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37 Cards in this Set

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