Post on 08-Apr-2018
8/7/2019 Puberty (OBGYN Presentation #1)
1/15
Female Puberty
Topic #1
By:
Alex Qader
8/7/2019 Puberty (OBGYN Presentation #1)
2/15
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
8/7/2019 Puberty (OBGYN Presentation #1)
3/15
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)
8/7/2019 Puberty (OBGYN Presentation #1)
4/15
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)
8/7/2019 Puberty (OBGYN Presentation #1)
5/15
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
8/7/2019 Puberty (OBGYN Presentation #1)
6/15
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
8/7/2019 Puberty (OBGYN Presentation #1)
7/15
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
8/7/2019 Puberty (OBGYN Presentation #1)
8/15
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
8/7/2019 Puberty (OBGYN Presentation #1)
9/15
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
8/7/2019 Puberty (OBGYN Presentation #1)
10/15
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)
8/7/2019 Puberty (OBGYN Presentation #1)
11/15
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
8/7/2019 Puberty (OBGYN Presentation #1)
12/15
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)
8/7/2019 Puberty (OBGYN Presentation #1)
13/15
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
8/7/2019 Puberty (OBGYN Presentation #1)
14/15
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
8/7/2019 Puberty (OBGYN Presentation #1)
15/15
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