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BY, Dr. Namrata Shirvastava

This document discusses puberty in girls. It defines puberty as the period linking childhood to adulthood involving biological, morphological, and psychological changes leading to sexual maturity and fertility. The five important physical changes are growth of breasts, pubic hair, underarm hair, increased height, and menstruation. Precocious puberty refers to signs of puberty before age 8 or menstruation before age 10 and has potential medical causes. Treatment depends on the underlying cause and aims to suppress premature activation of the hypothalamic-pituitary-ovarian axis. Delayed puberty refers to lack of secondary sex characteristics by ages 13-14 or menarche after age 16 and also has various medical causes requiring treatment.

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Yash Sharma
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109 views

BY, Dr. Namrata Shirvastava

This document discusses puberty in girls. It defines puberty as the period linking childhood to adulthood involving biological, morphological, and psychological changes leading to sexual maturity and fertility. The five important physical changes are growth of breasts, pubic hair, underarm hair, increased height, and menstruation. Precocious puberty refers to signs of puberty before age 8 or menstruation before age 10 and has potential medical causes. Treatment depends on the underlying cause and aims to suppress premature activation of the hypothalamic-pituitary-ovarian axis. Delayed puberty refers to lack of secondary sex characteristics by ages 13-14 or menarche after age 16 and also has various medical causes requiring treatment.

Uploaded by

Yash Sharma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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BY,

DR. NAMRATA SHIRVASTAVA


DEFINITION-
• Puberty in girls is the Period ,which links childhood to adulthood
• Period of gradual development of secondary sexual characters
• Profound biological,morphological,psychological changes that leads
to full sexual maturity and eventually fertility.
• 5 IMPORTANT PHYSICAL CHANGES
• BREAST
• PUBIC HAIR GROWTH
• AXILLARY HAIR GROWTH
• GROWTH IN HEIGHT
• MENSTRUATION
ENDOCRINOLOGY IN PUBERTY
• Onset of first menstruation in life is called menarche.
• Occur between 10 and 16 years , peak time being 13 years.
• First period is usually Anovular.
• OVARIES - Changes shape ,elongated shape becomes bulky and oval
• UTERINE BODY AND CERVIX RATIO-
At birth-1:2 becomes 1:1 when menarche
.VAGINAL CHANGES- Vaginal pH becomes acidic
VULVA - More reactive to steroid hormones
MONS PUBIS AND LABIA MINORA increases in size
BREAST CHANGES
• Precocious puberty is reserved for girls who exhibit any secondary sex
characteristics before the age of 8 or menstruate before the age of 10.
• PREMATURE THELARCHE- Isolated development of breast tissue
before age of 8

• PREMATURE PUBARCHE- Isolated development of axillary &/or pubic


hair prior to age of 8

• PREMATURE MENARCHE- Isolated event of cyclic vaginal bleeding


without any other signs of secondary sexual development.
DIAGNOSIS-
• TRUE PRECOCIOUS-
• CONSTITUTIONAL- most common
• History of early menarche of mothers and sisters
• pubertal changes in orderly sequence
• Tanner stages
Basic investigations
• Serum hCG,FSH LH, and Prolactin
• Thyroid profile
• Serum estradiol,testosterone, 17-OH progesterone,Dehydroepiandrosterone
(DHEA)
• USG ,CT or MRI of abdomen pelvis to rule out any pathology
• Skull X ray, CT Scan or MRI brain
• Electroencephalogram
• Xray hand and wrist for bone age
• GnRH STIMULATION TEST- 100 microgrm given subcutaneously and serum LH
is measured.
• LH > 15 mIU/ml suggests gonadotropin dependent precocious puberty.
PREMATURE THELARCHE-
• Breast bud enlarge 2-4 cm
• Somatic growth pattern not accelerated
• Bone age is not advanced
• Nipple development is absent
• Vaginal smear shows negative estrogen effect
• As continnum of GnRH dependent precocious puberty
PREMATURE PUBARCHE
• USG, CT , MRI to detect ovarian or adrenal tumor
• Estimation of serum 17- alpha -hydroxyorogesterone, DHEAS -S
and serum testosterone.
TREATMENT
• Depends upon the cause and speed of progress of disease
• Drugs used are-
• GnRH agonist therapy- suppresses premature activation of HPO axis due to
down regulation therefore diminishes oestrogen secretion.
• It is drug of choice in GnRH dependent precocious puberty
• DOSE- DEPOT FORMS (GOSERELIN OR LEUPROLIDE) once a month.
• Dose is adjusted to maintain the serum estradiol below 10pg/ml
• MEDROXYPROGESTERONE ACETATE-
• 30 mg daily orally or 100-200mg IM weekly to supress gonadal steroids

• DANAZOL- produces amenorrhea and arrest breast development


DELAYED PUBERTY
• Puberty is said to be delayed when breast tissue &/or
pubic hair have not appeared by 13-14 years or
menarche appears as late as 16 years.
• more common in boys
DIAGNOSIS
• Detailed history
• Examination of secondary sexual characters
• Mature: to evaluate mullerian agenesis/dysgenesis
• Asynchronus: development of breast ,pubic hair- Androgen insensitivity
syndrome
• Immature: increased FSH -Karyotype for Gonadal dysgenesis
• Low /Normal FSH- sellar CT/MRI-normal-constitiutional/
malnutrition
• Abnormal CT/ MRI-Hypopituitarism/CNS tumor
• TSH raised- HypothyroidisM
• TREATMENT ACCORDING TO CAUSE
TREATMENT-
• ACCORDING TO CAUSE
• Cases of HYPOGONADISM treated with cyclic estrogen .
• Unopposed estrogen 0.3 mg (conjugated estrogen) daily given for first
6 months then combined estrogen and progestin ,sequential regimen
is started.
• Chromosomal study to rule out intersexuality in hypogonadism.
PUBERTY MENORRHAGIA
• Menstual abnormality is common in adolescents.
CAUSES-
1. ABNORMAL UTERINE BLEEDING (95%)- Anovulatory cycles -unopposed
estrogen -endometrial hyperplasia -prolonged and heavy periods.
2. ENDOCRINE DYSFUNCTION-
.PCOS ,HYPO/HYPERTHYROIDISM
3. HEMATOLOGICAL-
ITP , VON WILLEBRAND DISEASE, LEUKAEMIA
4. PELVIC TUMORS-
FIBROID ,SARCOMA BOTRYROIDES
INVESTIGATIONS-
• ROUTINE HEMATOLOGICAL TESTS-
• BT,CT,PLATELET COUNT
• THYROID PROFILE
• COAGULATION PARAMETERS
• ULTRASONOGRAPHY OF PELVIS
MANAGEMENT-

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