Term
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Definition
| The onset of androgen secretion by the adrenal cortex. Occurs at 6-8YO |
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Term
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Definition
| The onset of breast development in girls (budding). Occurs after 8YO. Usually first physical sign of puberty. |
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Term
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Definition
| The onset of menstruation. Average onset is 13YO. |
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Term
| The presence of what affects Stage 1 of gonadal development In Utero? |
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Definition
| Presence of Y chromosome and SRY gene. If present, leads to testicular development, if absent leads to ovarian development. |
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Term
| The presence of what affects the second stage of Gonadal differentiation In Utero? |
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Definition
| The number of X chromosomes present |
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Term
| Adolescence covers what age range? |
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Definition
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Term
| What factor secretion from the Hypothalamus initiates puberty? |
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Definition
| Gonadotrophin Releasing Factors |
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Term
| The release of Gonadotrophin Releasing Factors stimulates what? |
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Definition
| The production and release of Luteinsing hormone and follicle stimulating hormone from the pituitary gland. |
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Term
| What does the action of LH on the gonads result in? |
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Definition
| Production of testosterone and oestrogen (male and female respectively) |
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Term
| What does the action of FSH on the gonads result in? |
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Definition
| Production of Ova or Sperm (female and male respectively) |
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Term
| What is the first sign of puberty in boys? |
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Definition
| Testicular growth >4mls in volume. |
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Term
| What is the first sign of puberty in girls? |
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Definition
| Breast development, this coincides with a growth spurt. |
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Term
| Pubic and axillary hair growth in girls is in response to what? |
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Definition
| Adrenal androgens, therefore this may be disconcordant to ovarian development. |
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Term
| Describe the pattern of consonance in girls pubertal changes |
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Definition
Breast buds followed by pubic hair and growth spurt and later on
menstruation. |
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Term
| Describe the pattern of consonance in boys pubertal changes |
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Definition
| Testicular growth followed by penile growth with pubic hair, and then growth spurt |
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Term
| Name 5 factors that can affect the initiation of puberty? |
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Definition
| Genetic factors, nutritional status, exercise, chronic inflammatory conditions (Chrons) and environment. |
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Term
| At what age would delayed puberty be considered in males and females? |
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Definition
Absence of breast development in a girl by age 13.5 or lack of menstruation 3 years post breast bud development.
Failure of testicular growth of >4mls in boys aged 14. |
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Term
| What is the most common cuase of delayed puberty in boys? |
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Definition
| Constitutional delay. Family history important. |
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Term
| Name a disorder in which a lack of gonadotrophins are produced? |
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Definition
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Term
| Delayed onset of puberty accompanied by a loss of the sense of smell in 50% of people would lead you to what differential? |
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Definition
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Term
| Name two conditions in which delayed onset of puberty is caused by a lack of gonadal response to gonadotrophins |
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Definition
Turners Syndrome (Single X)
Kleinfelters Syndrome (XXY) |
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Term
| What environmental factors may delay onset of puberty? |
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Definition
| Malnutrition and excess exercise (gymnasts). |
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Term
| Describe the three degrees of severity in androgen insensitivity syndrome |
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Definition
Complete androgen insensitivity syndrome (CAIS): external genitalia are that of a normal female.
Mild androgen insensitivity syndrome (MAIS): external genitalia are that of a normal male.
Partial androgen insensitivity syndrome (PAIS): external genitalia are partially, but not fully, masculinized. |
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Term
| In delayed onset of puberty with high LH/FSH, how would you treat? |
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Definition
| High FSH/LH with no puberty commensal indicates gonadal failure therefore replace sex steroids which are not being produced. |
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Term
| In delayed onset of puberty with low LH/FSH, how would you treat? |
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Definition
| Low LH/FHS indicates Hypogonadism/pituitary disorder/constituent delay. Therefore sex steroids until puberty begins or as a replacement. |
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Term
| At what age in puberty in a girl considered precocious? |
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Definition
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Term
| At what age in puberty in a boy considered precocious? |
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Definition
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Term
| Considering consonance, if pubic hair growth begins as a sign of precocious puberty, what is likely to be the problem? |
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Definition
| Gonadal or adrenal problem (or tumour) |
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Term
| Considering consonance, if breast bud development begins as a sign of precocious puberty, what is likely to be the problem? |
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Definition
| Hypothalmic/pituatary axis problem |
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Term
| What is the most common cause of precocious puberty following a disconcordant pattern? |
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Definition
| Congenital adrenal hyperplasia |
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Term
| What is the most common enzyme defect in congenital adrenal hyperplasia? |
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Definition
| 21 hydroxylase deficiency causing a lack of cortisol production and a build up of 17 hydroxyprogesterone causing the formation of androstenedione and then testosterone |
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Term
| How do you treat congenital adrenal hyperplasia? |
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Definition
| Steroid replacement e.g hydrocortisone |
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Term
| List Tanners 5 stages of Thelarche |
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Definition
Stage 1 – Pre-Adolescent
Stage 2 – Breast bud stage
Stage 3 – contd. dev of breast and areola but no
separation
Stage 4 – further enlargement with papilla and areola projecting above breast contour
Stage 5 – Mature breast, areola recesses, & papilla elevated |
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Term
| What pubertal changes are due to adrenal and ovarian androgens? |
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Definition
| Growth of axillary and pubic hair, acne and skin changes |
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Term
| List the 5 stages of pubertal change of external genitalia in boys? |
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Definition
Stage 1 – pre-adolescent
Stage 2 – Enlargement of scrotum and testis
Stage 3 – Further growth with enlargement of penis.
Hair on upper lip and cheeks
Stage 4 – further enlargement with development of glans penis
Stage 5 – Adult stage - Facial hair on lower lip and chin |
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Term
| What are the congenital causes of Hypogonadotrophic Hypogonadism (↓ FSH & ↓LH)? |
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Definition
Pituitary dysfunction, FSH /LH receptor defects, IHH,
-Syndromes – Kallmans, Prader Willi, etc |
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Term
| What are the acquired causes of Hypogonadotrophic Hypogonadism (↓ FSH & ↓LH)? |
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Definition
Chronic disease, eating disorders, Thyroid disease, Hyper-prolactinaemia
- Pituitary tumours, craniopharyngioma
-Medication or substance abuse
-Head Trauma |
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Term
| What are the congenital causes of Hypergonadotrophic Hypogonadism (↑ FSH & ↑ LH)? |
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Definition
-Gonadal Dysgenesis – Klinefelters, Turners syndromes
-Androgen Resistance (AIS)
- Steroid enzyme defects |
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Term
| What are the acquired causes of Hypergonadotrophic Hypogonadism (↑ FSH & ↑ LH)? |
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Definition
Trauma / surgery
-Cryptorchidism
-Post- infective – mumps
- Chemotherapy or DXT |
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