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.
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
Overview normal physiological development; skeletal growth, maturation of the reproductive tract, development secondary sexual characteristics, CNS maturation, personality and psychology of the female adolescent.
L6-8.Disorders of the reproductive system.pptxDr Bilal Natiq
In the male, the testis serves two principal functions: synthesis of testosterone by the interstitial Leydig cells under the control of luteinising hormone (LH), and spermatogenesis by Sertoli cells under the control of follicle-stimulating hormone (FSH) (but also requiring adequate testosterone).
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
Overview normal physiological development; skeletal growth, maturation of the reproductive tract, development secondary sexual characteristics, CNS maturation, personality and psychology of the female adolescent.
L6-8.Disorders of the reproductive system.pptxDr Bilal Natiq
In the male, the testis serves two principal functions: synthesis of testosterone by the interstitial Leydig cells under the control of luteinising hormone (LH), and spermatogenesis by Sertoli cells under the control of follicle-stimulating hormone (FSH) (but also requiring adequate testosterone).
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.
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
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.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
3. WHAT IS PRECOCIOUS PUBERTY?
This is the onset of sexual maturation at any age that
is 2.5 SD earlier than the normal age for the
population.
In other words: development of sexual maturation
before the ages of 8-9 years in girls and boys.
4. CLASSIFICATION
p TRUE PRECOCIOUS PUBERTY (GnRH-Dependant):
b. Idiopathic
c. CNS lesions: Hamartomas, Craniopharyngioma, etc
d. Primary hypothyroidism
V. PSEUDOPRECOCIOUS PUBERTY ( GnRH-independent):
f. Isolated precocious thelarche
g. Isolated precocious menarche
h. Estrogen-secreting tumors of the ovary or adrenals in girls
i. Ovarian cysts
j. McCune-Albright syndrome
k. Peutz-Jeghers syndrome
l. Iatrogenic
III. CONTRASEXUAL PRECOCITY (ISOLATED VIRILIZATION):
Isolated precocious adrenarche
Congenital adrenal hyperplasia
Androgen-secreting ovarian or adrenal neoplasm
Iatrogenic
6. True Precocious Puberty
This results from early maturation of the
hypothalamic- pituitary-gonadal axis.
Serum gonadotropins, gonadal pulsitality and sex
steroid concentrations are in the normal postpubertal
range.
idiopathic precocious puberty seems to be the most
common cause of CPP.
Neurogenic TPP seems to be found more frequently
in extremely young girls with the earliest onset of
puberty.
7. Etiology
CNS lesions identified include neoplasms, trauma,
hydrocephalus, postinfectious encephalitis, congenital
brain defects, and such genetic disorders as
neurofibromatosis type 1 and tuberous sclerosis.
The most commonly identified neurogenic neoplasms
found in TPP include hamartomas, astrocytomas, and pituitary
microadenomas
Hamartomas are congenital hypothalamic malformations
that histologically contain fiber bundles, glial cells and
GnRH- secreting neurons and often act as a mini-
hypothalamus.
8. Contd.
Girls with severe primary hypothyroidism can develop
true precocious puberty.
These girls have elevated gonadotropins in addition to
high TSH levels.
The associated precocity may result from cross-
activation of the FSH receptor by the high circulating
TSH or from direct stimulation of the ovary by the
gonadotropins.
9. MANAGEMENT
DIAGNOSIS:
The management of true precocious puberty requires
identification of underlying CNS lesions, if present, or
in other children identification of a pubertal
gonadotropin response to GnRH that is usually
associated with idiopathic true precocious puberty
and occasionally with a hamartoma.
Hence we do: Imaging of the CNS and a GnRH
challenge test.
10. Contd.
bone age X-rays are helpful to identify the advance
physiologic age associated with true precocious
puberty.
Ovarian imaging, thyroid and hCG testing may
also compliment the evaluation.
FSH AND LH LEVELS.
ULTRASOUND OF THE ADRENAL GLANDS.
14. TREATMENT
Administer GnRH analogues: they are
modifications of the native hormones which have
greater resistance to degradation and increased
affinity for the pituitary GnRH receptors.
They induce down-regulation of receptor function,
resulting in temporary, reversible inhibition of the
hypothalamic-pituitary-ovarian axis as reflected by
minimal or no response to GnRH stimulation and
regressionof the manifestation of puberty.
15. Gonadotropic Independent
Preococious Puberty (GIPP)
GIPP can originate from the gonads, the adrenals,
from extragonadal or intragonadal sources of human
chorionic gonadotropin, or from exogenous sources.
In girls, functionally autonomous ovarian cysts are the
most common cause of GIPP.
Ovarian follicles up to 8mm in diameter are common
in normal prepubertal girls and may appear or regress
spontaneously, but rarely secrete significant amounts
of estrogen
16. McCune-Albright syndrome
classically includes the triad
of hyperpigmented caf?au-lait spots
progressive polystotic fibrous dysplasia of the bones and
GnRH-independent sexual precocity.
At least 2 of these features must be present to consider the
diagnosis.
The sexual precocity of McCune Albright syndrome is due to
autonomously functioning follicular cysts
Testolactone, an aromatase inhibitor , has been shown to be
effective treatment for the GnRH independent phase of this
condition.
When the shift from gonadotropin independent to
gonadotropin dependent puberty takes place, GnRH analog
therapy then becomes effective.
18. PREMATURE THELARCHE
Isolated development of the breast tissue prior to age
8 yrs, most commonly occurring between 1 and 3
years of age. It may affect 1 or both breasts.
On examination, the somatic growth pattern is not
accelerated, bone age is not advanced and smear of
vaginal secretion fails to show estrogen effect.
Occurs on exposure to exogenous estrogen, as
happened in Puerto Rico in the 1970’s.
20. PREMATURE PUBARCHE
Defined as the appearance of pubic or axillary hair prior to
age 7 years in white girls and 6 years in black girls. Such
hair growth may be idiopathic and of clinical significance.
It usually results from an earlier than-usual increase in the
secretion of androgens by adrenal glands.
Thorough evaluation of the gonadal and adrenal function
should be made to exclude such abnormalities.
Signs of sever androgen excess( clitoral enlargement,
growth acceleration, acne) should prompt further
investigation for rare virilazation tumor.
23. PREMATURE MENARCHE
Denotes the appearance of cyclic vaginal bleeding in
children in the absence of other signs of secondary
sexual development.
It could be related to increased end-organ sensitivity
of the endometrium to low prepubertal levels of
estrogens.
Diagnosis is formulated by exclusion following
investigation of other causes of vaginal bleeding and
confirmed when the cyclic nature of the bleeding
becomes apparent.
24. Contrasexual precocity
Most girls with contrasexual precocious puberty present
with early appearance of pubic hair or hirsuitism.
The most common cause is a mild form of 21-
hydroxylase deficiency , which is present in 0.1-1.0% of
the population.
Other more rare forms of congenital adrenal hyperplasia
have also been identified in these patients.
Virilizing adrenal (occasionally malignant) and ovarian
tumors (e.g., Leydig or Sertoli cell tumors) in young girls
can similarly present with virilizing precocious puberty.
26. EVALUATION OF PATIENTS WITH
PRECOCIOUS PUBERTY
GENERAL CHANGES:
Enhancement of general growth is coincident with the onset of
estrogen-stimulated change. The child often exhibits accelerated
growth velocity, tall stature for age, and advanced skeletal maturation.
SKIN:
Additional androgen-dependent findings include, acne and adult-type
body odor.
BREAST:
According to TANNER, it is at stage II with areolae having a
broadened, darkened appearance.
GENITALIA:
Genital changes reflect estrogen-induced thickening of the genital
tissues. Increased vaginal secretions may result in leukorrhea. Dark,
coarse pubic hair may be present.
27. How an Individual Can Cope with
Precocious Puberty
Educate Yourself About the Changes
Realize that there are a variety of body types — big, small,
and everything in between.
Try not to compare yourself with those around you.
Avoid those with negative outlooks; surround yourself
with those who care about you
Talk to someone you trust, they could offer suggestions
and make you feel a little less alone
Avoid those with negative outlooks; surround yourself
with those who care about you.
Talk to someone you trust, they could offer suggestions
and make you feel a little less alone.
28. Warning Signs of Effects on
Emotional Development
poor grades
problems at school
loss of interest in daily activities and
depression
29. THE END
Give your child with precocious puberty OR
your friend or Patient love and support!