Lecture 5: Puberty

Puberty refers to […] changes, while adolescence refers to […] changes

physical, psychological/social

The first clinical sign of female puberty is […]

thelarche

Estrogen stimulates the […] system, while progesterone increases […] in the breast

lactiferous, lobular alveoli

Menarche typically occurs […] to […] years after thelarche

1.5, 3

Pubic hair and acne in girls are primarily driven by […]

testosterone, androgens

The hypothalamic trigger for GnRH pulsatility is the […] complex

KNDy neurons

The metabolic hormone […] links adipose tissue levels to GnRH activation

leptin

The normal consonant sequence of female puberty is […], growth spurt, pubarche, and […]

thelarche, menarche

A […] sequence of puberty suggests a peripheral (GnRH-independent) cause

disconsonant, abnormal

Precocious puberty in girls is defined as secondary sexual characteristics appearing before age […]

8

Central precocious puberty (CPP) is […] and follows a […] sequence

GnRH-dependent, consonant

The most common cause of Central Precocious Puberty in girls is […]

idiopathic

Peripheral Precocious Puberty (PPP) is […] and often follows a […] sequence

GnRH-independent, disconsonant

A triad of peripheral PP, café-au-lait spots, and fibrous bone dysplasia suggests […]

McCune-Albright Syndrome

Premature […] is a risk factor for insulin resistance and PCOS later in life

pubarche

Before diagnosing isolated premature menarche, you must exclude […], […], and abuse

infection, trauma

The most important physical parameter in evaluating precocious puberty is […]

growth velocity

The Gold Standard investigation to differentiate Central from Peripheral PP is the […]

GnRH stimulation test

In Central Precocious Puberty, the peak LH response to a GnRH stimulation test is […]

5–7 IU/L

In precocious puberty, […] is usually advanced compared to chronological age

bone age

The first-line medical management for Central Precocious Puberty is […]

GnRH agonists

GnRH agonists work by […] and […] pituitary GnRH receptors

down-regulating, desensitizing

GnRH agonist treatment provides no adult height benefit if started after age […]

8

Delayed puberty in females is defined as the lack of […] by age 14

thelarche, breast development

The most common cause of delayed puberty in females is […]

constitutional delay of growth and puberty, CDGP

Low LH/FSH and low oestrogen in delayed puberty indicates […]

hypogonadotropic hypogonadism

High LH/FSH and low oestrogen in delayed puberty indicates […]

hypergonadotropic hypogonadism, ovarian failure

Normal hormones but no menarche despite normal secondary characteristics suggests […]

eugonadism, outflow obstruction

To treat delayed puberty, […] is given for 6–12 months before adding progesterone

17-β oestradiol

The primary goals of managing precocious puberty are to stop progression and […]

preserve adult height

KNDy neurons consist of […], […], and Dynorphin

Kisspeptin, Neurokinin B

Isolated premature menarche is usually […] and resolves in 1-2 years

self-limiting

Large ovarian cysts causing peripheral PP are managed […] if >5.5cm

surgically

Common side effects of GnRH agonists include injection site reactions and […]

headaches

Menarche is triggered by a surge in […] and […]

FSH, LH