Professional Documents
Culture Documents
Objectives
Pubertal Development
Sexual Maturity Rating
a.
Breasts
b.
Pubic Hair
IV.
Precociuos Puberty
a.
Classification of Precocious Puberty
i. Central
ii. Peripheral
iii. Incomplete
b.
Evaluation Of Precocious Puberty
c.
Management of Precocious Puberty
V.
Primary Amenorrhea
a.
Definition
b.
History
i. Patient History
ii. Family History
c.
Physical Examination
d.
Goals of Management
VI.
Quiz
Note: Dr. Capitulo said that he already made the questions for the
exam and all the questions will be based on the lecture.
OBJECTIVES
To review the following:
o Physiology of normal puberty in girls
o Tanner staging of pubertal changes in girls
o Duration of normal puberty in girls
To
discuss
the
definition,
characteristics,
pathophysiology,
types,
evaluation
and
management of precocious puberty.
To
discuss
the
definition,
characteristics,
pathophysiology,
types,
evaluation
and
management of primary amenorrhea.
PUBERTAL DEVELOPMENT
Thelarche beginning of breast development
10/8 +/- 1.10 years
PUBIC HAIR
PH1 prepubertal, no pubic hair
PH2 labial hair present
PH3 labial hair spreads over mons pubis
PH4 slight lateral spread
PH5 further lateral spread to form inverse triangle
and reach medial thighs
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PRECOCIOUS PUBERTY
Appearance of any signs of secondary sexual
maturation at an early specific age more than 2.5
standard deviations below the mean
Initiation of secondary sexual characteristics before
age 8 or menarche before age 9 (The secondary
sexual characteristics are breast development,
pubic hair growth, maximum growth and
menarche.)
Associated with a wide range of disorders
A very rare disease (1 in 10,000 girls)
Concerns with precocious puberty
o Social stigma of child being physically
different from her peers
o Diminished ultimate height
Shorter than normal adult height due to
o Limited duration of the rapid growth spurt
(The period of maximum growth is limited
when you have precocious puberty. The
shorter the time for the maximum growth,
the shorter your height will be.)
o Accelerated bone maturation
o Premature closure of the distal epiphyseal
growth centers
edited: Sarah
Premature Thelarche
o Isolated unilateral
or bilateral breast
development
o Not accompanied by other signs of pubertal
development
o Usually occurs at age 1 to 4 years
o Benign self-limiting condition that does not
require treatment
The patient will just come to you with breast
enlargement. No axillary or pubic hair growth. No
increased in height. No menarche. This usually occurs
at the age of 1-4. It is benign self-limiting condition
that does not require any treatment, so you only have
to reassure the mother. Thats if you are sure that its
just premature thelarche. So when you encounter this
patient, you should follow her up for a couple of
months to see that she wont develop the other
changes.
edited: Sarah
Page 3 of 6
Pubertal History
PHYSICAL EXAMINATION
Anthropometric Measurements
BMI
Dysmorphic Features congenital anomalies
Rudimentary or Absent Uterus
Pubic Hair Pattern
Striae, buffalo hump, central obesity, etc.
Tanner Staging
Thyroid Examination
Vaginal Septum or Imperforate Hymen
Signs of Virilization
EVALUATION
History and P.E. completed
NO
Measure FSH and LH
PRIMARY AMENORRHEA
`DEFINITION
(+) secondary sexual characteristics and
(-) menarche by age 16.5 years (16 years and 6
months)
OR
(-) secondary sexual characteristics and
(-) menarche by age 14
Low
FSH & LH
High
FSH & LH
Ultrasound of Uterus
Uterus (-)
or
abnormal
Uterus (+)
or
normal
HISTORY
PATIENT HISTORY
Menstrual History
Illness, Drug Use
CNS Chemotherapy or Radiation (Brain
radiation will cause ischemia of pituitary
gland)
Pelvic Radiation
Psychosocial Stressors
Sexual Activity (Consider pregnancy)
Breast Changes
Anosmia
Abdominal Pain
Vasomotor Symptoms
FAMILY HISTORY
Genetic Defects
Pubic Hair Pattern
Infertility
Menarche and Menstrual History of Mother and
Sisters
YES
Low
FSH & LH
Hypogonadotropic
Hypogonadism
Hypothalamic
Failure
Pituitary Failure
High
FSH & LH
Hypergonadotropic
Hypogonadism
KARYOTYPE
POF
(46,XX)
Turners
Syndrome (45,XO)
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Ultrasound of Uterus
Uterus (-)
or
abnormal
Uterus (+)
or
normal
OUTFLOW
OBSTRUCTION?
KARYOTYPE
Mullerian
Agenesis
(46,XX)
AIS
(46,XY)
NO
Others
YES
Imperforate
Hymen or
septum
GOALS OF MANAGEMENT
Progression of normal pubertal development
Preservation of fertility if possible
Prevention of complications of hypoestrogenic
state
edited: Sarah
Answers:
1) Thelarche Adrenarche Max Growth Menarche
2) B3
3) PH3
4) 9
5) Granulosa cell tumor
edited: Sarah
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