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Puberty

The document discusses puberty in females, detailing its physiological phases, manifestations, and the hormonal changes that occur during this time. It covers abnormalities such as precocious and delayed puberty, including their definitions, types, causes, and treatment options. Special investigations and treatment strategies are outlined for both conditions, emphasizing the importance of hormonal regulation and addressing underlying causes.

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Nehal A. Mohammad
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5 views36 pages

Puberty

The document discusses puberty in females, detailing its physiological phases, manifestations, and the hormonal changes that occur during this time. It covers abnormalities such as precocious and delayed puberty, including their definitions, types, causes, and treatment options. Special investigations and treatment strategies are outlined for both conditions, emphasizing the importance of hormonal regulation and addressing underlying causes.

Uploaded by

Nehal A. Mohammad
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 PPT, PDF, TXT or read online on Scribd
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DR:MAHA SHINSHIN

Consultant obstetric &


gynecology
It is a physiological
phase lasting 2 to 5
years during which the
genital organs mature
Manifestations of puberty
: in the female include

1. Menarche,
2. Appearance of secondary sex
characters,
3. Physical development
4. Psychological changes.
Secondary sex characters
:include
development of the breast
buds with range of 8 -13
y appearance of pubic
hair a year later and
axillary hair.
The first sign of pubertal
development is usually breast
growth (thelarche), followed by
appearance of pubic hair
(pubarche), then (axillary hair),
then (menarche).range 10-16y.
The mean interval between breast
budding and menarche is 2.5 years
with a standard deviation of about
one year.
Adrenarche
means increased activity of the
suprarenal cortex at puberty
with increased production of
adrenal androgens which lead
to appearance of pubic and
axillary hair.
: Cause of puberty
During childhood , the hypothalamus is
extremely sensitive to the negative feedback
exerted by the small quantities of estradiol
& testosterone produced by the child's
ovaries .
As puberty approaches , the sensitivity of
the hypothalamus is decreased and
subsequently , it increase the pulsatile
GnRH secretion .
The anterior pituitary
responds by progressive
secretion of FSH and LH
associated with
increased secretion of
growth hormone .
The ovaries respond to
the increase
Gonadotrophin secretion
by follicular
development & estrogen
secretion .
Estrogen causes development
of the genital organs and the
appearance of the secondary
sexual characters .
With increased estrogen
secretion , menarche and
cyclic estrogen secretion
occurs .
Factors affecting the
initiation of pubertal
: development
1 - Height and weight ratio (nutritional
factors).
2 - Maturation of the hypothalamus .
3 - Increased neurotransmitter output
in CNS .
4 - Onset of adrenal androgen activity
:Genital organs changes
Mons pubes, labia majora & minora:
increase in size.
Vagina:
1. length: increase, appearance of the
rugae
2. Epithelium: thick, stratified
squamous., containing glycogen
3. pH: acidic.
Genital organs
:changes
Uterus:
enlarge, Uterus / Cervix :2 / 1
Ovaries:
1.Increase in size, almond shape
2.300 thousands primary follicle at
menarche ( 2 million at birth)
Abnormalities of puberty
1 - Precocious puberty .
2 - Delayed puberty.
FEMALE
PRECOCIOUS
PUBERTY
:Definition
It means menarche or
appearance of any of
the secondary sexual
characters before the
age of 8 years.
:Types
1 - True precocious puberty .
2 - False
(pseudo-precocious puberty).
3 - Incomplete precocious
puberty .
True (central ,cerebral) .1
.precocious puberty

It is due to increased
production of pituitary
gonadotrophins.
False (peripheral) precocious .2
puberty

It is of peripheral origin.


It is due to secretion of sex
hormones; (estrogen or androgen)
which is not dependent on
pituitary gonadotrophins as in
case of estrogenic or androgenic
ovarian tumors.
Etiology of precocious
puberty
1.Constitutional or idiopathic:
In most cases of precocious puberty
(90%) , no cause is found.
For some unknown reason the
hypothalamus stimulates the pituitary
gland to secrete its gonadotrophic
hormones.
There is normal menstruation and
ovulation.
Pregnancy can occur at young age.
Etiology of precocious
puberty
Organic lesions of the brain:
Examples include traumatic brain injury,
meningitis, encephalitis, brain abscess, brain
tumor as glioma, craniopharyngioma, and
hamartomas.
Adrenal causes; congenital adrenal
hyperplasia., tumor.
Estrogen secreting ovarian tumor (granulosa
&theca cell tumor)
Drugs ; oral estrogen .
Diagnosis of precocious
puberty

1. History:
2. Physical examination
3. investigations
:Special investigations .
a. X-ray examination of the hand and wrist
to determine bone age.
Estrogen stimulates growth of bone but
causes early fusion of the epiphysis.
So the child is taller than her peers during
childhood, but she is short during adult
life.
:Special investigations .
b. Hormonal assay:
including serum FSH, LH,
prolactin, estradiol, testosterone,
17α-hydroxy progesterone, TSH,
and human chorionic
gonadotrophin to diagnose
Choriocarcinoma.
:Special investigations .
c. Ultrasonography
to diagnose ovarian or adrenal
tumor.
d. CT or MRI :
to diagnose an organic lesion
of the brain, or adrenal tumor.
Idiopathic precocious
:puberty
is diagnosed after
excluding all other
causes.
Treatment of precocious
puberty
Objectives:
1. Arrest maturation until normal
pubertal age.
2. Attenuate & diminish established
precocious characteristics.
3. Maximize adult height.
4. reduce emotional & social problems
Treatment of precocious
puberty
1. Treatment of the cause, e.g.,
thyroxin for hypothyroidism,
removal of ovarian and adrenal
tumors.
2. Incomplete forms of precocious
puberty do not require treatment,
as estrogen production is not
increased.
Idiopathic type .
Treatment is given till
the age of 12 years
(mean age of pubertal
development).
Gonadotrophin releasing hormone
analogues
Drug of choice because it achieves all objectives:
1. It acts by binding to the anterior pituitary receptors causing down-
regulation & desensitization of the pituitary.
2. Regression of symptoms occurs in the first year
3. Delayed epiphyseal fusion; treatment more effective if begun before
bone age >12 yrs. .
4. Children require higher doses than adults for suppression.
5. Adrenarche will continue.
Delayed Puberty

Secondary Sexual Characters


do not develop by the age of 14y
or
no menstruation till age of 16y
Delayed Puberty
It is either :
* Delayed onset: Breast bud does not
appear till 13 years or menarche does
not occur till 16 years . or
* Delayed progreession : Menarche
does not occur within 5 years after
breast bud .
Investigations of delayed
puberty
History :
1 - Family history , nutritional history , any
systemic diseases
(e.g. history of endocrinal disturbance).
2 - Clinical picture of space occupying
lesion in the ovary , adrenal, pituitary &
hypothalamus.
3 - Periodic pain and +ve 2ry sexual
characteristics in imperforate hymen .
: Special Investigations
1 - FSH & LH assay important to
differentiate level of the lesion .
2 - Chromosomal study if short stature
or hypergonadotropic type .
3 - Radiological bone age study &
radiologic study for pituitary adenoma
Treatment of delayed
puberty
* Constitutional : Reassurance .
* Treatment of the cause (if treatable) or
cyclic estrogen-progesterone hormone
replacement therapy if the cause is not
treatable , for 3 cycles: Norethistrone
acetate 5 mg twice daily for 21 d or OCP
Thank you

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