40 Questions
What percentage of older adult men in the United States were obese in 2017–18?
42.4%
Describe the Tanner 4 stage of male development.
Continued enlargement of the penis and sculpturing of the glans; increased pigmentation of scrotum.
What is acromegaly?
A rare disease of excessive growth and distorted proportions caused by hypersecretion of growth hormone and insulin-like growth factor after closure of the epiphyses.
What does growth hormone excess lead to?
Slow skeletal growth and soft tissue enlargement.
What is the Tanner 1 stage of male development characterized by?
Testes, scrotum, and penis are the same size and shape as in the young child.
What is the Tanner 5 stage of male development?
Scrotum ample, penis reaching nearly to bottom of scrotum.
What is the growth pattern in acromegaly?
Excessive growth and distorted proportions.
What is the most common cause of acromegaly?
A benign pituitary adenoma or other rare tumor.
What is the purpose of pausing puberty using GnRH analogs in adolescents?
To solidify gender identity, treat gender dysphoria, and promote mental well-being.
What happens if an adolescent stops taking GnRH analogs?
Puberty will resume.
Describe Tanner stage 2 in females.
Initial, scarcely pigmented straight hair, especially along medial border of the labia.
What is the recommended weight gain range during pregnancy for patients with a prepregnancy BMI of 19.8 to 26.0?
11.5 to 16 kg (25 to 35 lb) over the entire pregnancy.
Why is it important to monitor the patient's weight throughout pregnancy using the BMI weight gain curve guidelines?
To provide guidance in weight gain during pregnancy and improve reproductive outcomes.
What is the significance of Tanner stage 5 in females?
Lateral spreading; type and triangle spread of adult hair to medial surface of thighs.
How can the weight gain during pregnancy be calculated?
Calculate the weight gain by subtracting the patient's prepregnancy weight from their current weight.
What should patients with a prepregnancy BMI of 26.0 or higher aim for in terms of weight gain during pregnancy?
7 to 11.5 kg (15 to 25 lb) over the entire pregnancy.
Explain Tanner 4 stage of breast development in females.
Increasing fat deposits; areola forms a secondary elevation above that of the breast.
What is Tanner 5 stage of breast development in females?
The areola is (usually) part of general breast contour and is strongly pigmented; nipple projects.
What could be a normal variant for delayed onset of puberty in males and females?
Delayed onset of puberty and secondary sexual characteristic development later than average.
What may accompany delayed puberty onset?
A lag of stature growth.
What is a possible cause of delayed puberty onset?
Use of puberty blockers in transgender and gender-diverse youth.
In Tanner 2 stage, what change occurs in females' breast development?
Budding stage; bud-shaped elevation of the areola; areola increased in diameter.
Describe a feature of Tanner 3 stage in females' breast development.
Breast and areola enlarged; no contour separation.
What happens in approximately half of all girls at Tanner 4 stage?
The areola forms a secondary elevation above that of the breast.
How do GnRH analogs work as puberty blockers?
GnRH analogs work by suppressing the secretion of LH and FSH, which ultimately suppress the body’s release of sex hormones like testosterone and estrogen during puberty.
What are the effects of GnRH analogs on individuals identified as male at birth?
In those identified as male at birth, GnRH analogs decrease the growth of facial and body hair, prevent voice deepening, and limit the growth of genitalia.
How do GnRH analogs impact individuals identified as female at birth?
In those identified as female at birth, GnRH analogs stop breast development, widening of the hips, and delay or stop menstruation.
Do puberty blockers like GnRH analogs stop acne, body odor, or axillary and pubic hair development?
No, puberty blockers do not stop acne, body odor, or axillary and pubic hair development.
What is the purpose of using GnRH analogs in adolescents?
The purpose is to delay changes in both primary and secondary sex characteristics that can affect gender expression.
Can the use of GnRH analogs cause permanent changes in an adolescent’s body?
No, the use of GnRH analogs does not cause permanent changes in an adolescent’s body.
What might the early development of sexual hair without signs of sexual maturation indicate?
It may indicate premature pubarche.
When is further evaluation needed if no evidence of pubertal development is seen in a female?
Further evaluation is needed if no evidence of pubertal development is seen in a female by 13 years of age.
What is the recommended weight gain range for underweight patients with a BMI of 29 during pregnancy?
5 to 9.1 kg (11 to 20 lb)
List three complications obese patients may face during pregnancy.
Gestational hypertension, preeclampsia, gestational diabetes
Why might pregnant adolescents younger than 16 years require higher weight gains during pregnancy?
To achieve an optimal infant birth weight
What is the recommended weight gain range during the first trimester of pregnancy?
1.4 to 2.7 kg (3 to 6 lb)
What is the recommended weekly weight gain range in the second and third trimesters of pregnancy?
0.23 to 0.45 kg (0.5 to 1 lb) per week
What risk are patients who gain too little weight during pregnancy at?
Risk for having a low-birth-weight infant
What risk are patients who gain too much weight during pregnancy at?
Risk for having a high-birth-weight infant
What are the measurement procedures for calculating the BMI of older adults?
Same as those used for other adults
Study Notes
Growth and Nutrition
Obesity in Older Adults
- In 2017-18, 42.4% of older adult men and 43.3% of older adult women in the United States were obese.
Tanner Stages of Male Genital Development
- Tanner Stage 1: Testes, scrotum, and penis are the same size and shape as in the young child.
- Tanner Stage 2: Enlargement of scrotum and testes; skin of the scrotum becomes redder, thinner, and wrinkled.
- Tanner Stage 3: Enlargement of the penis, especially in length; further enlargement of testes; descent of scrotum.
- Tanner Stage 4: Continued enlargement of the penis and sculpturing of the glans; increased pigmentation of scrotum.
- Tanner Stage 5 (adult stage): Scrotum ample, penis reaching nearly to bottom of scrotum.
Acromegaly
- A rare disease of excessive growth and distorted proportions caused by hypersecretion of growth hormone and insulin-like growth factor after closure of the epiphyses.
- Caused by a benign pituitary adenoma or other rare tumor, or familial syndromes (e.g., multiple endocrine neoplasia type 1 and McCune-Albright syndrome).
- Growth hormone excess leads to slow skeletal growth and soft tissue enlargement.
- Most common in middle-aged adults.
Puberty Blockers
- GnRH (gonadotropin-releasing hormone) analogs, a synthetic form of the human body’s GnRH hormone.
- Suppresses the release of LH and FSH, which suppresses the body’s release of sex hormones, including testosterone and estrogen, during puberty.
- Delays changes in both the primary and secondary sex characteristics that can affect gender expression.
- Does not cause permanent changes in an adolescent’s body.
Breast Development in Females
- Tanner Stage 1: Only the nipple is raised above the level of the breast, as in the child.
- Tanner Stage 2: Budding stage; bud-shaped elevation of the areola; areola increased in diameter and surrounding area slightly elevated.
- Tanner Stage 3: Breast and areola enlarged; no contour separation.
- Tanner Stage 4: Increasing fat deposits; areola forms a secondary elevation above that of the breast.
- Tanner Stage 5 (adult stage): The areola is part of general breast contour and is strongly pigmented; nipple projects.
Pubic Hair Development in Females
- Tanner Stage 1: No growth of pubic hair.
- Tanner Stage 2: Initial, scarcely pigmented straight hair, especially along medial border of the labia.
- Tanner Stage 3: Sparse, dark, visibly pigmented, curly pubic hair on labia.
- Tanner Stage 4: Hair coarse and curly, abundant but less than adult.
- Tanner Stage 5: Lateral spreading; type and triangle spread of adult hair to medial surface of thighs.
- Tanner Stage 6: Further extension laterally, upward, or dispersed (occurs in only 10% of women).
Weight Gain During Pregnancy
- Calculate the weight gain during pregnancy from the patient’s prepregnancy weight.
- Monitor the patient’s weight throughout pregnancy using the BMI weight gain curve guidelines on the prenatal weight gain chart.
- Guidelines for recommended weight gain during pregnancy are based on the patient’s prepregnancy BMI to improve reproductive outcomes.
- Patients with a prepregnancy BMI of 19.8 to 26.0 should gain 11.5 to 16 kg (25 to 35 lb) over the entire pregnancy.
Test your knowledge on the Tanner stages of breast development in females, as part of Chapter 8 on Growth and Nutrition. From Tanner 1 to Tanner 5, can you identify and understand the changes that occur during puberty?
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