pubertal disorders dr olcay evliyaoğlu pediatric endocrinology department

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Pubertal disorders Dr Olcay Evliyaoğlu Pediatric Endocrinology Department

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  • Slide 1
  • Pubertal disorders Dr Olcay Evliyaolu Pediatric Endocrinology Department
  • Slide 2
  • Puberty Sexual differentiation begins on 4-5th week of gestational age.
  • Slide 3
  • ADOLESENCE Physical, sexual, physcological development. Transition to adulthood from childhood Not an adult nor child Time of transition Establishment of individualism.
  • Slide 4
  • PUBERTY Secondary sex characteristics are developed Includes Physical growth Sexual development Psychological development
  • Slide 5
  • Growth spurt, disturbution of muscle and fat bone maturation and fusion of epiphysical centers Adult height At the end of this period spermatogenesis in boys, ovulation in girls occur
  • Slide 6
  • STRESS MATURATONNUTRTON ++ CENTRAL NERVOUS SYSTEM + +-- + + + --- -- -- ++ -- - - - - GLUTAMATGABAENDROFIN HYPOTHALAMUS GnRH PTUTARY PRL LH FSH TEKA OVARY GRANULOZA ANDROGEN ESTROGEN INHIBIN - LEPTIN What makes HHG axis work
  • Slide 7
  • HypothalamusGnRH pulse frequency and amplitude increase LH pulse frequency and amplitude increase At early stages at nights With progression of puberty pulses occur during day Pituitary Gonadarche
  • Slide 8
  • LH Granulosa cells FSH Estradiol (E2) androstenedionTeca cells Gonadarche
  • Slide 9
  • LH Leydig cells testosteron Gonadarche
  • Slide 10
  • Adrenarche Increase in the secretion of adrenal androgens Appearance of pubic hair (pubarche) Axillary hair
  • Slide 11
  • CRH ACTH Adrenal androgens Hypothalamus Pituitary Adrenal cortex Adrenarche
  • Slide 12
  • Genetic and environmental conditions effect timing of puberty Environmental factors: Socioeconomic factors Nutrition General health Geographical place lived
  • Slide 13
  • Nutrition and puberty Menarche is earlier in obese girls Malnutrition, chronic diseases, and excessive physical activity delay puberty and menarche
  • Slide 14
  • LEPTN Codes Ob gene Synthesized in adipose tissue. Leptin signals stimulate central nervous system Leptin levels are decreased in excessive physical activity, anorexia nevrosa and amenorea.
  • Slide 15
  • hypothalamus LHRH secreting neurons Leptin LHRH pituitary gonadotrophs Leptin mRNA Adipose cells LH, FSH
  • Slide 16
  • Timing of puberty is related to bone age rather than chronological age BA< CY ------------- delay in puberty BA = CA ------------- puberty on expected age BA>CA -------------- early puberty (puberty precocous)
  • Slide 17
  • In girls the first sign of puberty is telarche, generally observed on 10 - 11 ages, menarche is observed 2-3 years after telarche. In girls growth spurt occurs 2 years earlier than boys. Growth spurt in girls is at the time of telarche, In boys growth spurt occur at the time when testes volumes are 10 ml. Telarche Pubarche Menarche
  • Slide 18
  • Pubertal development in girls breast development(tanner staging) 1. Prepubertal 2. Palpation of breat bud 3. Palpation of breat tissue with out any changes in contures 4. Development of breast tissue 5. Adult type breast
  • Slide 19
  • Pubic hair 1.No hair 2. Appearance of short hair on labium majora 3. Black and thic hair on mons pubis 4. Adult type hair but not spread to inguinal area 5. Adult type with the shape of inverted triangle
  • Slide 20
  • Tanner staging Girls pubic hair Stage 1: no pubic hair Stage 2: lightly pigmented localized on labiums Stage 3: coarser, darker, more curved, increased in amount spread to pubis Stage 4: curved and increased still less than an adult. Stage 5: adult women triangle spread to thighs
  • Slide 21
  • Tanner staging Breast development Stage 1: prepubertal Stage 2: breast budding Stage 3: enlargement of breast tissue and areola Stage 4: Areola and papilla forms secondary mound. Stage 5: Mature
  • Slide 22
  • Tanner stage 4 2-3years after telarche Menarche
  • Slide 23
  • Tanner stage 4 2-3years after telarche Menarche
  • Slide 24
  • FSH secretion Dominant follicule estrogen LH secretion Ovulation corpus luteum Progesterone Endometrium prepared If no implantation uterine bleeding Follicular phase Luteal phase
  • Slide 25
  • Pituitary hormones Ovarian hormones ovary Endometrium stihdam Seim dominant istihdam Follicular /proliferative phaseLuteal /secretuary phase follicule ovulation corpus luteum corpus albicans
  • Slide 26
  • LH estrogen - + + Ovulation corpus luteumProgesterone endometrium is prepared for implantation Luteal phase
  • Slide 27
  • If no implantation occurs Corpus luteum regression Progesterone levels decline Endometrium can not hold itself-desquamation Spiral arteriols in the functional and basal layers of endometriumun contracts and approx in 7 gn days bleeding stops Luteal phase 14+2 days
  • Slide 28
  • In boys initial finding of puberty is enlargement of testes. This is followed by scrotum pigementation and thinning of scrotal skin. Penis enlarges. Pubic hair develops. Growth spurt occurs at 14-16 years and usually continues until 18 years.
  • Slide 29
  • Pubertal development in boys Tanner staging Testes volumes 1-3 ml P1 4-9 ml P2 10-14 ml P3 15-20 ml P4 > 20 ml P5 Prepubertal testes diameter < 2.5 cm= 4 ml
  • Slide 30
  • Tanner staging Pubic hair stage 1: no pubic hair Stage 2: little pubic hair Stage 3: pubic hair on pubis Stage 4: adult type hair but no invasion on tighs Stage 5 : adult type hair spread to thighs