3.2 Precocious Puberty

most documented hypothalamic/pituitary cause of precocious puberty

*McCune Albright*

less than ____% of children will develop signs of puberty before the age of ___ in girls and ____ in boys

1% 8girls 9boys

types of precocious puberty

1) *CENTRAL/TRUE* something wrong in the brain. normal gonadotropin secretion but it happens too soon 2) *PERIPHERAL/PSEUDO*: ectopic source of gonadotropins [organ or environment]

signs and symptoms of *delayed sexual maturation*

1) Lack of breast development by age 13 2) > 5 years from beginning breast growth to menarche 3) lack of pubic hair by age 14 4) lack of menses by age 16 (primary amenorrhea) 5) short stature

presentation of *McCune Albright*

1) Polyossotic fibrous dysplasia 2) cafe au lait spotrs 3) precocious puberty 4) other endocrine disturbances

List common exogenous exposures to precocious puberty

1) Skin creams and Lotions w/ estrogens 2) Exposure to oral contraceptives and hormone replacement 3) high amounts of dietary steroids via fattened beef and dairy cattle 4) ingestion through estrogenic plasticizers (bisphenol and dioxins) 5) ingestion thru tap water 6) skin contact from herbicides and pesticides

*2 main signs of precocious puberty in a girl*

1) breasts 2) menses

current medical treatment for precocious puberty

1) educating family, teachers, patients 2) eliminating known exposure 3) surgical removal tumors or cysts 4) suppressing mensis with injections that can cause menopause

a variation in normal development with *breast budding w/o pubic hair* can be caused by _____

1) exogenous source of estrogens 2) tumor

a variation in normal development with *pubic hair w/o breast budding* can be caused by _____

1) extragonadal source of androgens 2) lack of estrogen conversion

premature ovarian failure is fairly common, what are the causes?

1) lack of follicles 2) non-responsive follicles 3) autoimmune disease (kills off own oocytes) 4) unknown cause

top causes of *secondary amenorrhea*

1) pregnancy 2) premature ovarian failure 3) abnormal organ development

tests for ovarian tumor that causes precocious puberty

PAP smear Urine analysis

*hypothalamic/pituitary cause of precocious puberty* are usually due to ______

Tumors Lesions Cysts

when should you refer a young girl for an endocrine workup?

Variation in normal development: 1) Pubic Hair w/o breast budding 2) Breast Budding w/o pubic hair

*Girls who go thru puberty before age 8 are at increased risk for developing*: a) what endocrine ovarian disorder? b) what cancer?

a) polycystic ovarian disorder b) breast cancer

obesity increases exposure to estrogens through _____

adipocyte production

what is *congenital adrenal hyperplasia*

autosomal recessive disorder with wide variation in severity

ovarian tumor causes of precocious puberty characterisitcs

benign or malignant and usually palpable rare

females commonly get *secondary amenorrhea* form ___

birth control

in females *congenital adrenal hyperplasia*, the most severe forms are recognized at _____ and treatment begins ___

birth; soon after

*most common adrenal tumor* leading to precocious puberty

congenital adrenal hyperplasia

what is *McCune Albright*

congenital defect of the hypothalamus

what is *delayed sexual maturation*

delay in onset of puberty and development of sexual organs

amenorrhea is a good indicator that something is wrong with the ____

endocrine system

Precocious puberty causes adult height to be shorter than average. Why?

epiphysis close earlier

*secondary amenorrhea* definition

had a menses but it stopped for at least 6 months

*adrenal tumors* produce hormones that can cause ____ development

heterosexual or mixed

what is *cryptogenic precocious puberty*

idiopathic early sexual development. 80-90%

*hypothalamic/pituitary cause of precocious puberty* can be an acquired CNS injury from _______

inflammation surgery trauma radiation abscess

what is *amenorrhea*

lack of menses

primary amenorrhea definition

lack of menses by age 16

primary amenorrhea is diagnosed by ____

lack of menses by age 16

Precocious puberty may be noted in infancy. As a youth the children appear ________ and why?

larger and taller than peers (accelerated long bone growth)

Precocious puberty girls have ____ but rarely have _____

menstrual cycles; ovulate

*primary amenorrhea* definition

no menses ever

liver tumors producing hormones may stimulate the gonads to _________

stimulate sex hormones by increasing HCG

removal of the tumor or cyst may cause _________

stoppage of sexual development