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37 Cards in this Set
- Front
- Back
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What is premature thelarche?
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isolated breast development in girls younger than 8 years of age
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What hormones affect breast development?
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estrogen stimulates ductal and stromal proliferation; Progesterone promotes acinar differentiation of the ductal system; Prolactin has a trophic effect on the alveolar buds, promoting acinar formation and the secretory differentiation of the mammary epithelium to support lactation
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Which sex hormones does the adrenal release?
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androstenedione and dehydroepiandrosterone (DHEA)
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What happens to testosterone in non-gonadal tissues?
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It is converted into the more biologically active androgen dihydrotestosterone
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what happens to Androstenedione in peripheral tissues?
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Androstenedione can be aromatized to estrogen in peripheral tissues
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What happens to Testosterone in the ovary?
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Testosterone produced in the ovary is converted to estradiol by the enzyme aromatase
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How long can gynecomastia persist in an infant boy?
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Breast enlargement usually resolves within the first few months after birth but may persist for up to 12 months in males
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How long can thelarche persist in an infant girl?
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Breast enlargement usually resolves within the first few months after birth but may persist for up to 18-24 months in girls
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When is the peak of male adolescent gynecomastia?
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13-14 years, mid-puberty, Tanner 2-3
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How does gynecomastia differ in obese vs non-obese boys?
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Gynecomastia is more common in obese males and typically persists longer than in nonobese males.
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Why is gynecomastia more persistent in obese males?
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Breast enlargement may be due to increased aromatization of androstenedione to estrone by adipose tissue.
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What is idiopathic gynecomastia?
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No pathologic cause has been identified. A benign condition.
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which hormone imbalances may cause pathologic gynecomastia?
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Increased estrogen or decreased androgen
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DDX of pathologic gynecomastia
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hormone imbalance, certain drugs
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DDX of increased estrogen causing gynecomastia
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• Estrogen-secreting tumors
• Tumors secreting human chorionic gonadotropin • Increased aromatase activity • Exogenous estrogen• Liver dysfunction • Hyperthyroidism • Congenital adrenal hyperplasia |
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DDX of decreased androgen causing gynecomastia
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• Primary gonadal dysfunction
• Defects in testosterone biosynthesis • Androgen insensitivity |
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What medications are associated with gynecomastia?
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Growth hormone, estrogen, anabolic steroids, ketoconazole, Isoniazid, zantac, alcohol, marijuana, heroin, amphetamines, chemotherapeutic agents, diuretics, some calcium channel blockers, some psychiatric drugs
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Name 3 kinds of testicular neoplasm
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germ cell, sertoli cell and leydig cell tumors
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Which is the most common type of testicular tumor?
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Germ cell
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What is the peak age for germ cell testicular tumors?
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2 peaks—one in first two years, one after 14
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What do germ cell tumors secrete?
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hCG, resulting in increased secretion of both testosterone and estradiol by the testis, with the increase in estradiol secretion out of proportion to that of testosterone.
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What is primary hypogonadism?
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Gonadal dysfunction
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What happens to gonadotropins in primary hypogonadism?
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LH and FSH increase
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What is the most common diagnosis associated with hypergonadotropic hypogonadism?
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Klinefelter syndrome
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What is the peak incidence of craniopharyngioma?
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5-9 years
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What thyroid condition may lead to gynecomastia?
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thyrotoxicosis (hyperthyroidism) due to increased production of androstenedione
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How does liver cirrhosis cause gynecomastia?
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through impaired catabolism of estrogens
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gynecomastia with early age of puberty
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Consider tumors that produce androgen and estrogen
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gynecomastia with late age of puberty
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Consider gonadal dysfunction, abnormalities of testosterone biosynthesis or action
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gynecomastia precedes puberty
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gynecomastia with early age of puberty Consider tumors that produce androgen and estrogen
gynecomastia with late age of puberty Consider causes of prepubertal gynecomastia such as steroid-secreting tumors |
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gynecomastia after puberty
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consider abnormalities such as gonadal dysfunction, tumors, drugs
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What is macrogynecomastia?
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Breast diameter of greater than 4 cm
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What is the cause of Precocious puberty in boy under 9
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CNS lesion or underlying malignancy until proven otherwise
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Lab work up for Pathologic gynecomastia
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8 AM fasting serum concentrations of LH, FSH, testosterone, estradiol, beta-hCG, DHEAS, and liver enzymes.
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What is central precocious puberty?
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early (before 8 years of age) maturation of the hypothalamic-pituitary-gonadal axis with development of two or more sexual characteristics
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When does premature thelarche typically occur?
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during the first 2 years after birth
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How does McCune-Albright syndrome present?
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with the classic triad of gonadotropin-independent precocious puberty, café au lait macules, and polyostotic fibrous dysplasia.
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