Puberty

Question 1

What is the definition of adrenarche?

Answer 1

Increase in adrenal androgens

Question 2

What hormonones iniate andrenarche?

Answer 2

DHEA and Androstenedione

Question 3

At what age do rise in adrenal androgens begin?

Answer 3

Age 6

Question 4

What is the likely explanation of decreasing age of menarche?

Answer 4

improvement in health and nutrition

Question 5

What is the general sequence of development?

Answer 5

Thelarche, pubarche, menarche

Question 6

What race begins puberty the earliest?

Answer 6

African American

Question 7

What stimulates growth in puberty for girls?

Answer 7

Estrogen, Growth hormone

Question 8

What stimulates epiphyseal fusion?

Answer 8

Estrogen

Question 9

When does menarche occur in relation to breast budding (thelarche)?

Answer 9

2.5 years following

Question 10

How long does it take to establish an ovulatory pattern of bleeding?

Answer 10

1.5 years

Question 11

What is the traditional definition of precocious puberty?

Answer 11

Onset of changes in girls before the age of 8

Question 12

What is the most common central cause of precocious puberty?

Answer 12

Idiopathic

Question 13

What is the most common peripheral cause of precocious puberty?

Answer 13

Ovarian cyst or tumor

Question 14

What is the most likely diagnosis in a patient presenting with precocious puberty, Cafe Au Lait spots, cystic bone lesions?

Answer 14

McCune - Albright Syndrome

Question 15

What is the most common cause of precocious puberty with onset after 4 years of age?

Answer 15

Idiopathic

Question 16

What is the most common cause of precocious puberty with onset prior to 4 years of age?

Answer 16

CNS lesion

Question 17

What is the first step in evaluation of a patient who presents with precocious puberty with breasts or pubic hair?

Answer 17

Bone age

Question 18

During workup for precocious puberty with advanced bone age, what is the next step in management?

Answer 18

GnRH stimulation test

Question 19

If a patient presents with precocious puberty and BOTH breasts and pubic hair, what is the next best step in management even with a normal bone age?

Answer 19

GnRH stimulation test

Question 20

If a patient with precocious puberty has normal bone age and either breast OR pubic hair only, what is the next best step in management?

Answer 20

Observation

Question 21

In a patient presenting with precocious puberty who has a high LH (Gonadotropin dependent) on GnRH stimulation test, what is the next step in management?

Answer 21

Brain MRI, TSH, Free T4, Pelvic US

Question 22

In a patient presenting with precocious pubertty who has a normal LH (Gonadotropin independent) on GnRH stimulation test, what is the next best step in management?

Answer 22

Pelvic US, Estradiol, 17 OHP, Testosterone, DHEAS

Question 23

How do you treat idiopathic precocious puberty?

Answer 23

GnRH agonist - depo Lupron

Question 24

What is the definition of delayed puberty?

Answer 24

No breast development by 13 years of age, No menarche by 16 years of age

Question 25

What is the most common type of delayed puberty?

Answer 25

Hypergonadotropic Hypogonadism

Question 26

What values of FSH and LH suggest Hypergonadotropic Hypogonadism?

Answer 26

FSH > 20, LH > 40

Question 27

What values of FSH and LH suggest Hypogpnadotropic Hypogonadism?

Answer 27

FSH <5, LH <5

Question 28

What is the definition of primary amenorrhea?

Answer 28

Absence of menses by age 16

Question 29

What is the differential diagnosis for hypergonadotropic hypogonadism?

Answer 29

Gonadal dysgenesis, Premature ovarian failure, 17 alpha hydroxylase deficiency

Question 30

What are the two syndromes associated with gonadal dysgenesis?

Answer 30

Turner syndrome, Swyer syndrome

Question 31

What is the differential diagnosis for hypogonadotropic hypogonadism?

Answer 31

Prolactinoma, Hypothyroidism, CAH, Cushings syndrome, Anorexia, Kallmans syndrome

Question 32

What is the most common CNS or pituitary tumor associated with delayed puberty?

Answer 32

Craniopharyngioma

Question 33

What is the differential diagnosis in a patient with delayed puberty with normal FSH and LH?

Answer 33

Mullerian agenesis, vaginal septum, imperforate hymen, androgen insensitivity syndrome

Question 34

If you make the diagnosis of mullerian agenesis, what other tests should you order?

Answer 34

CT urogram, IVP, renal ultrasound

Question 35

How often are abnormalities with the GU system present in mullerian agenesis?

Answer 35

33% of the time

Question 36

What are the first set of tests to order in a patient with delayed puberty?

Answer 36

FSH, LH, Estradiol

Question 37

if you diagnose a patient with hypergonadotropic hypogpnadism, what should you order?

Answer 37

Karyotype

Question 38

If you diagnose a patient with hypogonadotropic hypogonadism, what should you order?

Answer 38

TSH/T4, prolactin, MRI brain/pituitary, bone age

Question 39

What is the treatment for delayed puberty?

Answer 39

low dose estrogen, followed by progesterone after menses begin or 12-24 months following initiation of treatment

Question 40

What is the most common cause of delayed puberty?

Answer 40

Gonadal dysgenesis

Question 41

What is the differential diagnosis of a patient who presents with a short vagina, and no cervix?

Answer 41

Androgen insensitivity, mullerian agenesis, transverse vaginal septum