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ENDOCRINOLOGY DIVISION
DEPARTMENT OF CHILD HEALTH
MEDICAL SCHOOL
UNIVERSITY OF SUMATERA UTARA
What is Puberty?
Puberty, from the Latin word: Pubertas
age of maturity refers to the stage of transition
from the sexually immature child to the potentially
fertile adolescent, during which secondary sexual
characteristics appear and the ability to procreate is
established.
Close interaction between the hypothalamic-pituitarygonadal axis (HPG axis) & adrenal cortex.
HYPOTHALAMIC-PITUITARY-GONADAL (HPG)
AXIS
Peripheral signals
(Leptin, Ghrelin)
Central signals
(GABA, NPY, Glutamate)
Kisspeptin
GnRH
Pituitary
FSH
LH
Ovary
Testis
Ley
Gran
Ser
Testosterone
LH
Inhibin
The
Estradiol
HORMONAL CHANGES IN
PUBERTY
Increased GnRH secretion the first identifiable
event of puberty.
At the onset of puberty LH pulse secretion are
evident only during the night, approximately 1-3
years before any external signs of puberty are
manifest. Mid puberty LH pulse secretion appears
during the day. Adulthood The day/night pattern
disappears
Increase LH levels as much as 25x during puberty as
compared to FSH (2,5 fold) LH level Better
indicators of pubertal status compared to FSH levels.
LH (IU/L)
FSH
(IU/L)
Testoster
one
(ng/dL)
<3 10
18 150
100
320
220
620
350
970
GIRLS
SMR
Stage
LH (IU/L)
0,8
12,1
Hormonal changes..
Hormones:
-Gonadotroin
-Sex Steroid
-Growth
hormone
Physical:
-Reproductive system
-Secondary sex
characteristics
-Growth spurt
Final Height
Maturation reproductive
system
Fertility
Influencing factors
1. Genetics : 50 80% of variation in
pubertal timing
2. Environmental factors e.g. nutritional
status
3. Leptin Regulates appetite and
metabolism through hypothalamus.
Permissive role in reegulation of timing of
puberty.
4. Adrenarche : development of pubic and
axillary hair, body odour, and acne
Females
years
Males
: 8 13
: 9 14 years
- Corpus/Cervix ratio
Pepubertal < 1 Pubertal = 1
- Endometrium proliferation
Stimulates endometrial growth
Stimulates cervical mucus secretion
Labia Majora : Pigmentation, vascularisation, erotisation
Enlargement of clitoris
Vagina: - Mucosal thickening
-Changes in Epithelial cell ratio (superficial, intermediate,
parabasal)
- glicogen deposit pH , fungal infection
4 ml
Siklus Menstruasi
Menstruasi: Terjadi akibat interaksi hormon yang
Any