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Puberty (Precocious Puberty below is table of development & normal…

- - - - Growth Spurt(10)
        
        Menarche (11)
        
        Lips :lips:
        
        where she bleeds from
        
        :pencil2:1. Precocious puberty isn't a problem unless
        
        growth spurt ends/ menarche occurs at a lower height than normal.
        
        tx will intervene to prevent menarche
        
        Or if deficiencies of bone
        
        (bone age > chronological age)
        
        Path: something is overstimulating HPA axis
        Pt: 2º sex characteristics
        ≤ 8yo :girl::skin-tone-2:
        
        Dx: Bone age via wrist XR
        
        :check:bone age 2y > chron. age: Precocious puberty
        
        Where is the stimulation on HP axis coming from? CNS (pit) or not?
        GNrH stim test (aka Leuprolide stim test)
        
        1 more item...
        
        Mits :boxing_glove:
        
        long bones, like in fingers of hand
      - Pits
  - - - Dx: Bone age:
        
        wrist XR
        &
        
        biochemical profile: FSH/LH
        
        :check:Hypergonadotropic hypogonadism: elev. FSH/LH
        HPA is turned on. Nothing receiving the signal
        (Pretest FM):
        Path: Gonadal Dysgenesis (50% of primary amenorrhea cases)
        
        Turner Syndrome 45 XO
        
        f/u: Karyotype
        
        :green_cross:Hypogonadotropic hypogonadism: not elevated FSH/LH
        HPA not on
        
        Cause for why HPA not on?
        :warning:Don't do below tests if there is a strong family Hx. (mom didn't start puberty until 16)
        
        Prolactin level: Prolactinoma
        (Pretest FM): Hyperprolactinemia (rare)
        
        TSH/free T4: Thyroid disease
        (Pretest FM): Hypothyroidism (rare)
        
        incr TSH
        
        :pregnant_woman::skin-tone-2:Pregnancy test if concerned about bleeding
        (Pretest FM): most common cause of 2º amenorrhea
        
        suspect if pt denies sexual activity & normal periods prior
        
        1 more item...
- - - - Ant. Pit
        
        FSH/LH
        
        Ovaries
        
        E/P
        
        Endometrium
        
        Bleeds
        
        Cyst (peripheral lesion)
        
        Germ cell tumor
        
        Granulosa theca (↑E)
        
        Sertoli-Leydig (↑T)
        
        :green_cross:Continuous Leuprolide (GnRH) shuts down HPA here.
        
        Brain Tumor: ↑FSH/LH sec (rare)