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Puberty - Coggle Diagram

- - - - FHx
    - - Puberty occurs without intervention but may be delayed by 1-2 years
    - - REassureance
  - - - X-linked
      - Characterised by anosmia
      - Deficiency of LH and FSH
  - - - Absence of testes
      - Congenital or aquired (torsion)
    - - Exogenous sex hormones
        Boys: Testosterone monthly for 3mnth or Oxandrolone to start
  - - - 45, XO in females
    - - Webbed neck
      - Broad shield chest - widely space nipples
      - Lymphoedema of extremities at birth
      - Low posterior hairline
      - Streak ovaries - underdeveloped
      - Short stature
      - Congenital heart disease - 10-15% Coarctation of aorta
      - Renal anomalies - Horshoe kidney, duplicate ureters
    - - Oestrogen / Progesterone replacement
        Initiates secondary sexual characteristics
      - GH
        Increased height
      - Resproduction:
        Assisted via ova donation
  - - - Compare growth charts
    - - Consider genetic patterns
    - - Tanner staging
    - - Signs of chronic illness
      - Syndromic features
  - - - Asses gonadal fx
    - - Differentiate between central / gonadal causes
    - - In Suspected Turner's or Klinefelter's
    - - Assess testosterone production
    - - Assess skeletal maturity
    - - Assess ovarian/ uterine development
- - - - More common in girls
      - Idiopathic in 80%
      - Often pathological in boys
    - - Intracranial lesions
        Tumous, cysts, germinoma
      - Cerebral palsy / brain injury
      - Hypothyroidism
        Elevated TRH → LH / FSH release
      - Hepatoblastoma in boys
        Ectopic LH/FSH secretion
    - - GnRH test
      - MRI brain to ID lesions
    - - GnRH test: LH >5 IU
  - - - McCune-Albright Syndrome
        
        Mutation of GNAS1 gene chr 20
        
        Abnormal hormone production , skin pigmentation with ragged borders, fibrous dysplasia of bones
      - Adrenal Tumours / CAH
      - Gonadal Tumours / Ovarian cysts
      - Ingestion of sex hormones
        
        Anabolic steroids
    - - Plasma Estradiol / Testosterone
      - USS adrenals, ovaries, uterus, testes
  - - - High maternal porlactin
  - - - Isolated pubarche between 68 yrs → early adenal andorgen production
    - - Slight increase in growth rate and bone age
    - - Typically self-limiting
      - Girls with premature adrenarch at risk for PCOS
  - - - Differentiates central and peripheral causes
    - - Advanced bone age indicates accelerated growth
    - - Boys
        
        Adrenals
        Liver
        Testes
      - Girls
        
        Adrenal
        Ovaries
        Uterus
        
        Changes in uterine shape from tubular to pear-shaped, with identifiable endometrial lining near menarche
  - - - Borderline cases (7-9yrs)
    - - Tumours
      - Hormone excess
    - - GnRH / LHRH analogues
      - Suppresses pituitary secretion
      - Monthly injections of puberty blockers
      - Expected height gain of 3-5cm can be achieved by delaying puberty
- - - - Pre-pubertal
        
        ↓ LH
        ↓ FSH
        Immature gonads + HPG axis
      - Pubertal / Adult
        
        ↑ LH
        ↑ FSH
        Functional HPG axis
- - - - 50-80% genetic variation
      - Genetic variants:
        MKRNS
        IGSF 10
      - Multiple genes contributing
  - - - Early pubertal onset - Precocious puberty
      - Especially in girls
    - - Causes
        
        ANorexia
        
        Chronic illness
        
        Atheletes (dancers, gymnasts)
      - Delayed Puberty