Puberty

Jack Biko MBBCh, Mmed O & G, FCOG, Dip Advanced Endoscopic Surgery

Definition

• Process of physical change by which a child’s body becomes an adult body capable of reproduction

• Average age of onset is 10.7yrs

• Average duration is 4.5yrs

Puberty

• Maturation of hypothalamus

• Stimulation of sex organs

• Secretion of sex steroids

• Sexual characteristics begin to develop

• Sexual reproduction achieved

Neurohormonal changes

• Hypothalamus release pulses of GNRH

• Anterior pituatory release FSH and LH

• Gonads grow and release Oestrogen and Testosterone

• Oestrogen and testosterone produce body changes of female & male puberty

Puberty

• Fertility achieved, secondary sex characteristics develop – Features that distinguish sexually mature men and women

• Increase in release of anterior pituitary hormones – Growth hormone – acts on bone and muscle – Gonadoptrophic hormone – Adrenocorticotrophic hormone

Copyright © 2006 by Allyn and Bacon

Factors affecting onset

• Genetic

• Nutrition

• General health

• Geographic location

• Exposure to light

• Psychological state

Factors affecting onset

• More boys than girls present with delayed puberty

• Overweight girls have earlier onset

• Blacks have earlier onset

Physical changes

• Accelerated growth

• Breast budding (Thelarche)

• Pubic hair growth (Pubarche)

• Peak growth velocity

• Onset of mentruation (menache)

Other changes

• White vagina secretions (leukorrhea)

• Acne

• Widening of lower body (hips) due to increased body fat

Tanner staging

Delayed puberty

• No secondary sexual characteristics by 13/14yrs, or

• No menarche by 16yrs

• Constitutional delay is the most common cause

Delayed Puberty

• Elevated gonadotropins: gonadal disease/ primary hypogonadism

• Low/normal gonadotropins: Hypothalamic/ pituatory disease/ secondary hypogonadism

History

• Anorexia/bulemia

• Exersive exercise

• Family history

• Chemotherapy

• Previous surgery

• Head injury

• Drug abuse

• Growth measurement

• Sexual maturity

• Physical stigmata

• Behavioral abnormalities

• thyroid

Hypogonadotropic Hypogonadism

• Constitutional delay

• Congenital deficiencies LH & FSH receptor abnormalities

IHH (GNRH deficiency)

Kallmann’s syndrome

• Chronic disease

• Hypothyroid

• Hyperprolactinemia

• Brain tumours

Hypergonadotropic Hypergonadism

• Gonadal dysgenesis Turner’s syndrome

• Androgen resistance

• Autoimmune

Treatment

• Treat the cause: Thyroid treatment

Growth hormone

? Gonadectomy for XY

Hormone therapy

Precocious puberty

• Premature production of GNRH FSH & LH

• Production of Oestrogens or Androgens from ovaries, adrenals

Premature onset of secondary sexual characteristics (before 8yrs)

Precocious puberty

• True precocity • Ealy maturation of HPG axis

• Idiopathic

• CNS pathology

• Precocious pseudopuberty • Increased steroid hormone production independent of Gonadotopins

• Ovarian cysts

• Adrenal musculinization

• Ectopic gonadotropin production

Clinical features

• Breast development

• Rapid height growth

• Onset of periods

• Mature body habitus

• Acne

Effects

• Does not fit in with friend

• Poor body image

• Lower self esteem (increased libido in boys, early menses in girls)

• Early growth spurt initially – tall stature BUT:

• Rapid bone maturation – short adult stature.

Aims of treatment

• Diagnose and treat intracranial disease

• Arrest maturation until normal pubertal age

• Attenuate established precocious features

• Maximize eventual adult height

• Avoid abuse and emotional problems

• contraception

Treatment

• Surgery

• Radiotherapy

• GNRH agonists

Thank you