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Flashcards in Puberty Deck (73):
1

What is adrenarche, and when does this occur?

-Regeneration of the zona reticularis in the adrenal cortex

Occurs between ages 6-8

2

What is gonadarche, and when does this begin?

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

3

Are there phenotypic changes with adrenarche? Gonadarche?

No

4

What are the basophils of the anterior pituitary? Acidophils?

B-FLAT
GPA

5

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

Occurs around age 11
Breast bud development and first phenotypic signs of puberty

6

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

Thelarche
Estrogen

7

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

Onset of pubic and axillary hair growth around age 12

result of increased androgens

8

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

False- normal variant, especially in black females

9

Pubarche precedes menarche by approximately how many years?

2

10

What is menarche, and what does this occur?

Onset of menses
Avg age 12.5 years

11

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

2 years

12

What is the very first sign of puberty?

Growth acceleration

13

What hormone is responsible for increasing estrogen production?

FSH

14

What hormone is responsible for increasing androgens and progesterones production?

LH

15

What is the main form of estrogen?

Estradiol

16

What is the enzyme that converts testosterone to estrogen?

Aromatase

17

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

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

18

What happens to the HPA axis in the prepubertal years?

Downregulation of HPA with reduction in GnRH
-Increases in ovarian size and vaginal length

19

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

Increases (1:1 to 3:1)

20

What happens to GnRH production around 8 years of age?

Increased amplitude and frequency of GnRH release

21

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

LH

22

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

Estrogen increases LH/FSH alone, but decreases with inhibin

23

When does the growth peak occur?

2 years after breast budding and 1 year prior to menarche

24

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

True since epiphyseal plates close

25

What fraction of total body calcium is laid down during puberty

1/2

26

How long is the process of sexual maturation for girls?

4.5 years

27

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

-Breast development before 7 years
-Pubic hair development before 8 yr
-Menstruation before 10 yr

28

In which gender does precocious puberty happen more often?

Girl:boy 23:1

29

What are the two general types of precocious puberty?

GnRH dependent or independent

30

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

Idiopathic

31

What can cause GnRH independent precocious puberty?

Ovarian cysts/tumors
Adrenal tumors

32

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

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

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

21-hydroxylase

34

Draw out adrenal pathway

Draw

35

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

Elevated 17-OH progesterone

36

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

GnRH agonists like Leuprolide

37

What is the use and MOA of leuprolide?

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

38

How do you use leuprolide to prevent precocious puberty?

Continuously

39

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

-Decrease in estrogen to prepubertal range
-Regression of breast development
-Cessation of menses

40

What is the best test to assess for precocious puberty?

Bone age

41

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

-Vaginal smear for estrogen effect
-hormone levels

42

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

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

43

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

-No secondary sex characteristics by age 13
-No menarche by 15
-Menses has not begun after 5 years after thelarche

44

What is the usual cause of hypogonadotropic hypogonadism?

Turner's syndrome

45

What is Kallmann syndrome?

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

What are the two major causes of delayed puberty?

Hypergonadotropic hypogonadism

Hypogonadotropic hypogonadism

47

What is the genotype of Turner's syndrome?

XO

48

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

Streaked gonads with absence of ovarian follicles

49

What is the treatment for hypergonadotropic hypogonadism?

-GH to reach height
-Estrogen administration at normal time of puberty

50

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

Tanner stage IV o prevent breast developing an abnormal contour

51

What is the most common cause of hypogonadotropic hypogonadism?

Constitutional delay

52

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

True

53

What happens with hyperprolactinemia to GnRH release?

Decreases

54

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

Craniopharyngioma

From Rathke's pouch (oral ectoderm)

55

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

Congential absence of vagina, and probably uterus and fallopian tubes

BUT normal ovarian function

56

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

Mullerian agenesis

57

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

True

58

What other organ is commonly affected with Mullerian agenesis?

Renal

59

What is an imperforate hymen?

Genital plate canalization is incomplete, so hymen is closed

60

What happens in menarche with an imperforate hymen?

Little bleeding, causing pelvic pain and bruising in the area

61

What is the definitive treatment for an imperforate hymen?

Hymenotomy

62

What is Tanner breast stage 1?

Elevation of the papilla only

63

What is Tanner breast stage 2?

elevation of the breast and papilla as a small mound

64

What is Tanner breast stage 3?

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

65

What is Tanner breast stage 4?

Secondary mound

66

What is Tanner breast stage 5?

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

67

What is Tanner pubic hair stage 1?

None

68

What is Tanner pubic hair stage 2?

Sparse growth of long, slightly pigments, downy hair

69

What is Tanner pubic hair stage 3?

Dark hair that spreads over the junctions of the pubes

70

What is Tanner pubic hair stage 4?

Dark hair over the mons, but not thighs

71

What is Tanner pubic hair stage 5?

Dark hair over the thighs

72

What is the typical sequence of puberty? (4)

-Accelerated growth
-Thelarche
-Pubarche
-Menarche

73

When do black girls tend to start menses?

11 years old