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