Disorder Of Puberty

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Kuliah Tumbuh Kembang Remaja Adolescent
FKUB 2007 KBK
(Untuk Kalangan Sendiri)

Published in: Health & Medicine

Disorder Of Puberty

  1. 1. Disorder of Puberty Disorder of Puberty (Precocious & Delayed Puberty) (Precocious & Delayed Puberty) Competencies-based curricullum 4th Competencies-Based semester 7th block Curricullum th Semester 7th Block 4
  2. 2. What is puberty? • biological changes and sexual maturation that occur during the transition from childhood to adulthood • Average age of onset: –10 (range 8-13) years in Girls –12 (range 10-15) years in Boys
  3. 3. Important items in the puberty evaluation History : - Growth record - Family history of growth disorders and ages of maturation - Review of systems, and - Nutritional history. Neinstein L.S. Adolescent Health Care: A Practical Guide, 2002 Neinstein LS and Kaufman FR: Abnormal Growth and Development, 2002.
  4. 4. Physical examination Should include a complete examination but particularly focus on: - Nutritional status - Body measurements - Sexual maturity rating - Thyroid exam - Cardiac exam (for congenital heart disease) - Chest exam (for chronic pulmonary disease) - Abdominal exam (hepatosplenomegaly as sign of chronic system disease) - External vaginal examination (evaluate for presence of uterus and ovaries) - Neurologic exam (for intracranial pathology)
  5. 5. Basic Laboratory tests - Complete blood count (anemia) - Urinalysis (chronic renal disease) - Sedimentation rate (screen for chronic systemic disease) - Chemistry panel including glucose, creatinine, calcium phosphorus, albumin, protein and liver enzymes - A bone age is an essential part of the evaluation for delayed puberty. - TSH: A screen for thyroid dysfunction
  6. 6. • For specific diagnostic assessments & therapeutic management needs appropriate other health professionals (Endocrinologist, Gynaecologist) • Health care provider must be prepared to help the adolescent with long term follow-up & psychological support including - Identification of the problem, - Growth and sexual maturation, - Sexual identity and - Reproductive potential.
  7. 7. PRECOCIOUS PUBERTY Precocious onset of puberty is defined as occurring younger than 2 SD before the average age  Girls <8 years old : Develops breast & pubic hair before 8 years old  Boys <9 years old : Has an increase in testicle size & penis length before 9 years of age
  8. 8. Causa of Precocious Puberty 1. Gonadotrophin-dependent (true / central) - Intra-cranial lesions (tumours, hydrocephalus, CNS malformations, irradiation, trauma) - Gonadotrophin secreting tumours – v. rare 2. Gonadotrophin-independent (FSH & LH suppressed) Exogenous Sex Hormone
  9. 9. Delayed puberty Delayed onset of puberty is defined as occurring older than 2 SD after the average age  Girls > 13.4 years old  Boys > 14 years old Adolescents that are beyond these limits should be considered for evaluation for hypothalamic, pituitary, gonadal dysfunction, or undiagnosed chronic illness.
  10. 10. Male Guidelines for Delayed Puberty • Genital (G) stage 1 persists beyond age 13.7 years, or • Pubic hair (PH) stage 1 persists beyond 15.1 years of age • More than 5 years have elapsed from initiation to completion of genital growth. • The following sexual maturity ratings (SMRs) persist past the listed guidelines: - G2 > 2.2 years - G3 > 1.6 years - G4 > 1.9 years - PH2 > 1.0 year Neinstein L.S. Adolescent Health Care: A Practical Guide, 2002 - PH3 > 0.5 year Neinstein LS and Kaufman FR: - PH4 > 1.5 years Abnormal Growth and Development, 2002.
  11. 11. Female Guidelines for delayed puberty • Breast (B) stage 1 persists beyond age 13.4, or • Pubic hair stage 1 persists beyond 14.1 years, or • There is failure to menstruate beyond 16 years of age. • More than 5 years have elapsed between initiation of breast growth and menarche. • The following sexual maturity ratings persist past the listed guidelines: – B2 > 1.0 year – B3 > 2.2 years – B4 > 6.8 years – PH2 > 1.3 years Neinstein L.S. Adolescent Health Care: A Practical Guide, 2002 – PH3 > 0.9 years Neinstein LS and Kaufman FR: – PH4 > 2.4 years Abnormal Growth and Development, 2002.
  12. 12. Causa of Delayed Puberty General • Constitutional delay of growth and puberty • Malabsorption – Coeliac / imflammatory bowel disease • Underweight – Dieting, anorexia nervosa, over-exercise • Chronic illness – Asthma, malignancy, beta thallasaemia major
  13. 13. Causa of Delayed Puberty (con’t) • Gonadal failure - Chromosomal Abnormalities – Post-malignancy chemo / radiotherapy / surgery – Polyglandular autoimmune syndromes • Gonadal deficiency – Congenital hypogonadotrophic hypogonadism – Hypothalamic/pituitary lesions (tumours, post- radiotherapy) – Rare gene mutations inactivating FSH/LH or their receptors
  14. 14. Turner’s Syndrome • About one case in 3,000 live female births • Short stature • CVS •Coarctation of aorta •Spont. aortic dilatation •hypertension • Lymphoedema • Recurrent otitis media • Dysplastic nails • Crohn’s/U.C., cancer colon • R.A. • Thyroid disease • D.M.
  15. 15. Klinefelter's syndrome • One case in 700 live male births • Tall stature • Eunuchoid body : - Long legs - Relatively short arms, - Height:arm-span ratio >1.0 • Testes are small but firm, and • Gynecomastia is often present.
  16. 16. Constitutional delay of puberty • 90% of delayed puberty is constitutional delay of puberty • The following items should be considered : - No chronic disease contribute to growth failure - Nutritional status is normal - Growth rate at least 3.7 cm/year - Physical examination normal including genital anatomy - Normal CBC, sedimentation rate, urinalysis result and TSH - Normal serum LH & FSH (may not be needed in all cases) - The bone age is delayed 1.5 to 4.0 years - Supportive evidence includes a family history of constitutional delay & a height between 3 rd and 25th percentiles for chronologic age

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