Puberty PDF
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كلية التمريض
Dr Mahmoud Awad
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Summary
This document provides an overview of puberty, covering various aspects such as the period of life during which sexual maturation is completed, the pubertal cascade, factors affecting the timing of puberty, and the physiology of puberty, including hormonal and physical changes, in addition to psychological changes. Different aspects of female puberty are described. This also includes information on precocious puberty.
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PUBERTY Dr Mahmoud Awad Period of life during which sexual maturation is completed (maturation of sex organs & development of 2ry sex characters) & reproductive capacity is attained. Age: 9-16 years. starts 2 -3 years before menarche Pubertal cascade: occur between 10 & 16 years of ag...
PUBERTY Dr Mahmoud Awad Period of life during which sexual maturation is completed (maturation of sex organs & development of 2ry sex characters) & reproductive capacity is attained. Age: 9-16 years. starts 2 -3 years before menarche Pubertal cascade: occur between 10 & 16 years of age 1) Release of pulsatile GNRH from CNS inhibition leading to increase GNRH 2) Increase GNRH leads to increase release of FSH and LH 3) Increase FSH &LH causes increase in estrogen and Progesterone 4) Menarche and ovulation Factors affecting the time of puberty 1) Genetics : The major determinant of the timing of puberty. 2) Geographical location: children closer to the equator, start earlier 3) Nutritional condition: obese ……early puberty Physiology of puberty (pubertal changes): A) Hormonal changes: 1) Release of hypothalamus from effect of higher cortical inhibitory impulses (which are present before puberty) → maturation of hypothalamic-pituitary- ovarian axis → GnRH release → acts on pituitary to release FSH & LH → act on ovaries to become functioning → steroid hormones release. 2) ↑↑ release of growth hormone (GH), TSH & ACTH from anterior pituitary (to ↑↑ muscular & skeletal growth). Physiology of puberty (pubertal changes): B) Physical changes: 1) Thelarche (breast development): 1st visible sign of puberty due to ovarian estrogen production. Starts at 9-11 years & completes in 3 years. 2) Adrenarche: Adrenal gland maturation è production of androgens leading to: a) Pubarche (pubic hair development): May be 1st sign of puberty in 20% of girls b) Axillarche (axillary hair development) Physiology of puberty (pubertal changes): B) Physical changes: 3) Development of genital organs. 4) Appearance of other 2ry sex characters: a) High pitched voice. b) Feminine distribution of SC fat (breast, buttocks, thighs & waist). c) Pelvis enlarges, widens & takes gynecoid shape. Physiology of puberty (pubertal changes): B) Psychological changes: 1) Girl develops shyness, becomes secretive & refuses her parents control. 2) Tendency to other sex (sex urge). Tanner’s staging for pubertal events Thelarche Prepubertal Stage 1 (elevation of papilla only) Stage 2 Breast bud Stage 3 Breast elevation Stage 4 Areolar mound Stage 5 Adult breast contour Tanner’s staging for pubertal events Pubarche Axillarche Prepubertal Prepubertal Stage 1 (no hair) (no hair) Stage 2 Presexual hair Scanty hair Stage 3 Sexual hair but sparse Adult hair Stage 4 Sexual hair limited to mons Sexual hair over mons è transverse upper border & Stage 5 spreading to labia majora & medial aspects of upper thighs Precocious puberty Pubertal changes before age of 9 years. Etiology: A) Isosexual precocious puberty: Female sex characters. 1) Complete: All pubertal events occur precociously. a) Central (true): GnRH dependent. b) Peripheral (false): (GnRH non dependant). 2) Incomplete: Mostly idiopathic. B) Heterosexual precocious puberty: Male sex characters. Pubertal changes before age of 9 years. Etiology: A) Isosexual precocious puberty: Female sex characters. 1) Complete: All pubertal events occur precociously. a) Central (true): GnRH dependent. 1- Idiopathic or constitutional: Commonest cause. 2- Organic brain lesions: a- Congenital: Hamartomas & hydrocephalous. b- Traumatic: Skull injuries. c- Inflammatory: Meningitis & encephalitis. d- Neoplastic: Any brain tumor near hypothalamus. Precocious puberty Pubertal changes before age of 9 years. Etiology: A) Isosexual precocious puberty: Female sex characters. 1) Complete: All pubertal events occur precociously. b) Peripheral (false): (GnRH non dependant). 1- McCune Albright syndrome: Precocious puberty + disseminated cystic bone anomalies + café au lait skin patches + hyperfunctioning endocrinopathies. 3- Estrogen secreting ovarian or adrenal tumors. 4- Gonadotropin secreting tumors (as choriocarcinoma or teratoma). 5- Iatrogenic: Exogenous estrogens. Precocious puberty Pubertal changes before age of 9 years. Etiology: A) Isosexual precocious puberty: Female sex characters. 1) Complete: All pubertal events occur precociously. 2) Incomplete: Mostly idiopathic. a) Premature thelarche. b) Premature pubarche & axillarche. c) Premature menarche. Precocious puberty Pubertal changes before age of 9 years. Etiology: A) Isosexual precocious puberty: Female sex characters. 1) Complete: All pubertal events occur precociously. 2) Incomplete: Mostly idiopathic. B) Heterosexual precocious puberty: Male sex characters. 1) Congenital adrenal hyperplasia (CAH): Late type. 2) Androgen secreting ovarian or adrenal tumors. 3) Iatrogenic: Exogenous androgens. Diagnosis A) History: 1) Pubertal changes. 2) Family history of similar condition (in constitutional type). 3) Symptoms of the cause or history of drug intake. B) Examination: 1) Pubertal changes. 2) Signs of the cause. C) Investigations: 1) Hormonal assay (FSH, LH, estrogen, progesterone & androgens). 2) Investigations to detect the cause. Treatment: Treatment: Aim is to prevent premature closure of epiphysis. A) Psychological support: Reassurance & explanation. B) Treatment of the cause: If there is treatable cause. C) Medical treatment: To ↓↓ gonadotropins secre on. 1) GnRH agonists: The best drugs to treat precocious puberty. 2) Gestagens: MPA. 3) Danazol: Has androgenic effects.