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Flashcards in Puberty II Deck (15)
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Turner Syndrome

female 45, XO in 50% or
Mosaics or
Struct. abnormality of X ch.

Can be cause of Primary ovarian failure

Short stature


Causes of Primary ovarian failure

1. Turner syndrome
2. XX or XY complete gonadal dysgenesis
3. Galactosemia
4. Radiation
5. Chemotherapy
6. Autoimmune


Phenotypic characteristics of Turner syndrome

1. Short stature (100%)
2. Ovarian failure (94%)
3. Hx of otitis (75%)
4. Dysmorphic facies (60%)
5. Cardiovascular (55%)


Causes of primary testicular failure

1. Klinefelter's syndrome
2. Cryptorchidism
3. Testicular regression syndrome
4. Radiation
5. Chemotherapy (alkylating agents)


Klinefelter's syndrome

47, XXY

Hyalinization and fibrosis of seminiferous tubules

1. microphallus
2. small testes
3. learning dis
4. eunochoid
5. delayed/arrested puberty
6. gynecomastia
7. infertility


Tx of hypogonadism

T Q3-4 weeks @ low dose --> gradually increase

E followed by cyclic therapy of E + progesterone


Complete Precocious puberty

1. Early onset and progression of physical development
2. Accelerated linear growth
3. advancement of skeletal age
4. Central (GnRH dependent)
5. Peripheral (GnRH independent)

- If untreated, their skeletal maturation will advance dispropirtionately -->
early closure of growth plate and end up short as an adult


% of time girls and boys central precocious puberty is due to CNS abnormality

Girls: 5%

Boys: 50%

CNS abnormalities: anything that disrupts CNS inhibition of GnRH
- hypothalamic hamartoma


Causes of peripheral puberty in girls

Think of where E comes from

1. Ovarian cysts: progression of ovarian follicles to form cysts (make enough E)
- vaginal bleed with withdrawal of estrogen
2. Granulosa Cell tumor
3. Exogenous estrogens
4. Lavender/tea tree products
5. SEVERE HYPOTHYROIDISM (stim FSH receptors - high E)
- boys and girls


McCune albright syndrome (80)

activating mutation in the a subunit of Gs

Triad of:
1. precocious puberty
2. cafe-au-lait spots
3. Polyostotic fibrous dysplasia

Can also have GH excess, hyperthyroidism, cushings syndrome


Peripheral precocious puberty

1. adrenal tumor
2. Leydig cell tumor
- makes T
3. hCG secreting tumor
- like LH, which stim leydig cells
4. Late onset CAH
- high T at very early age (present by age 2)
- TSH is liek FSH
(stim of seminiferous tubules - big testes, low T)


SEVERE HYPOTHYROIDISM-Presentation in boys and girls
- Key?

Cause of peripheral puberty in both or girls

- TSH is like FSH
Boys: testicular enlargement (stim of seminiferous tubules
Girls: breast development

Key is delayed bone age and poor linear growth


If bone age is advanced, this suggests what?

Long standing sex hormone action and exposure

Evaluate for precocious puberty


GO over evaluation outline of precocious puberty

Random LH + FSH -->
Prepubertal LH -->
GnRH stimulation test -->
Prepubertal LH -->
Peripheral precocious puberty
- if GnRH stim test shows pubertal LH it is Central percocious puberty -->

Random LH + FSH -->
Pubertal LH lvl -->
Central precocious puberty -->
Central MRI


tx of central precocious puberty and peripher precocious puberty

central precocious puberty
- GnRH analog (lupron/supprelin): down reg pit GnRH receptors and secretion

peripher precocious puberty: Depend on cause
Ovarian cyst: watchful waiting w/ US