Puberty (OBGYN Presentation #1)

8/7/2019 Puberty (OBGYN Presentation #1)

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Female Puberty

Topic #1

By:

Alex Qader


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Puberty What is it?

Development of

secondary sexual

characteristics and the

acquisition ofreproductive capability

Onset

Genetic factors / race

Geographic location

Nutritional status

Excessive exercise

>48Kg

Psychological factors


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Endocrinologic Changes of Puberty

Fetal & Newborn period Peak number of oocytes

20wks gestestion (LH, FSH)

Peak level of gonadotropins by 3 month decline until nadir(4yrs)

Childhood

H-P-G axis suppressed

Low Estradiol negative feedback on gonadostat

Intrinsic CNS inhibition of GnRH secretion

Late prepubertal period Androgen production/ differentiation

Zona reticularis

Axilary and pubic hair (adrenarche/pubarche)


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Pubertal onset

sensitivity by gonadostat

to negative feedback

GnRH pulses LH, FSH

Follicular maturation, Sex

steroid production

Secondary sexual

characteristics

Endocrinologic Changes of Puberty

(continued)


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Somatic Changes of Puberty:Stages of Breast development

Stage 1 Preadolescent

Elevation of papilla only

Stage 2 Breast bud stage

Elevation of breast and papilla

(small mound), areolarenlargement

Stage 3 Further enlargement

Stage 4 Secondary mound

Projection of areola and papilla

Stage 5 Mature stage

Projection of papilla only

Recession of areola


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Stages of Pubic Hair development Stage 1

Preadolescent Absent of pubic hair

Stage 2 Sparse hair

Downy, sparse, slight pigment

Stage 3 Hair over junction of pubes

Darker and coarser

Stage 4 Adult-type hair

Stage 5 Adult-type hair

Spread to medial surface ofthighs


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Growth Spurt

Adolescent growth spurt Seen ~2 yrs earlier than

boys

Body comp and bone

age Correlates with onset of

2ndary sexual

characteristics and

menarche Radiographs of non

dominant wrist, elbow,

knee


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Precocious puberty Definition

Development of any sign of

2ndary sexual maturation

earlier than 2.5 standard

deviation of expected ageof pubertal onset

Female age 8 or younger

Incidence ~ 1/10,000

Female 5X more

common 75% idiopathic

Tall as children, short

as adult Fun fact

Lina Medina: 5 years, 7

months, 21 days


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Heterosexual precocity Definition

The development of secondary sexual characteristics opposite those ofthe anticipated phenotypic sex

Causes Virilizing neoplasms

Types Ovarian

Sertoli-Leydig cell

Adrenal

Diagnosis Abdominal/ physical/ radiologic exam

Treatment Surgical removal

Congenital adrenal hyperplasia

Most common cause 21-hydroxylase deficiency

Treatment Replacement of cortisol

Surgical correction of anatomical abnormalities

Exposure to exogenous androgens


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Isosexual Precocious Puberty

Definition

appearance of phenotypically appropriate

secondary sexual characteristics before age 8

years in girls Secondary sexual characteristics

Increased levels of sex steroids

Types

True Isosexual

Involves H-P-G axis

Pseudoisosexual

Exposure to estrogen (no HPG axis involvement)


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True Isosexual Precocity

75% constitutional Diagnosis by exogenous GnRH administration

rise in LH

10% due CNS disorder Including:

Tumors Obstetric lesions

Granulomatous diseases

Innterfere with normal inhibition of GnRH release

Exhibit neurologic symptoms before apperance of prematuresexual maturation

Treatment Long term GnRH agonist (leuprolide) therapy

Final stature influenced by chronologic age at diagnosis and initiation oftreatment

If untreated only 50% will reach 5 feet


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Pseudoisosexual Precocity

estrogen w/t no HP axis involvement

Causes

Ovarian tumors

Diagnosis- radiology

Treatment surgical

McCune-Albright syndrome

Precocity, cystic bones, caf au lait spots, hypercortisolism

Hypothyroidism

Increased pitiutary gonadotropin release inresponse to TRH

Peutz-Jeghers Syndrome

Associated with rare sex cord tumor (may be estrogen secreting)


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Delayed Puberty

Evaluation required for failiure of thelarche by age 14. Causes

Hypogonadotropic hypogonadism (FSH + LH < 10 mlU/ml)

Anorexia nervosa / extreme exercise

Kallmann syndrome No GnRH migration into hypothalamus

Mutations of GnRH receptor gene

FSH -subunit / receptor gene mutations

Aromatase deficiency

17-hydroxylase deficiency


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Delayed Puberty

Hypergonadotropic hypogonadism (FSH > 30 mlU/mL)

Chromosomal abnormalities

Turner syndrome

Injuries to ovaries

Surgery, Chemotherapy, radiation

Treatment

Estrogen therapy

Low dose OCP after establishment of 2ndary sexual characteristics to

avoid menopausal symptoms and prevent osteoporosis

1500 mg Ca+ and 400 mg Vit D with exercises


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Reference

Hacker and Moores. Essentials of Obstetrics and Gynecology. Saunders, and imprint of Elsevier Inc

2010: 343-354

Beckmann, charles and peers. Obstetrics and Gynecology. Lippincott Williams & wolters 2010:309-313

Puberty, retrieved April 21, 2011 (Medline)

http://www.mayoclinic.com/health/guillain-barre-syndrome/DS00413

http://www.nlm.nih.gov/medlineplus/ency/article/000684.htm

http://emedicine.medscape.com/article/792008-overview

http://www.ncbi.nlm.nih.gov/pubmed/15304587

http://www.ncbi.nlm.nih.gov/pubmed/19388722

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm59e0602a1.htm?s_cid=mm59e0602a1_e%0d%0a

http://www.medicalnewstoday.com/articles/204022.php

http://www.sciencedaily.com/releases/2010/10/101007093617.htm

http://brain.oxfordjournals.org/content/118/3/577.long

Puberty (OBGYN Presentation #1)

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