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2a- Endocrinology > Puberty: advancements, delays, investigation and management > Flashcards

Puberty: advancements, delays, investigation and management Flashcards

1
Q

Define puberty

A

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

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2
Q

What are the definitive signs of puberty in boys and girls?

A
  • Girls: menarche - first menstrual bleeding
  • Boys: first ejaculation, often nocturnal
    • These do not signify fertility
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3
Q

What are the secondary sexual characteristics for girls?

A

Occur at puberty:
- Ovarian oestrogens regulate the growth of breast and female genitalia
- Ovarian and adrenal androgens control pubic and axillary hair

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4
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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5
Q

What are Tanner stages?

A

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

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6
Q

Describe tanner stage 1 in boys

A
  • Prepubertal: No pubic hair
  • Testicular length <2.5 cm
  • Testicular volume <3.0 mL
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7
Q

Describe tanner stage 2 in boys

A
  • Sparse growth of slightly curly pubic hair, mainly base of penis
  • Testes >3mL (>2.5cm in longest diameter)
  • Scrotum thinning and reddening
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8
Q

Describe tanner stage 3 in boys

A
  • Thicker, curlier hair spread to mons pubis
  • Growth of penis in width and length; further growth of testes
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9
Q

Describe tanner stage 4 in 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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10
Q

Describe tanner stage 5 in boys

A
  • Adult-type hair spread to medial surface of thighs
  • Genitalia adult size and shape
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11
Q

What instrument measures testicular volume in mL?

A

Orchidometer

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12
Q

Describe tanner stage 1 in girls

A
  • Prepubertal: No pubic hair
  • Elevation of papilla only
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13
Q

Describe tanner stage 2 in 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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14
Q

Describe tanner stage 3 in girls

A
  • Darker, coarser hair spreading over mons pubis
  • Further enlargement of breast and areola, with no separation of contours
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15
Q

Describe tanner stage 4 in 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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16
Q

Describe tanner stage 5 in girls

A
  • Hair adult-type and distributed in classic inverse triangle
  • Adult contour breast with projection of papilla only
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17
Q

What is thelarche?

A

breast development
- First visible change of puberty

18
Q

What is thelarche induced by?

A

Oestrogen

19
Q

How long does thelarche take?

A

Completed in about 3 years

20
Q

What are the effects of oestrogen on the breast?

A
  • Ductal proliferation
  • Site specific adipose deposition
  • Enlargement of the areola & nipple
21
Q

What other hormones are involved with thelarche?

A

prolactin, glucocorticoids, insulin

22
Q

What is precocious puberty?

A

onset of secondary sexual characteristics before 8 years (girls), 9 years (boys)

23
Q

What might menarche before 9 years old lead to?

A

Short stature

24
Q

Define delayed puberty

A

absence of secondary sexual characteristics by 14 years (girls), 16 years (boy)

25
Q

What does delayed puberty lead to?

A

reduced peak bone mass and osteoporosis

26
Q

What is adrenarche?

A

Maturational process of the adrenal gland
- Only observed in humans and in some old world primates
- Mild advanced bone age, axillary hair, oily skin, mild acne, body odour

27
Q

What is pubarche?

A
  • 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
28
Q

What are indications for delayed puberty in girls?

A
  • 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
29
Q

What are indications for delayed puberty in boys?

A
  • Lack of testicular enlargement by age 14 yrs
  • Lack of pubic hair by age 15 yrs
  • More than 5 years to complete genital enlargement
30
Q

What laboratory investigations would you to investigate delayed puberty?

A
  • Complete red blood count
  • U + E, renal, LFT
  • LH, FSH
  • Testosterone/ oestradiol
    • Low concentrations of this and LH/ FSH can be seen during quiescent phase and early puberty
  • Thyroid function, prolactin
  • DHEA-S, ACTH, Cortisol
31
Q

When would karyotyping be needed?

A

In ALL girls with short stature

32
Q

What are the functional causes of delayed puberty?

A
  • Chronic renal disease
  • Chronic lung disease
  • Anorexia nervosa
  • Psychosocial/ stress
  • Drugs
33
Q

What happens in primary hypogonadism in females?

A

In ovaries
● Oestrogen goes down
● Lack of feedback
● LH and FSH increase

34
Q

What happens in primary hypogonadism in males?

A

In testes
● Testosterone goes down
● Lack of feedback
● LH and FSH increase

35
Q

What happens in secondary hypogonadism in females?

A

In hypothalamus and pituitary
● LH and FSH low
● No response to feedback
● Oestrogen decreases

36
Q

What happens in secondary hypogonadism in males?

A

In hypothalamus and pituitary
● LH and FSH low
● No response to feedback
● Testosterone decreases

37
Q

What is Klinefelter syndrome?

A

Primary hypogonadism
47, XXY

38
Q

What is Turner syndrome?

A

45, X0 girls

39
Q

What is seen in Turner syndrome?

A
  • Renal malformations – horseshoe kidney (fusion of the kidney)
  • Short stature
  • Cardiovascular malformations – aortic arch, spontaneous rupture
40
Q

What is the incidence of Turner syndrome?

A

1 in 2000 girls

2a- Endocrinology (17 decks)

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