguous genitalia and cryptorchidism
What are some of the causes of central failure in delayed puberty?
Constitutional Anorexia Excessive excersize Hypothyroidoism Intracranial tumour Isolated GH or GnRH deficiency
Define precocious puberty
Onset of secondary sexual characteristics in less than 8 in girls and less than 9 in boys
How do you manage precocious puberty?
Check bone age and pelvic structures (usually advanced by +2years)
MRI the pituitary
Treat with GnRH analogue until puberty should begin at about 11/12
What are the two divisions of classifying precocious puberty?
True central - gonadotrophin dependant
Peripheral - gonadotrophin independant
What are some of the causes of true central precocious puberty?
Most commonly idiopathic (more common in obese children and females) Tumours hydrocephalus chronic inflammatory disease Trauma, abuse or adoption