Puberty is the transition period between childhood and adulthood that involves physical and hormonal changes. Precocious puberty refers to the onset of puberty before age 8 in girls and age 9 in boys. It can be classified as central, peripheral, or combined based on whether the cause is in the brain or peripheral organs. Diagnosis involves physical exams, hormone tests, imaging, and puberty staging. Treatment depends on the type but may include medication to delay puberty or surgery to remove tumors.
Disorders of pubertal development can involve delayed, premature, or arrested puberty. The document discusses the normal physiology of puberty and various conditions that cause abnormalities in pubertal development, including central precocious puberty, peripheral precocious puberty, premature adrenarche, constitutional delay of growth and puberty, and pubertal arrest. Evaluation and management of disorders of pubertal development involves assessment of signs of puberty, auxiliary investigations, and potential treatments depending on the underlying cause.
This case discusses a 7-year-old boy presenting with early signs of puberty over the past 5-6 months. Laboratory tests showed elevated levels of testosterone, LH, and FSH, confirming precocious puberty. A GnRH stimulation test showed an LH spike, indicating central precocious puberty. The patient was diagnosed with idiopathic central precocious puberty and prescribed injections of Decapeptyl to delay further pubertal progression until age 11 in order to avoid short adult stature. The document discusses evaluation and management of precocious puberty.
1) Precocious puberty is the onset of secondary sexual characteristics before age 8 in girls and age 9 in boys. It can be caused by premature activation of the hypothalamic-pituitary-gonadal axis (central) or premature sex hormone secretion from other sources like the adrenal glands (peripheral).
2) Treatment involves suppressing sex hormone production using GnRH analogues to stop further sexual development and rapid growth. This helps preserve final adult height.
3) Pubertal development is assessed using the Tanner stages, which evaluate breast/genital development and pubic hair growth. Precocious puberty disrupts the normal timing and progression of these stages.
Additional important history:
- Family history of precocious or early puberty
- Developmental milestones
- Medications/supplements
Examination:
- Bone age X-ray
- Pelvic/abdominal ultrasound
- MRI brain
Differential diagnosis:
- Central precocious puberty
- Peripheral precocious puberty (e.g. McCune-Albright syndrome)
- Pseudoprecocious puberty
Investigations:
- LH, FSH, estradiol
- Chromosome analysis
- MRI to rule out CNS pathology
Final diagnosis: Central precocious puberty likely due to early activation of hyp
Precocious puberty is when sexual and physical maturation occurs earlier than normal. It can begin as early as age 6-7 in girls and before age 9 in boys. This is caused by the early release of hormones from the hypothalamus and pituitary gland. Treatment aims to stop further sexual development and rapid growth to allow children to reach their full adult height. Medications that block sex hormones are commonly used, and can help reverse physical changes and return behavior to age-appropriate levels. Precocious puberty affects girls more often than boys and carries health risks if not properly treated.
Andrea l. de maria your hair down there- a pubic hair storyBlackzao
This document discusses pubic hair removal practices and trends. It notes that pubic hair removal has become more common since WWII due to cultural and media influences promoting hairless ideals of femininity. Today most women and men remove all or most of their pubic hair, often before sexual encounters or medical visits. Common removal methods include shaving, waxing, and hair removal creams, which can sometimes cause ingrown hairs or cuts. The document provides tips for safe hair removal and examines why people remove pubic hair and cultural trends related to pubic hair and genital aesthetics.
Delayed Puberty Topics in Adolescent Gynecology Delayed Puberty Topics in A...MedicineAndHealth14
This document discusses delayed puberty in adolescent girls. It begins by outlining normal pubertal development and defining delayed puberty. Delayed puberty is then classified into three categories: hypergonadotropic hypogonadism (43%), hypogonadotropic hypogonadism (31%), and eugonadism (26%). For evaluation and management, the document recommends obtaining a history, physical exam, initial labs (TSH, prolactin), and a progestational challenge to determine gonadotropin levels and identify underlying causes. Treatment strategies aim to correct the underlying pathology, prevent disease complications, and provide sex steroids.
This document discusses precocious puberty, which is defined as the appearance of secondary sex characteristics before age 8 in girls and age 9 in boys. It notes that the incidence is estimated to be between 1 in 5,000 to 10,000 children, with the female to male ratio being around 10:1. Girls adopted from developing countries are at higher risk. Modern factors that may contribute include increased obesity, consumption of sugary drinks, environmental toxins, lack of nutrients like iodine, and lack of rest. Iodine deficiency in particular can lead to issues with hormonal expression and pubertal development.
Disorders of pubertal development can involve delayed, premature, or arrested puberty. The document discusses the normal physiology of puberty and various conditions that cause abnormalities in pubertal development, including central precocious puberty, peripheral precocious puberty, premature adrenarche, constitutional delay of growth and puberty, and pubertal arrest. Evaluation and management of disorders of pubertal development involves assessment of signs of puberty, auxiliary investigations, and potential treatments depending on the underlying cause.
This case discusses a 7-year-old boy presenting with early signs of puberty over the past 5-6 months. Laboratory tests showed elevated levels of testosterone, LH, and FSH, confirming precocious puberty. A GnRH stimulation test showed an LH spike, indicating central precocious puberty. The patient was diagnosed with idiopathic central precocious puberty and prescribed injections of Decapeptyl to delay further pubertal progression until age 11 in order to avoid short adult stature. The document discusses evaluation and management of precocious puberty.
1) Precocious puberty is the onset of secondary sexual characteristics before age 8 in girls and age 9 in boys. It can be caused by premature activation of the hypothalamic-pituitary-gonadal axis (central) or premature sex hormone secretion from other sources like the adrenal glands (peripheral).
2) Treatment involves suppressing sex hormone production using GnRH analogues to stop further sexual development and rapid growth. This helps preserve final adult height.
3) Pubertal development is assessed using the Tanner stages, which evaluate breast/genital development and pubic hair growth. Precocious puberty disrupts the normal timing and progression of these stages.
Additional important history:
- Family history of precocious or early puberty
- Developmental milestones
- Medications/supplements
Examination:
- Bone age X-ray
- Pelvic/abdominal ultrasound
- MRI brain
Differential diagnosis:
- Central precocious puberty
- Peripheral precocious puberty (e.g. McCune-Albright syndrome)
- Pseudoprecocious puberty
Investigations:
- LH, FSH, estradiol
- Chromosome analysis
- MRI to rule out CNS pathology
Final diagnosis: Central precocious puberty likely due to early activation of hyp
Precocious puberty is when sexual and physical maturation occurs earlier than normal. It can begin as early as age 6-7 in girls and before age 9 in boys. This is caused by the early release of hormones from the hypothalamus and pituitary gland. Treatment aims to stop further sexual development and rapid growth to allow children to reach their full adult height. Medications that block sex hormones are commonly used, and can help reverse physical changes and return behavior to age-appropriate levels. Precocious puberty affects girls more often than boys and carries health risks if not properly treated.
Andrea l. de maria your hair down there- a pubic hair storyBlackzao
This document discusses pubic hair removal practices and trends. It notes that pubic hair removal has become more common since WWII due to cultural and media influences promoting hairless ideals of femininity. Today most women and men remove all or most of their pubic hair, often before sexual encounters or medical visits. Common removal methods include shaving, waxing, and hair removal creams, which can sometimes cause ingrown hairs or cuts. The document provides tips for safe hair removal and examines why people remove pubic hair and cultural trends related to pubic hair and genital aesthetics.
Delayed Puberty Topics in Adolescent Gynecology Delayed Puberty Topics in A...MedicineAndHealth14
This document discusses delayed puberty in adolescent girls. It begins by outlining normal pubertal development and defining delayed puberty. Delayed puberty is then classified into three categories: hypergonadotropic hypogonadism (43%), hypogonadotropic hypogonadism (31%), and eugonadism (26%). For evaluation and management, the document recommends obtaining a history, physical exam, initial labs (TSH, prolactin), and a progestational challenge to determine gonadotropin levels and identify underlying causes. Treatment strategies aim to correct the underlying pathology, prevent disease complications, and provide sex steroids.
This document discusses precocious puberty, which is defined as the appearance of secondary sex characteristics before age 8 in girls and age 9 in boys. It notes that the incidence is estimated to be between 1 in 5,000 to 10,000 children, with the female to male ratio being around 10:1. Girls adopted from developing countries are at higher risk. Modern factors that may contribute include increased obesity, consumption of sugary drinks, environmental toxins, lack of nutrients like iodine, and lack of rest. Iodine deficiency in particular can lead to issues with hormonal expression and pubertal development.
The document discusses intersexuality and sexual differentiation. It defines key terms like sex, gender, sexual identity and discusses normal sexual differentiation in humans. Intersex is defined as discordance between chromosomal, gonadal, genital or phenotypic sex. Causes of intersex include congenital adrenal hyperplasia, androgen exposure, gonadal dysgenesis and true hermaphroditism. Management of intersex infants involves medical evaluation, counseling, sex assignment and possible surgery. Intersex may also present in adolescence, requiring hormonal or surgical treatment depending on the condition. Proper long-term management is important to allow affected individuals to live happy and well-adjusted lives.
El documento describe los cambios físicos, hormonales y de desarrollo que ocurren durante la pubertad normal y precoz. Explica que la pubertad implica cambios en el crecimiento, desarrollo de las gónadas y caracteres sexuales secundarios según estadios de Tanner. También describe las causas, manifestaciones clínicas y tratamiento de la pubertad precoz central y periférica.
This document discusses precocious and delayed puberty. It defines precocious puberty as the development of sexual characteristics before age 8 or menstruation before age 10. Causes can be idiopathic, an intracranial lesion, or disorders like McCune-Albright syndrome. Treatment aims to slow bone maturation and reduce gonadotropin secretion, using medications like GnRH agonists. Delayed puberty is defined as lack of breast or pubic hair development by ages 13-14 or menarche after 16. Causes include hypogonadism, chronic illness, or eugonadism. Treatment depends on the underlying cause and may involve cyclic or combined estrogen therapies.
1) Puberty is the process of physical maturation from child to adult, triggered by hormonal changes. It involves growth, development of secondary sex characteristics, and reproductive ability.
2) The timing of puberty is influenced by genetics as well as environmental factors like nutrition and geography. It typically occurs between ages 8-13 in girls and 9-14 in boys.
3) Precocious puberty describes the onset of puberty before age 8 in girls and age 9 in boys. It can be caused by genetic conditions, brain abnormalities, or tumors and requires medical evaluation and sometimes treatment to delay puberty.
Precocious puberty refers to the onset of puberty before age 8 in girls and age 9 in boys. It can be caused by central activation of the hypothalamic-pituitary-gonadal axis or peripheral problems affecting the ovaries, testes or adrenal glands. Treatment typically involves suppressing early hormone production through GnRH analogues to delay puberty and allow for normal adult height. Parents can help children cope by educating them about the changes, monitoring for emotional impacts, and offering praise and support through participation in other activities rather than focusing on appearance.
The document discusses pubertal disorders and their classification, causes, diagnosis, and management. It begins by defining key terminology related to puberty and describing the normal physiology and regulation of the hypothalamic-pituitary-gonadal axis during puberty. Pubertal disorders are classified as either precocious or delayed puberty. Causes of delayed puberty include hypergonadotropic hypogonadism due to genetic defects or acquired conditions, and hypogonadotropic hypogonadism caused by tumors or CNS disorders that disrupt the HPG axis. Assessment of pubertal development involves the Tanner staging system.
The document discusses normal sexual differentiation and various disorders of sexual development including:
1. Normal sexual differentiation involves establishment of chromosomal sex, gonad development, and genital differentiation under hormonal influences.
2. Disorders include seminiferous tubule dysgenesis (Klinefelter), 46 XX males, Turner's syndrome, gonadal dysgenesis, congenital adrenal hyperplasia, and androgen insensitivity.
3. Evaluation of ambiguous genitalia involves examination for testes, imaging of internal structures, labs, and potential for gender assignment and psychosocial well-being.
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
Puberty is the process of physical changes that transforms a child's body into an adult capable of sexual reproduction and fertility. During puberty, the brain signals the ovaries in girls and testes in boys to produce hormones that stimulate growth and changes in organs and tissues across the body, including the brain, bones, muscles, skin, hair, breasts, and sexual organs.
Puberty is the physiological transition from childhood to reproductive maturity associated with growth spurts and development of primary and secondary sexual characteristics between ages 8-14. It is controlled by the hypothalamic-pituitary-gonadal axis, which stimulates sex hormone secretion and profound biological changes. Precocious or delayed puberty may have underlying pathological causes that require investigation through assessments of medical history, examinations, blood tests, and imaging to diagnose conditions and guide management.
Precocious puberty is an early onset of sexual maturation, usually defined as beginning before age 8 in girls and age 9 in boys. It can be caused by genetic factors or physical abnormalities affecting the hypothalamus or other parts of the hormonal system. Symptoms in girls include breast development and menstruation, while boys experience genital growth and facial hair. Treatment aims to stop further sexual development using drugs that block hormone production.
Este documento describe el desarrollo puberal normal y patológico. Explica las modificaciones somáticas que ocurren durante la pubertad como el aumento del crecimiento, la acumulación de grasa y el desarrollo de los caracteres sexuales secundarios. También describe las causas de la pubertad precoz, como tumores y trastornos endocrinos, y los métodos de diagnóstico e intervención médica para tratar este trastorno.
This document discusses disorders of sexual development (DSDs). It begins by defining DSDs as conditions where chromosomal, gonadal, or anatomical sex is atypical, often presenting as ambiguous genitalia. It then discusses the physiology of typical sexual development and classifies common types of DSDs. It provides examples of clinical features, diagnostic considerations, and genetic and gonadal characteristics for different DSD types, including 21-hydroxylase deficiency, gonadal dysgenesis, ovotesticular DSD, and partial androgen insensitivity. Images are included to illustrate some clinical presentations. The document emphasizes the importance of karyotyping and hormonal testing to diagnose DSDs.
The document discusses the development of the female reproductive system from embryological development through adulthood. It covers stages from the neonatal period through puberty and adolescence, describing the anatomical changes that occur at each stage. The focus is on providing guidance for evaluating and examining pediatric and adolescent patients, including what to assess, techniques to use, and important considerations for each age group.
The document discusses normal sexual differentiation and disorders of sexual differentiation. It describes the process of normal sexual differentiation including chromosomal, gonadal, ductal, and genital differentiation. It also discusses several common disorders of sexual differentiation including congenital adrenal hyperplasia, androgen insensitivity syndrome, mixed gonadal dysgenesis, and others. Specific conditions discussed in more detail include Klinefelter syndrome, Turner syndrome, XX maleness, and mixed gonadal dysgenesis.
This document discusses delayed puberty in children. It begins by defining normal puberty and factors that can affect the timing of puberty. It then defines delayed puberty and describes the main types as hypogonadotropic hypogonadism, characterized by low gonadotropins, and hypergonadotropic hypogonadism, characterized by high gonadotropins. The document outlines the evaluation and management of delayed puberty, including history, physical exam, laboratory tests, and treatment approaches depending on the underlying cause. Treatment may involve hormone replacement therapy, addressing underlying medical conditions, or observation in cases of constitutional delay.
The document discusses several topics related to puberty in girls and boys:
- It describes some of the physical changes girls experience during puberty like breast development between ages 8-13 and that breasts usually continue growing until ages 17-18.
- It explains that girls are born with all the eggs they will ever have and ovaries typically release one egg per month through ovulation.
- Periods usually last 3-7 days and occur about once a month, though cycles can vary between 21-35 days.
- For boys, puberty brings body growth, voice changes, and new hair growth typically between ages 9-14, though everyone develops at their own pace.
The document discusses various topics related to puberty, including definitions of key terms, the normal sequence and timing of pubertal changes, causes and treatment of precocious and delayed puberty, and case studies. Precocious puberty can be true/idiopathic, due to tumors or other medical issues, or pseudopuberty caused by medication or conditions like premature adrenarche. Delayed puberty may be due to constitutional delay, medical issues impairing the HPA axis, or prior treatments like radiation therapy. Evaluation and management depends on the underlying cause and aim to initiate puberty normally or replace missing hormones.
This document discusses precocious puberty, including central precocious puberty and peripheral precocious puberty. Central precocious puberty is the early activation of the hypothalamic-pituitary-gonadal axis, leading to the onset of secondary sexual characteristics before age 8 in girls and 9 in boys. Peripheral precocious puberty is caused by external sex hormones and may be isosexual or heterosexual. McCune-Albright syndrome is a rare cause of peripheral precocious puberty associated with patchy skin pigmentation and fibrous dysplasia. Treatment for central precocious puberty involves suppressing puberty with GnRH agonists to help increase adult height potential.
The document discusses intersexuality and sexual differentiation. It defines key terms like sex, gender, sexual identity and discusses normal sexual differentiation in humans. Intersex is defined as discordance between chromosomal, gonadal, genital or phenotypic sex. Causes of intersex include congenital adrenal hyperplasia, androgen exposure, gonadal dysgenesis and true hermaphroditism. Management of intersex infants involves medical evaluation, counseling, sex assignment and possible surgery. Intersex may also present in adolescence, requiring hormonal or surgical treatment depending on the condition. Proper long-term management is important to allow affected individuals to live happy and well-adjusted lives.
El documento describe los cambios físicos, hormonales y de desarrollo que ocurren durante la pubertad normal y precoz. Explica que la pubertad implica cambios en el crecimiento, desarrollo de las gónadas y caracteres sexuales secundarios según estadios de Tanner. También describe las causas, manifestaciones clínicas y tratamiento de la pubertad precoz central y periférica.
This document discusses precocious and delayed puberty. It defines precocious puberty as the development of sexual characteristics before age 8 or menstruation before age 10. Causes can be idiopathic, an intracranial lesion, or disorders like McCune-Albright syndrome. Treatment aims to slow bone maturation and reduce gonadotropin secretion, using medications like GnRH agonists. Delayed puberty is defined as lack of breast or pubic hair development by ages 13-14 or menarche after 16. Causes include hypogonadism, chronic illness, or eugonadism. Treatment depends on the underlying cause and may involve cyclic or combined estrogen therapies.
1) Puberty is the process of physical maturation from child to adult, triggered by hormonal changes. It involves growth, development of secondary sex characteristics, and reproductive ability.
2) The timing of puberty is influenced by genetics as well as environmental factors like nutrition and geography. It typically occurs between ages 8-13 in girls and 9-14 in boys.
3) Precocious puberty describes the onset of puberty before age 8 in girls and age 9 in boys. It can be caused by genetic conditions, brain abnormalities, or tumors and requires medical evaluation and sometimes treatment to delay puberty.
Precocious puberty refers to the onset of puberty before age 8 in girls and age 9 in boys. It can be caused by central activation of the hypothalamic-pituitary-gonadal axis or peripheral problems affecting the ovaries, testes or adrenal glands. Treatment typically involves suppressing early hormone production through GnRH analogues to delay puberty and allow for normal adult height. Parents can help children cope by educating them about the changes, monitoring for emotional impacts, and offering praise and support through participation in other activities rather than focusing on appearance.
The document discusses pubertal disorders and their classification, causes, diagnosis, and management. It begins by defining key terminology related to puberty and describing the normal physiology and regulation of the hypothalamic-pituitary-gonadal axis during puberty. Pubertal disorders are classified as either precocious or delayed puberty. Causes of delayed puberty include hypergonadotropic hypogonadism due to genetic defects or acquired conditions, and hypogonadotropic hypogonadism caused by tumors or CNS disorders that disrupt the HPG axis. Assessment of pubertal development involves the Tanner staging system.
The document discusses normal sexual differentiation and various disorders of sexual development including:
1. Normal sexual differentiation involves establishment of chromosomal sex, gonad development, and genital differentiation under hormonal influences.
2. Disorders include seminiferous tubule dysgenesis (Klinefelter), 46 XX males, Turner's syndrome, gonadal dysgenesis, congenital adrenal hyperplasia, and androgen insensitivity.
3. Evaluation of ambiguous genitalia involves examination for testes, imaging of internal structures, labs, and potential for gender assignment and psychosocial well-being.
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
Puberty is the process of physical changes that transforms a child's body into an adult capable of sexual reproduction and fertility. During puberty, the brain signals the ovaries in girls and testes in boys to produce hormones that stimulate growth and changes in organs and tissues across the body, including the brain, bones, muscles, skin, hair, breasts, and sexual organs.
Puberty is the physiological transition from childhood to reproductive maturity associated with growth spurts and development of primary and secondary sexual characteristics between ages 8-14. It is controlled by the hypothalamic-pituitary-gonadal axis, which stimulates sex hormone secretion and profound biological changes. Precocious or delayed puberty may have underlying pathological causes that require investigation through assessments of medical history, examinations, blood tests, and imaging to diagnose conditions and guide management.
Precocious puberty is an early onset of sexual maturation, usually defined as beginning before age 8 in girls and age 9 in boys. It can be caused by genetic factors or physical abnormalities affecting the hypothalamus or other parts of the hormonal system. Symptoms in girls include breast development and menstruation, while boys experience genital growth and facial hair. Treatment aims to stop further sexual development using drugs that block hormone production.
Este documento describe el desarrollo puberal normal y patológico. Explica las modificaciones somáticas que ocurren durante la pubertad como el aumento del crecimiento, la acumulación de grasa y el desarrollo de los caracteres sexuales secundarios. También describe las causas de la pubertad precoz, como tumores y trastornos endocrinos, y los métodos de diagnóstico e intervención médica para tratar este trastorno.
This document discusses disorders of sexual development (DSDs). It begins by defining DSDs as conditions where chromosomal, gonadal, or anatomical sex is atypical, often presenting as ambiguous genitalia. It then discusses the physiology of typical sexual development and classifies common types of DSDs. It provides examples of clinical features, diagnostic considerations, and genetic and gonadal characteristics for different DSD types, including 21-hydroxylase deficiency, gonadal dysgenesis, ovotesticular DSD, and partial androgen insensitivity. Images are included to illustrate some clinical presentations. The document emphasizes the importance of karyotyping and hormonal testing to diagnose DSDs.
The document discusses the development of the female reproductive system from embryological development through adulthood. It covers stages from the neonatal period through puberty and adolescence, describing the anatomical changes that occur at each stage. The focus is on providing guidance for evaluating and examining pediatric and adolescent patients, including what to assess, techniques to use, and important considerations for each age group.
The document discusses normal sexual differentiation and disorders of sexual differentiation. It describes the process of normal sexual differentiation including chromosomal, gonadal, ductal, and genital differentiation. It also discusses several common disorders of sexual differentiation including congenital adrenal hyperplasia, androgen insensitivity syndrome, mixed gonadal dysgenesis, and others. Specific conditions discussed in more detail include Klinefelter syndrome, Turner syndrome, XX maleness, and mixed gonadal dysgenesis.
This document discusses delayed puberty in children. It begins by defining normal puberty and factors that can affect the timing of puberty. It then defines delayed puberty and describes the main types as hypogonadotropic hypogonadism, characterized by low gonadotropins, and hypergonadotropic hypogonadism, characterized by high gonadotropins. The document outlines the evaluation and management of delayed puberty, including history, physical exam, laboratory tests, and treatment approaches depending on the underlying cause. Treatment may involve hormone replacement therapy, addressing underlying medical conditions, or observation in cases of constitutional delay.
The document discusses several topics related to puberty in girls and boys:
- It describes some of the physical changes girls experience during puberty like breast development between ages 8-13 and that breasts usually continue growing until ages 17-18.
- It explains that girls are born with all the eggs they will ever have and ovaries typically release one egg per month through ovulation.
- Periods usually last 3-7 days and occur about once a month, though cycles can vary between 21-35 days.
- For boys, puberty brings body growth, voice changes, and new hair growth typically between ages 9-14, though everyone develops at their own pace.
The document discusses various topics related to puberty, including definitions of key terms, the normal sequence and timing of pubertal changes, causes and treatment of precocious and delayed puberty, and case studies. Precocious puberty can be true/idiopathic, due to tumors or other medical issues, or pseudopuberty caused by medication or conditions like premature adrenarche. Delayed puberty may be due to constitutional delay, medical issues impairing the HPA axis, or prior treatments like radiation therapy. Evaluation and management depends on the underlying cause and aim to initiate puberty normally or replace missing hormones.
This document discusses precocious puberty, including central precocious puberty and peripheral precocious puberty. Central precocious puberty is the early activation of the hypothalamic-pituitary-gonadal axis, leading to the onset of secondary sexual characteristics before age 8 in girls and 9 in boys. Peripheral precocious puberty is caused by external sex hormones and may be isosexual or heterosexual. McCune-Albright syndrome is a rare cause of peripheral precocious puberty associated with patchy skin pigmentation and fibrous dysplasia. Treatment for central precocious puberty involves suppressing puberty with GnRH agonists to help increase adult height potential.
Precocious puberty is defined as the onset of secondary sexual characteristics before age 8 in girls and 9 in boys. It can be classified as central (gonadotropin-dependent) or peripheral (gonadotropin-independent) puberty. Central puberty is treated with GnRH agonists to slow progression, while peripheral causes like tumors require treatment of the underlying condition. Evaluation involves assessing pubertal development, growth, bone age, and hormone levels to distinguish central from peripheral puberty and identify any lesions.
This document provides an overview of paediatric endocrinology for adult endocrinologists. It discusses various growth and puberty related conditions seen in paediatric endocrinology practice including short stature, precocious and delayed puberty, congenital hypothyroidism, and growth hormone deficiency. It also covers approaches to evaluating growth using height measurements and bone age assessments. Case examples are presented to illustrate various conditions.
Puberty is the stage of physical maturation triggered by increased secretion of hormones like Luteinizing Hormone and GnRH, resulting in sexual and somatic development. It involves breast development in females starting around age 10-14 and testicular growth in males around age 12-16. Puberty encompasses five stages of physical changes through Tanner stages including growth spurts that make individuals reproductively mature.
This document provides information about puberty and reproductive development in females. It discusses physical changes during puberty like breast development, hip widening, and growth of pubic hair. It also describes the female reproductive system including the uterus, ovaries, fallopian tubes, and vagina. The menstrual cycle is explained in detail, covering hormone regulation, egg maturation and release, potential fertilization, and menstruation if not pregnant. Pregnancy and the stages of development are briefly outlined as well.
The document provides information on anatomy and physiology changes during pregnancy and assessment of high-risk conditions. It discusses the uterus, cervix, vagina and other organs. It also covers fetal development stages and complications that can arise. Common high-risk conditions addressed include preterm labor, incompetent cervix, premature rupture of membranes, diabetes, and abruptio placenta. Nursing interventions are outlined for monitoring and managing clients with various complications.
Identify the midline of thigh and locate the vastus lateralis muscle by
palpating the femur. Insert needle at 90 degrees, 1-2 inches above the patella and
1-2 inches below inguinal ligament.
Risk of injury to major blood vessels is minimal.
DELTOID
Female reproductive functions can be divided into two major phases:
preparation of the female body for conception and pregnancy and
(2) the period of pregnancy itself.
This lecture is concerned with preparation of the female body for pregnancy, and presents the physiology of pregnancy and childbirth
Aktualne trendy w leczeniu przewlekłej choroby żylnej i jej powikłańMichał Molski
Aktualne trendy we flebologii które realizujemy i planujemy wdrożyć w Szpitalu ESKULAP - prezentacja z zebrania naukowo-szkoleniowego Oddziału Bydgosko-Toruńskiego Towarzystwa Chirurgów Polskich 19.03.2016.
Mobile Computing Applications in Adolescents problemRamesh Kumar
Mobile or cell phone can be used for parent to track the adolescents and prevention can be taken. Of course this is not a fulproof solution but atleast assist in some percentage
The breast is made up of glandular tissue, fibrous tissue, and fatty tissue. In females, the breast fully develops at puberty. The breast extends from the 2nd to 6th ribs and contains 15-20 lobes drained by lactiferous ducts that open onto the nipple. During pregnancy and lactation, the breasts undergo proliferation and changes to support milk production. The blood supply comes from branches of the axillary, internal thoracic, and intercostal arteries, while lymphatic drainage is primarily to the axillary nodes. Breast carcinoma is more common in females and prognosis is generally worse for males. Treatment options for breast cancer include breast-conserving surgery or mastectomy depending on tumor characteristics and
This document discusses different types of amenorrhea, or absent menstrual periods. It describes primary amenorrhea, which is the absence of menstruation by age 16 with no development of secondary sex characteristics. This can be caused by hypogonadotropic or hypergonadotropic hypogonadism. Hypergonadotropic amenorrhea is often due to genetic conditions like Turner's syndrome or enzyme deficiencies. Hypogonadotropic amenorrhea has causes like Kallmann's syndrome, infections, or pituitary tumors. Treatment depends on the underlying cause and may include hormone replacement, surgery, or removal of obstructions. Anorexia nervosa can also cause amenorrhea due to severe weight loss and altered
This document discusses precocious puberty and summarizes key points about central precocious puberty (CPP) and peripheral precocious puberty (PPP). CPP is caused by early activation of the hypothalamic-pituitary axis, while PPP is caused by elevated sex steroid levels independent of gonadotropin secretion. Imaging depends on gender and lab results, including MRI of the CNS for boys with CPP and pelvic ultrasound for girls. Common causes of CPP include hypothalamic hamartoma and hypothalamic-chiasmatic astrocytoma. Adrenal cortical neoplasms are a potential cause of PPP in girls presenting as virilization.
1. The transformation zone of the cervix is the area where the columnar epithelium of the endocervix meets the squamous epithelium of the ectocervix, and it is prone to precancerous changes known as cervical intraepithelial neoplasia (CIN).
2. CIN is graded on a scale from I to III based on the severity of cellular abnormalities, with CIN III considered a precancerous condition.
3. Screening techniques like the Pap smear and colposcopy are used to detect CIN so that treatment with methods like LEEP or conization can remove precancerous tissue and prevent the development of invasive cervical cancer.
Dickson Cv Akankwatsa is an ambitious 3rd year student at Bishop Stuart University, Uganda , pursuing a bachelor of Nursing science. More so, a HOSTEL councilor contestant 2016/17 in the same institution.
This document discusses various aspects of ovarian stimulation for infertility treatment. It provides an overview of infertility facts and causes, methods for assessing ovarian reserve, and different protocols for ovarian stimulation including clomiphene, letrozole, and gonadotropins. It also discusses indications for and outcomes of ovarian stimulation combined with intrauterine insemination.
The document discusses the various stages of female development from embryonic development through menopause. It covers the neonatal period, childhood, puberty, adolescence, sexual maturity, climacterium, and senium. For each period, it describes the development of the reproductive system including the uterus, ovaries, and other genital organs. It provides details on hormonal influences, the onset of puberty and its stages, and physiological changes that occur during the various life stages of women.
Central precocious puberty (CPP) is the early activation of the hypothalamic-pituitary-gonadal axis, leading to premature sexual maturation. Peripheral precocious puberty (PPP) involves the appearance of secondary sex characteristics without activation of the HPG axis, instead caused by direct sex steroid production. Evaluation of precocious puberty involves determining which pubertal changes are present to classify it as CPP or PPP, followed by laboratory tests and imaging studies to identify potential underlying causes.
Mark Perloe, MD Atlanta, 404-843-2229 Learn about the factors that can adversely affect fertility and the tests that can help pinpoint problems. Fertility treatment options including IVF and other high tech options are presented.
This document discusses precocious puberty, which is the early onset of sexual maturation before age 8-9. It classifies types as true (GnRH-dependent) or pseudo (GnRH-independent) precocity. True precocity is usually idiopathic and can be caused by brain lesions or hypothyroidism. Pseudo precocity has causes like ovarian cysts. Evaluation involves physical exams, blood tests, and imaging. Treatment depends on type but may include GnRH analogs. Supporting emotional health for those with precocious puberty is important.
Pregnancy can be diagnosed through several presumptive signs and tests. Presumptive signs include missed periods, morning sickness, breast changes, and increased urination. Tests such as a urine or blood test can detect human chorionic gonadotropin (HCG) levels. An ultrasound can visualize and examine the fetus, and listen for a heartbeat starting at around 12 weeks. More definitive tests include examining the softening of the cervix and uterus, feeling fetal movements, and medical tests such as amniocentesis that analyze amniotic fluid cells. Prenatal diagnosis helps manage the pregnancy and plan for any complications or decisions.
Disorder of Sex Differentiattion ( ambiguos genitelia )Dr Anand Singh
Disorders of sex development (DSD) occur when the development of chromosomal, gonadal, or anatomical sex is atypical. Evaluation of DSD involves a physical exam, karyotype testing, hormone level testing, and imaging exams. Diagnosis is made based on gonadal status and further tests can include hormone stimulation tests, biopsy of gonads, and genetic analysis. Treatment is determined based on diagnosis and may include surgery and hormone replacement therapy.
KR has been unsuccessfully trying to get pregnant for 1.5 years with irregular periods and no positive ovulation readings. She is feeling depressed and has questions about seeing a fertility specialist. A fertility specialist can run tests on both partners to determine the cause of infertility and has extensive training in this area. The first visits would involve hormone level tests and the second would include additional tests like ultrasounds, hormone tests, and procedures like hysteroscopy and laparoscopy to examine the reproductive organs. If clomiphene treatment fails to induce ovulation, injectable fertility drugs may be considered. Metformin is sometimes used alongside clomiphene to treat infertility in women with PCOS.
KR has been unsuccessfully trying to get pregnant for 1.5 years with irregular periods and no positive ovulation readings. She is feeling depressed and has questions about seeing a fertility specialist. A fertility specialist can run tests on both partners to determine the cause of infertility and has extensive training in this area. The first visits would involve hormone level tests and the second would include additional tests like ultrasounds, hormone tests, and procedures like hysteroscopy and laparoscopy to examine the reproductive organs. If clomiphene treatment fails to induce ovulation, injectable fertility drugs may be considered. Metformin is sometimes used alongside clomiphene to treat infertility in women with PCOS.
Phenylketonuria (commonly known as PKU) is an inherited disorder that increases the levels of a substance called phenylalanine in the blood. Phenylalanine is a building block of proteins (an amino acid) that is obtained through the diet. It is found in all proteins and in some artificial sweeteners. If PKU is not treated, phenylalanine can build up to harmful levels in the body, causing intellectual disability and other serious health problems.
This document provides information on delayed puberty, including its definition, causes, evaluation, and treatment. Delayed puberty can be functional, due to hypogonadotropic hypogonadism, or hypergonadotropic hypogonadism. The most common cause is constitutional delay of growth and puberty. Evaluation involves medical history, physical exam, lab tests like LH, FSH and bone age. Treatment depends on the underlying cause, but aims to induce normal pubertal development and growth. For constitutional delay, watchful waiting is often recommended, while permanent hypogonadism requires hormone therapy like testosterone to initiate puberty.
1) Anti-Müllerian hormone (AMH) is produced by granulosa cells and reflects the ovarian follicle pool, making it a useful marker of ovarian reserve that is not affected by hormones or the menstrual cycle.
2) AMH levels decline with age in a predictable pattern and lower levels predict a poorer response to fertility treatments, while higher levels indicate greater risk of ovarian hyperstimulation syndrome.
3) AMH alone or in combination with antral follicle count is currently the best assessment of ovarian reserve compared to other hormonal or ultrasound markers. AMH can predict both poor and excessive responses to fertility medication.
This document discusses various methods of antenatal fetal surveillance to monitor fetal well-being and detect any issues. It describes clinical tests like fundal height measurements, biochemical tests like estriol levels, and biophysical tests like fetal movement counts and non-stress tests. The aim is to determine gestational age, check for fetal anomalies, detect growth abnormalities, and identify acute or chronic fetal hypoxia through regular surveillance. This monitoring is especially important for high-risk pregnancies.
Hello everyone
This presentation will give a insight into the recent advances in fetal therapy. Hope it might help you
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MD Pediatrics
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Recent Trends in Pubertal Timing and Current Management of Precocious Puberty...Apollo Hospitals
Precocious puberty is defined as the development of pubertal signs at a younger age than the accepted lower limits for the onset of puberty. In girls, breast development before the age of 8 years, appearance of sexual pubic hair before the age of 8 years or beginning menses before the age of 9.5 years is traditionally considered as precocious puberty. This is accompanied by rapid growth rate, advanced skeletal maturation and increased levels of gonadotropins and/or sex steroids.
The document provides information on various methods used to assess maternal and fetal wellbeing during pregnancy. The goals of antenatal assessment are to ensure fetal growth and detect any risks affecting the fetus. Methods discussed include maternal serum screening tests, amniocentesis, biophysical profile monitoring, ultrasonography, and Doppler studies. Together these non-invasive and minimally invasive tests can evaluate fetal growth, check for abnormalities, and detect any signs of fetal distress.
This document provides information about infertility, its causes, diagnostic testing, and treatment options. It discusses common female causes of infertility like damaged fallopian tubes or hormonal issues. It also describes fertility drugs that can be used to treat ovulation disorders, including clomiphene, gonadotropins, and aromatase inhibitors. The risks of multiple pregnancies from fertility drugs is addressed. Metformin is discussed as a treatment for infertility associated with polycystic ovary syndrome.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
2. Puber- marriageable age
Pubertus – adulthood
The period of transition between sexual
immaturity and maturity
Puberty is first phase of adolescence.
How puberty occurs ?
10/04/13 2
3. Fetal and InfancyFetal and Infancy
During the latter half of fetal life, the
hypothalamus pituitary ovarian axis is
functional completely.
FSH levels are suppressed from 20 weeks
gestation by the production of estrogen by
the placenta and by the fetus itself.
At birth, the fetus is separated from its
placenta and therefore the major source of
estrogen is removed.
10/04/13 3
4. Hypoestrogenic
state of the fetus
FSH level rises and
remains elevated for
6-10 months
After birth
But FSH is suppressed by Central
inhibition of production of GnRH
Controlled by gene
in the GnRH cell
nucleus in the
hypothalamus
10/04/13 4
5. FSH pulses are
undetectable -8-9 yrs
1-2 yrs – spike of
FSH increases in
frequency
Childhood
4-5 yrs – frequency of the FSH
pulses increases in day light hours
Fully functional
production of GnRH
with N adult frequency,
amplitude and pulse s
5-10yrs ovulatory
menstrual cycle
10/04/13 5
6. Pituitary glands
All activities increases
At puberty – increase secretion of releasing
factors by the hypothalamus
Manifested by sudden spurt in height,
enlargement of thyroid, adrenal cortex
activity, skin pigmentation
Cyclical production of gonadotrophin
and estrogen in amount10/04/13 6
9. STAGES OF PUBERTYSTAGES OF PUBERTY
Growth spurt
Breast development (thelarche)
Pubic hair growth (Adrenarche)
Menstruation (menarche)
Axillary hair growth
70% of girls, variation often occur in
Tanner
Definite signs of puberty are usually
present by the age 9 or 10 years
10/04/13 9
10. Growth spurtGrowth spurt
It begins around the age of 11yrs in girls
6 to 10cms per year for around 2 years
Effect of estrogen – fusion of end plate of
the femur and growth ceases by the age
of 15 yrs
10/04/13 10
11. Tanner staging of breastTanner staging of breast
development –development – Marshall and Tanner (1969)Marshall and Tanner (1969)
Elevation of papilla
Elevation of papilla & breast
on a small mount, increased
in areola
Further enlargement
Secondary mound of areola
and papilla
Recession of areola to
contour of breast
prepubertal
9-13 yrs
10-14 yrs
11-15 yrs
12-17 yrs
10/04/13 11
13. MenarcheMenarche
occurs at any between 9 to 17 yrs
In India -13.5 yrs
Age of menarche varies
family
Race
Social class
Family size,
birth order
Environment
Diet
General health
10/04/13 13
15. Axillary hairAxillary hair
Appears later
During the 2yrs before the menarche the
genital tract develops
Menstrual phase itself often preceded by
mucoid vaginal discharge
10/04/13 15
16. Other Changes during pubertyOther Changes during puberty
Apart from development of secondary
sexual characters and growth spurt
other changes are
Gonads
Sex organs
Pelvis
Skin changes
Psychological changes
Hormonal
10/04/13 16
19. Precocious pubertyPrecocious puberty
Tanner stage 2 of
breast development
prior the age of 8
yrs in white and 7
yrs in black
Elevation of papilla &
breast on a small
mount, increased in
areola
10/04/13 19
23. CompleteComplete
Central isosexual pubertyCentral isosexual puberty
Systemic estrogen effect
True or gonadotrophin dependent
90%
Cyclic release of gonadotrophin
Classification: Idiopathic or organic brain
disease
Idiopathic :
Most common
70%
Underlying etiology unknown
10/04/13 23
24. Growth spurt is rapid with short duration
Rate of progression vary
General health is not impaired
USG- functional follicular ovarian cyst
Incidence of POF and infertility is not
increased
Other causes are to be excluded before
diagnosis – MRI, CT scan, etc
30% cases may have organic brain disease
10/04/13 24
27. Ovarian tumourOvarian tumour
It is common cause for PPP
Granulosa theca cell tumour – benign,
estrogen secreting, confined to one
ovary,
Palpable rectal abdominal examination or
USG
Treatment : unilateral
salpingoopherectomy
10/04/13 27
28. Mc Cune Albright syndromeMc Cune Albright syndrome
Rare – girls
Triad
1. Precocious puberty
2. multiple area of fibrous dysplasia of bone
3. café au lait spots of the skin
facial asymmetry or skeletal deformities
X-ray shows dysplastic lesions
Fluctuation of estrogen levels and low
gonadotrophin- independent of GnRH
stimulation
10/04/13 28
29. Café au lait skin pigmentationCafé au lait skin pigmentation
10/04/13 29
31. X ray showing dysplastic lesionX ray showing dysplastic lesion
Single view of the left hand demonstrates
multiple large expansile "bubbly" lytic
lesions with sharp transition zones and
without an associated periosteal reaction (
arrows). The lesions are located in the
phalanges, carpels, metacarpals, distal ulna
and radial bones. The cortex is very thin in
many areas overlying the expansile lytic
lesion, making it difficult to determine if a
fracture has occurred
10/04/13 31
35. Incomplete precocious pubertyIncomplete precocious puberty
No systemic estrogen effect
One pubertal change is clinically apparent
Absence of superficial cell desquamated
from vaginal mucosa or bone age
10/04/13 35
36. Premature thelarche – development ofPremature thelarche – development of
breast < 8yrs in white and <7yrs in blackbreast < 8yrs in white and <7yrs in black
10/04/13 36
This is a bilateral enlargement of breasts in 1-2 yr olds that is
common. There are no other signs of puberty development
and the growth is normal. As long as the vulva, labia, vagina
are normal infantile, and there is no pubic hair, then nothing is
done.
37. 10/04/13 37
Benign and needs no therapy
Commonly occurs between 1and 4 yrs of
age.
No progression
1/3th regression
1/10 progression
Estradiol level < 20 ng/ml
GnRH stimulation: FSH increases and LH
no response
38. Appearance of pubic hair <8
yrs
No other pubertal changes
No evidence of systemic
estrogen
Other androgen mediated
clinical findings- axillary hair
growth, oily skin, and acne
One half children have
organic brain disease.
10/04/13 38
Premature AdrenarchePremature Adrenarche
41. DiagnosisDiagnosis
To distinguished heterosexual and
isosexual puberty- History
Physical examination –identify
Tanner staging
Height
Incomplete precocious puberty-serial
observation for at least 6 months
10/04/13 41
42. Diagnosis contdDiagnosis contd
Thyroid dysfunction can be evaluated by
thyroid profile.
Serum HCG concentrations are elevated
in the presence of trophoblastic disease.
Iatrogenic sources of estrogen – medical
history
Mc Cune Albright – clinical features
10/04/13 42
46. Incomplete precocious puberty -Incomplete precocious puberty -
Premature adrenarchePremature adrenarche
Cranial CT scan,
17 alpha hydroxyprogesterone level at
baseline and following intravenous ACTH
stimulation
10/04/13 46
47. To distinguish Peripheral PP fromTo distinguish Peripheral PP from
central precocious pubercentral precocious pubertyty
GnRH stimulation test - In PPP no
change in gonadotrophin levels whereas
True PP FSH increases more than LH
advanced bone age in both
Increase in ovarian volume and uterine
size in TPP
10/04/13 47
48. A rectal abdominal examination and pelvic
USG – identify ovarian tumours and
ovarian cysts.
Adrenal tumours –adrenal sonograms
CNS diseases is confirmed with the use of
neurologic and ophthalmologic
examination, skull x – ray, EEG and CT
cranial scan or MRI study of the brain.
10/04/13 48
49. TreatmentTreatment
Incomplete forms – self limiting
Hypothyroid –thyroid replacement
therapy
Iatrogenic
Ovarian and adrenal tumours – removed
10/04/13 49
50. Mc Cune Albright syndrome-
Testolactone – total daily oral dose of 20
mg/kg body in four divided doses-
over a 3 weeks interval the total daily
dose is increased to 40 mg/kg body wt
Continue till the sign regress
Side effects: diarrhoea,
abdominalcramping
10/04/13 50
51. Idiopathic – GnRH analogs are reported
as being sucessful in the treatment of IPP
and central nervous system .
Therapy – early – increase the height
Long acting GnRH agonist
Deslorelin 4-8 ug/kg
Leuprolide acetate 20-60ug/kg
Buserelin 20-30 ug/kg
Leuprolide acetate IM 60ug/kg every 4
weeks
Buserelin 1200-1800 ug/kg intranasally
10/04/13 51
Once
daily SC
injection
52. GnRH agonist are not useful in PPP
Side effects:
allergic reactions
allergy symptoms of lungs with intranasal
GnRH should be continued TPP till the
mean age of pubertal development.
10/04/13 52
53. Precocious puberty can be differentiated from
premature adrenarche by the concomitant
appearance of pubic hair with breast
development in girls and with testicular
enlargement in boys.
Other differential diagnoses include virilization
caused by congenital adrenal hyperplasia and an
adrenocortical or gonadal tumor. In premature
adrenarche, serum concentrations of
dehydroepiandrosterone,
dehydroepiandrosterone sulfate (DHEAS),
androstenedione, and testosterone and urinary
17-ketosteroids are usually increased for
chronological age and in the range of those found
in early puberty.
10/04/13 53
54. The bone age is usually within 2 standard
deviations of the chronological age.
Moderately elevated levels of serum
androgen other than DHEAS, bone age
advancement, or signs of atypical
premature pubarche (such as cystic acne or
symptoms of systemic virilization) indicate
the need for a corticotropin test to rule
out late-onset congenital adrenal
hyperplasia.
Marked elevation of serum androgen levels
and advanced bone age suggest the
possibility of an adrenocortical or gonadal
tumor.
10/04/13 54
55. Delayed pubertyDelayed puberty
breast tissue and/or pubic hair have not
appeared by 13-14 yrs of age
Or menarche appears as late as 16 yrs
The normal upper age limit of menarche
is 15 yrs.
15% cases – constitutional delay –
PCOD, cryptamenorrhoea.
10/04/13 55
59. Weight:Weight:
Underweight :
1. malnutrition
2. malabsorption syndrome
3. aneroxia nervosa
4. Excessive dieting
5. other psychiatric diseases
Normal weight or obese :
1. constitutional delay,
2. XY gonadal dysgenesis
3. Kallman syndrome
4. pituitary tumours, PCOS,
5. Adrenal abnormalities and other causes of
secondary amenorrhoea.
10/04/13 59
60. InvestigationsInvestigations
Physical examination
karyotyping
FSH level – Increased in ovarian failure
Decreased in hypopituitarism
Thyroid and prolactin
Ultrasound
X ray pituitary
MRI
CT scan
Laparoscopy
10/04/13 60
61. TreatmentTreatment
Treatment is directed according to the
etiology
Assurance, improvement of general
health and treatment of any illness may
be of help in non endocrinal causes
cases with hypogonadism may be treated
with cyclic estrogen
Unopposed estrogen 0.3 mg (conjugated
estrogen) daily is given for first 6 months
10/04/13 61
62. combined estrogen and progestin
sequential regimen is started
cases of hypergonadotrophic
hypogonadism should have
chromosomal study to exclude
intersexuality.
10/04/13 62