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OB/GYN > Puberty > Flashcards

Puberty Flashcards

1
Q

What is adrenarche, and when does this occur?

A

-Regeneration of the zona reticularis in the adrenal cortex

Occurs between ages 6-8

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2
Q

What is gonadarche, and when does this begin?

A

Pulsatile release of GnRH from the hypothalamus begins, causing release of LH/FSH

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3
Q

Are there phenotypic changes with adrenarche? Gonadarche?

A

No

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4
Q

What are the basophils of the anterior pituitary? Acidophils?

A

B-FLAT

GPA

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5
Q

What is thelarche, and what does it occur? What occurs with this?

A

Occurs around age 11

Breast bud development and first phenotypic signs of puberty

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6
Q

During what stage of puberty do phenotypic changes occur? What is the hormone that is responsible for this?

A

Thelarche

Estrogen

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7
Q

What is pubarche, and when does this occur? What causes this to occur?

A

Onset of pubic and axillary hair growth around age 12

result of increased androgens

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8
Q

True or false: having pubarche prior to thelarche is a concerning finding

A

False- normal variant, especially in black females

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9
Q

Pubarche precedes menarche by approximately how many years?

A

2

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10
Q

What is menarche, and what does this occur?

A

Onset of menses

Avg age 12.5 years

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11
Q

How long does it take for menstrual cycles to become regular?

A

2 years

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12
Q

What is the very first sign of puberty?

A

Growth acceleration

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13
Q

What hormone is responsible for increasing estrogen production?

A

FSH

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14
Q

What hormone is responsible for increasing androgens and progesterones production?

A

LH

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15
Q

What is the main form of estrogen?

A

Estradiol

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16
Q

What is the enzyme that converts testosterone to estrogen?

A

Aromatase

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17
Q

What is the general progression of the HPA axis from in utero to childhood?

A

High in utero, but drops after delivery d/t loss of maternal hormones.

Pulsatile release increases in infancy, peaking around 12-18 months, when negative feedback ensues

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18
Q

What happens to the HPA axis in the prepubertal years?

A

Downregulation of HPA with reduction in GnRH

-Increases in ovarian size and vaginal length

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19
Q

What happens to the uterine body / cervix ratio as females progress through childhood?

A

Increases (1:1 to 3:1)

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20
Q

What happens to GnRH production around 8 years of age?

A

Increased amplitude and frequency of GnRH release

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21
Q

Which is produced in larger amounts during puberty: LH or FSH?

A

LH

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22
Q

What is the positive and negative feedback mechanisms on the HPA axis with estrogen?

A

Estrogen increases LH/FSH alone, but decreases with inhibin

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23
Q

When does the growth peak occur?

A

2 years after breast budding and 1 year prior to menarche

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24
Q

True or false: there is limited growth potential after menarche. Why or why not?

A

True since epiphyseal plates close

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25
Q

What fraction of total body calcium is laid down during puberty

A

1/2

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26
Q

How long is the process of sexual maturation for girls?

A

4.5 years

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27
Q

What is the definition of precocious puberty (breast, pubic hair, and menstruation times)?

A
  • Breast development before 7 years
  • Pubic hair development before 8 yr
  • Menstruation before 10 yr
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28
Q

In which gender does precocious puberty happen more often?

A

Girl:boy 23:1

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29
Q

What are the two general types of precocious puberty?

A

GnRH dependent or independent

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30
Q

What is the most common cause of GnRH dependent precocious puberty?

A

Idiopathic

31
Q

What can cause GnRH independent precocious puberty?

A

Ovarian cysts/tumors

Adrenal tumors

32
Q

What is McCune-Albright syndrome? S/sx (3)?

A

Genetic disease that causes the ovary to produce estrogen without FSH, characterized by at least two of the following:

  • precocious puberty
  • Polyostotic fibrous dysplasia
  • Unilateral café au lait spots
33
Q

Which type of congenital adrenal hyperplasia causes precocious puberty in females?

A

21-hydroxylase

34
Q

Draw out adrenal pathway

A

Draw

35
Q

What is the test that is 100% specific for 21-hydroxylase deficiency?

A

Elevated 17-OH progesterone

36
Q

What general type of medication is used to prevent precocious puberty?

A

GnRH agonists like Leuprolide

37
Q

What is the use and MOA of leuprolide?

A

GnRH agonist that decreases GnRH release in precocious puberty of for BPH

38
Q

How do you use leuprolide to prevent precocious puberty?

A

Continuously

39
Q

How can you tell that you are using the correct amount of Leuprolide? (3)

A
  • Decrease in estrogen to prepubertal range
  • Regression of breast development
  • Cessation of menses
40
Q

What is the best test to assess for precocious puberty?

A

Bone age

41
Q

What are the labs that are useful for determining the etiology of precocious puberty?

A
  • Vaginal smear for estrogen effect

- hormone levels

42
Q

(Early/late) puberty and (early/late) menopause increases the risk for breast cancer. (fill in the blank)

A

Early puberty and late menopause (longer fertile period = higher risk)

43
Q

What are the signs of delayed puberty (secondary sex characteristics, menarche, menses)?

A
  • No secondary sex characteristics by age 13
  • No menarche by 15
  • Menses has not begun after 5 years after thelarche
44
Q

What is the usual cause of hypogonadotropic hypogonadism?

A

Turner’s syndrome

45
Q

What is Kallmann syndrome?

A

a genetic condition where the primary symptom is a failure to start puberty or a failure to fully complete it. It occurs in both males and females and has the additional symptoms of hypogonadism and almost invariably infertility. Kallmann syndrome also features the additional symptom of an altered sense of smell; either completely absent (anosmia) or highly reduced (hyposmia).[1][2] Kallmann syndrome occurs when the hypothalamic neurons that are responsible for releasing gonadotropin-releasing hormone (GnRH neurons) fail to migrate into the hypothalamus during embryonic development

46
Q

What are the two major causes of delayed puberty?

A

Hypergonadotropic hypogonadism

Hypogonadotropic hypogonadism

47
Q

What is the genotype of Turner’s syndrome?

A

XO

48
Q

What are the characteristics of the ovaries with Turner’s syndrome?

A

Streaked gonads with absence of ovarian follicles

49
Q

What is the treatment for hypergonadotropic hypogonadism?

A
  • GH to reach height

- Estrogen administration at normal time of puberty

50
Q

Progestins should not be given to hypogonadotropic hypogonadism until when? Why?

A

Tanner stage IV o prevent breast developing an abnormal contour

51
Q

What is the most common cause of hypogonadotropic hypogonadism?

A

Constitutional delay

52
Q

True or false: with constitutional delay, the height is appropriate for the bone age

A

True

53
Q

What happens with hyperprolactinemia to GnRH release?

A

Decreases

54
Q

What is the most common tumor associated with delayed puberty? Where does this usually arise from?

A

Craniopharyngioma

From Rathke’s pouch (oral ectoderm)

55
Q

What is Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome)?

A

Congential absence of vagina, and probably uterus and fallopian tubes

BUT normal ovarian function

56
Q

What is the most common cause of amenorrhea in women with normal breast development?

A

Mullerian agenesis

57
Q

True or false: there is normal ovarian function with Mullerian agenesis

A

True

58
Q

What other organ is commonly affected with Mullerian agenesis?

A

Renal

59
Q

What is an imperforate hymen?

A

Genital plate canalization is incomplete, so hymen is closed

60
Q

What happens in menarche with an imperforate hymen?

A

Little bleeding, causing pelvic pain and bruising in the area

61
Q

What is the definitive treatment for an imperforate hymen?

A

Hymenotomy

62
Q

What is Tanner breast stage 1?

A

Elevation of the papilla only

63
Q

What is Tanner breast stage 2?

A

elevation of the breast and papilla as a small mound

64
Q

What is Tanner breast stage 3?

A

Further enlargement of breast and areola, with NO separation of contours

65
Q

What is Tanner breast stage 4?

A

Secondary mound

66
Q

What is Tanner breast stage 5?

A

Projection of papilla only, resulting from recession of the areola to the general contour of the breast

67
Q

What is Tanner pubic hair stage 1?

A

None

68
Q

What is Tanner pubic hair stage 2?

A

Sparse growth of long, slightly pigments, downy hair

69
Q

What is Tanner pubic hair stage 3?

A

Dark hair that spreads over the junctions of the pubes

70
Q

What is Tanner pubic hair stage 4?

A

Dark hair over the mons, but not thighs

71
Q

What is Tanner pubic hair stage 5?

A

Dark hair over the thighs

72
Q

What is the typical sequence of puberty? (4)

A
  • Accelerated growth
  • Thelarche
  • Pubarche
  • Menarche
73
Q

When do black girls tend to start menses?

A

11 years old

OB/GYN (33 decks)

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