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56 Cards in this Set
- Front
- Back
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How does puberty begin?
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Secondary to reduction of hypothalamic inhibition
Leads to activation of Hypothalamic-Pituitary-Gonadal Axis |
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Hormone cascade of puberty?
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GnRH from hypothalamus-->
LH/FSH from Pituitary--> Sex hormones from Gonads |
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When is the Axis activated?
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Fetal Life and Early Infancy
And then not till puberty |
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What does LH induce in gals?
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Progesterone-->Secretory Endometrium
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What does FSH induce gals?
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Estrogen-->Ductal Breast Dev, Prolif Endometrium, Bone Growth, Inc Body Fat
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What do the adrenal glands induce in gals?
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Androgens (DHEA) --> Pubic Hair, Acne
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What does LH induce in guys?
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Ledig Cells-->Testosterone
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What does LH induce in guys?
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Inc Linear Growth
Inc Epiphyseal Fxn Dev Penis, Scrotum, Prostate, Seminal Vesicles Pubic, Facial, Axillary Hair Larynx-->Deep Voice Inc Muscle Mass Inc RBC mass early on |
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What does FSH induce in guys?
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Spermatogenesis
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Sequence of Puberty in Girls?
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Thelarche (budding)
Adrenarche (pubes) Peak Height Velocity Menarche |
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average age of beginning of girl puberty?
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9-10
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average age of menarche?
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12.7
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First sign of guy puberty?
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nut enlargement
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When does PHV occur (i.e. which tanner stage) in gals vs. guys
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Gals: 2-3
Guys: 4 (bout 2 years after girls) |
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When is puberty considered precocious?
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White Girls < 7
Black Gals < 6 Boys < 9 |
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Typical cause of Precocious Puberty in Girls?
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Idiopathic in 80%
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Typical Cause of Precocious Puberty in Guys?
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Idiopathic in 10-40%
CNS in 25% Adrenal 25% |
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Definition of Delayed Puberty in Gals?
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No signs by 13
No menarche by 16 No menarche 4-5 yrs after breast dev |
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Def of Delayed Puberty in Guys?
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No Nut Enlargement by 14
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Typical Cause of Delayed Puberty in guys?
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Constitutional Delay (50%)
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Most common cause of delayed puberty in gals?
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Gonadal Pathology
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What causes increased growth during puberty?
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sex steroids-->GH-->IGF-1
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How does Thyroxine levels change during puberty?
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THEY DON'T
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How many boys experience gynecomastia during puberty?
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2/3rd!!!!
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Cause of pubertal gynecomastia?
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Direct testicular secretion of estrogen
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Typical prognosis of pubertal gynecomastia?
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Spontaneous Remission
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Normal Duration of Flow?
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2-8 days
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Normal Cycle Length?
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21-40 days
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Normal Blood Loss?
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20-80cc
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How many gals have anovulatory cycles after menarche?
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50% in first 2 years, but will bounce back in 5 years (80%)
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Normal Hormone progression during menstrual cycle?
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Increase in Estradiol-->
LH Surge--> Increase in Progesterone |
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Effect of inc estradiol?
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Proliferation
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Effect of Increase in Progesterone?
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Prolif--> Secretory
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Effect of decreased estradiol and progesterone?
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Sloughing
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What initiates the beginning of the cycle?
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FSH which recruits ovarian follicles to secrete estradiol
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What happens when LH surges?
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Ovulation
Corpus Luteum synthesizes progesterone |
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How long is it ok to have irregular menstrual cycles?
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2 years after menarche w/o organic lesion
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What is lacking in an anovulatory cycle?
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Progesterone
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What is DUB and what causes it?
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Dysfunctional Uterine Bleeding
Caused by anovulatory cycle (unopposed estrogen secretion-->excess endometrial growth) |
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What is the only way to assess degree of bleeding?
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Hemoglobin
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Mild vs Moderate vs Severe bleeding?
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Hb>12
Hb between 10 and 12 Hb<10 |
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What do you need to rule out if there is excessive bleeding?
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bleeding disorders like VW, ITP, Hemophilia
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Poly vs Oligo Menorrhea?
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Poly occurs at intervals of < 21 days
Oligo occurs irregularlly at intervals of >45days |
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Hypermenorrhea = ?
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prolonged/excessive bleeding at regular intervals
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Metrorrhagia?
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Uterine bleeding at irregular intervals
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Menometrorrhagia?
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prolonged/excessive bleeding at irregular intervals
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Diff Dx of DUB?
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Preg Complications
Genital Infections Endocrinopathies Drugs (OCP, seizure meds) Coagulation Disorders Neoplasms Chronic Illness Hypothalamic Dysfxn |
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Rx of DUB
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maybe OCPs
maybe Iron maybe NSAIDs or Premarin |
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Clinical characteristics of Polycystic Ovary Syndrome?
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Chronic Anovulation and Androgen Excess
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Criteria for Dx of PCOS?
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2 out of 3
Hyperandrogenism Oligo-ovulation/Anovulation Polycystic Ovaries on ultrasound |
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Other clinical features of PCOS?
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Obesity in 50-70%
Insulin resistance (acanthosis nigricans) Family History |
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Other than reproductive morbidity, what else does PCOS affect?
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Metabolism
Cardiovascular |
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Management of PCOS?
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Wt Loss
Oral Contraceptives Insulin Sensitizing Agents Monitor BP |
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Primary vs Secondary Amenorrhea?
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Primary: no menarche by 16
Secondary: absence for 6 months after regular cycles |
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Female Athlete Triad
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Amenorrhea
Eating Disorder Osteoporosis |
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Management of Amenorrhea?
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Inc Ca
Dec intensity of exercise Improve nutrition OCPs |
