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endocrinology lectures phase 2 > puberty > Flashcards

puberty Flashcards

1
Q

what does puberty describe

A

the physiological, morphological, and behavioural changes as the gonads switch from infantile to
adult forms

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2
Q

what is the definitive sign of puberty onset in girls

A

Girls – menarche – first menstrual bleeding

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3
Q

what is the definitive sign of puberty onset in boys

A

boys – first ejaculation – often nocturnal

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4
Q

do the first definitive signs of puberty signify fertility

A

no

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5
Q

when do secondary sexual characteristics occur

A

at puberty

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6
Q

what are the secondary sexual characteristics for girls

A

Ovarian oestrogens regulate the growth of breast and female genitalia

Ovarian and adrenal androgens control pubic and axillary hair

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7
Q

what are the secondary sexual characteristics for boys

A

Testicular androgens – external genitalia and pubic hair growth, enlargement of larynx and laryngeal muscles (voice deepening)

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8
Q

what is the tanner scale

A

A scale that defines physical measurements of development based on external primary and secondary sex characteristics.

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9
Q

stage 1 of tanner scale - boys

A
  • Prepubertal: No pubic hair
  • Testicular length <2.5 cm
  • Testicular volume <3.0 mL
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10
Q

stage 2 of tanner scale - boys

A
  • Sparse growth of slightly curly pubic hair, mainly base of penis
  • Testes > 3 mL (>2.5 cm in longest diameter)
  • Scrotum thinning and reddening
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11
Q

stage 3 of tanner scale - boys

A
  • Thicker, curlier hair spread to mons pubis
  • Growth of penis in width and length; further growth of testes
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12
Q

stage 4 of tanner scale - boys

A
  • Adult-type hair, not yet spread to medial surface of thighs
  • Penis further enlarged; testes larger, darker scrotal skin colour
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13
Q

stage 5 of tanner scale - boys

A
  • Adult-type hair spread to medial surface of thighs
  • Genitalia adult size and shape
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14
Q

what does an orchidometer measure

A

testicular volume in ml

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15
Q

stage 1 of tanner scale - girls

A
  • Prepubertal: No pubic hair
  • Elevation of papilla onl
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16
Q

stage 2 of tanner scale - girls

A
  • Sparse growth of long, straight or slightly curly, minimally pigmented hair, mainly on labia
  • Breast bud noted/ palpable; enlargement of areola
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17
Q

stage 3 of tanner scale - girls

A

*Darker, coarser hair spreading over mons pubis
* Further enlargement of breast and areola, with no separation of contours

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18
Q

stage 4 of tanner scale - girls

A
  • Thick adult-type hair, not yet spread to medial surface of thighs
  • Projection of areola and papilla to form secondary mound above level of breast
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19
Q

stage 5 of tanner scale - girls

A
  • Hair adult-type and distributed in classic inverse triangle
  • Adult contour breast with projection of papilla only
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20
Q

what is the first visible change of puberty for girls

A

Thelarche – breast development

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21
Q

what induces breast develpment

A

oestrogen

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22
Q

how long does breast development take

A

about 3 years

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23
Q

3 effects of oestrogen on breast

A
  • Ductal proliferation
  • Site specific adipose deposition
  • Enlargement of the areola and nipple
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24
Q

can breasts be unilateral

A

yes for several months

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25
Other hormones involved in breast development
prolactin, glucocorticoids, insulin
26
describe pre pubertal uterus
* Corpus : cervix ratio 1:2 * Tubular shape * Length 2-3 cm * Volume 0.4-1.6 ml * Endometrium single layer of cuboidal cells
27
describe pubertal - adult uters
* Corpus : cervix ratio 2:1 * Pear shape * Length 5-8 cm * Volume 3-15 ml * Endometrium increased thickness
28
describe pre pubertal ovaries
* Volume 0.2-1.6 ml * Non functional
29
describe pubertal - adult ovaries
* Volume 2.8-15 ml * Multicystic
30
what to check in a pevlic ultrasound - females
* Are the Mullerian structures present? * Morphology of uterus? * Morphology of ovaries?
31
describe pre pubertal vagina
* Reddish in colour * Thin atrophic columnar epithelium * pH neutral *Length 2.5-3.5 cm
32
describe pubertal - adult vagin
* Dulling of the reddish colour * Thickening of the epithelium * Cornification of the superficial layer stratified squamous epithelium * pH acidic 3.8-4.2 * Secretion of clear whitish dischargein the months before menarche * Length 5-8 (-12)cm
33
what happens under the effect of oestrogens
– Labia majora & minora increase in size & thickness – Rugation & change in colour of the labia majora – Hymen thickens – Clitoris enlarge – Vestibular glands begin secretion
34
what do Adrenal androgens & ovarian androgens cause
growth of pubic and axillary hair
35
define precocious puberty
onset of secondary sexual characteristics before 8 years (girls), 9 years (boys)
36
what can Menarche before 9 yrs cause
may lead to short stature
37
define delayed puberty
absence of secondary sexual characteristics by 14 years (girls), 16 years (boy)
38
what can delayed puberty lead to
reduced peak bone mass and osteoporosis
39
describe female HPG axis
hyppthalamus -> GnRH anterior pituitary -> LH & FSH FSH -> bind to granulosa cells -> convert androgens to oestrogen LH -> act on theca cells -> produce andorgens
40
describe male HPG axis
hyppthalamus -> GnRH anterior pituitary -> LH & FSH LH -> stimulate leydig cells to make testeosterone FSH -> stimulates sertoli cells to make ABG & inhibin
41
what are physical change aat puberty controlled by
by gonadal and adrenal sex steroids regulated by the gonadotrophins, LH and FSH
42
what is the Hypothalamic maturation hypothesis (GnRH pulse generator)
– Puberty only requires increased hypothalamic GnRH – Emphasises the direct link 1CNS and pituitary and hypothalamic GnRH neurons
43
at the start if puberty what factors regulate GnRH secretion (INCREASED STIMULATORY FACTORS)
glutamate and kisspeptin
44
at the start if puberty what factors regulate GnRH secretion (DECREASED INHIBITORY FACTORS)
mostly through GABAergic neurons secreting γ-aminobutyric acid (GABA) and opioidergic neurons
45
what is adrenarche
Maturational process of the adrenal gland
46
which species is adrenarche observed in
Only observed in humans and in some old world primates
47
impacts of adrenarche
Mild advanced bone age, axillary hair, oily skin, mild acne, body odour
48
what is pubarche
Most pronounced clinical result of adrenarche Result of androgen action on the pilosebaceous unit transforming vellus hair into terminal hair in hair-growth prone parts of the skin
49
treatment of precocious puberty
GnRH superagonist to suppress pulsatility of GnRH secretion
50
what % of children have delayed puberty
3%
51
is delayed puberty more common in girls or boys
boys
52
what can delay in puberty lead to
delay in acquisition of secondary sex characteristics, psychological problems, defects in reproduction and reduced peak bone mass
53
Indications for investigation of delayed puberty - girls
* Lack of breast development by 13 yrs * More than five years between breast development and menarche * Lack of pubic hair by age 14 yrs * Absent menarche by age 15-16 yrs
54
Indications for investigation of delayed puberty - boys
* Lack of testicular enlargement by age 14 yrs * Lack of pubic hair by age 15 yrs * More than 5 years to complete genital enlargement
55
diseases associated with delayed puberty
Idiopathic (constitutional) delay in growth and puberty Hypogonadotrophic hypogonadism Hypergonadotrophic hypogonadism
56
what is Idiopathic (constitutional) delay in growth and puberty
– delayed activation of the hypothalamic pulse generator
57
what is Hypogonadotrophic hypogonadism
sexual infantilism related to to gonadotrophin deficiency
58
lab investigations for delayed puberty
- Complete red blood count - U + E, renal, LFT - LH, FSH - Testosterone/ oestradiol - Thyroid function, prolactin
59
what test to do in all girls with short stature
karyotyping Physical examination/ biochemistry suggestive of genetic syndrome
60
functional cuases for delayed puberty
Chronic renal disease Chronic lung disease Anorexia nervosa Psychosocial/ stress Drugs
61
what is hypogonadism
Reduction or absence of hormone secretion of the gonads.
62
what happens to ovary in female hypogonadism
Oestrogen goes down Lack of feedback LH and FSH increase
63
what happens to hypothaalmys and pituitary in hypogonadism
LH and FSH low No response to feedback Oestrogen decreases
64
what happens to testes in male hypogonadims
Testosterone goes down Lack of feedback LH and FSH increase
65
what happens to hypothalamus and pituitary in hypogonadism
LH and FSH low No response to feedback Testosterone decreases
66
what is primary hopogonadsm
ovary or testes fails
67
what is secondary hypogonadims
hypothalamus or pituitary fails
68
describe tuner syndrome
Turner syndrome – 45, X0 girls Renal malformations – horseshoe kidney (fusion of the kidney) Short stature Cardiovascular malformations – aortic arch, spontaneous rupture 1 in 2000 girls

endocrinology lectures phase 2 (17 decks)

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