Puberty
Jack Biko MBBCh, Mmed O & G, FCOG, Dip Advanced Endoscopic Surgery
Definition
• Process of physical change by which a child’s body becomes an adult body capable of reproduction
• Average age of onset is 10.7yrs
• Average duration is 4.5yrs
Puberty
• Maturation of hypothalamus
• Stimulation of sex organs
• Secretion of sex steroids
• Sexual characteristics begin to develop
• Sexual reproduction achieved
Neurohormonal changes
• Hypothalamus release pulses of GNRH
• Anterior pituatory release FSH and LH
• Gonads grow and release Oestrogen and Testosterone
• Oestrogen and testosterone produce body changes of female & male puberty
Puberty
• Fertility achieved, secondary sex characteristics develop – Features that distinguish sexually mature men and women
• Increase in release of anterior pituitary hormones – Growth hormone – acts on bone and muscle – Gonadoptrophic hormone – Adrenocorticotrophic hormone
Copyright © 2006 by Allyn and Bacon
Factors affecting onset
• Genetic
• Nutrition
• General health
• Geographic location
• Exposure to light
• Psychological state
Factors affecting onset
• More boys than girls present with delayed puberty
• Overweight girls have earlier onset
• Blacks have earlier onset
Physical changes
• Accelerated growth
• Breast budding (Thelarche)
• Pubic hair growth (Pubarche)
• Peak growth velocity
• Onset of mentruation (menache)
Other changes
• White vagina secretions (leukorrhea)
• Acne
• Widening of lower body (hips) due to increased body fat
Tanner staging
Delayed puberty
• No secondary sexual characteristics by 13/14yrs, or
• No menarche by 16yrs
• Constitutional delay is the most common cause
Delayed Puberty
• Elevated gonadotropins: gonadal disease/ primary hypogonadism
• Low/normal gonadotropins: Hypothalamic/ pituatory disease/ secondary hypogonadism
History
• Anorexia/bulemia
• Exersive exercise
• Family history
• Chemotherapy
• Previous surgery
• Head injury
• Drug abuse
• Growth measurement
• Sexual maturity
• Physical stigmata
• Behavioral abnormalities
• thyroid
Hypogonadotropic Hypogonadism
• Constitutional delay
• Congenital deficiencies LH & FSH receptor abnormalities
IHH (GNRH deficiency)
Kallmann’s syndrome
• Chronic disease
• Hypothyroid
• Hyperprolactinemia
• Brain tumours
Hypergonadotropic Hypergonadism
• Gonadal dysgenesis Turner’s syndrome
• Androgen resistance
• Autoimmune
Treatment
• Treat the cause: Thyroid treatment
Growth hormone
? Gonadectomy for XY
Hormone therapy
Precocious puberty
• Premature production of GNRH FSH & LH
• Production of Oestrogens or Androgens from ovaries, adrenals
Premature onset of secondary sexual characteristics (before 8yrs)
Precocious puberty
• True precocity • Ealy maturation of HPG axis
• Idiopathic
• CNS pathology
• Precocious pseudopuberty • Increased steroid hormone production independent of Gonadotopins
• Ovarian cysts
• Adrenal musculinization
• Ectopic gonadotropin production
Clinical features
• Breast development
• Rapid height growth
• Onset of periods
• Mature body habitus
• Acne
Effects
• Does not fit in with friend
• Poor body image
• Lower self esteem (increased libido in boys, early menses in girls)
• Early growth spurt initially – tall stature BUT:
• Rapid bone maturation – short adult stature.
Aims of treatment
• Diagnose and treat intracranial disease
• Arrest maturation until normal pubertal age
• Attenuate established precocious features
• Maximize eventual adult height
• Avoid abuse and emotional problems
• contraception
Treatment
• Surgery
• Radiotherapy
• GNRH agonists
Thank you