PUBERTYPUBERTY

Definition:Hormonal changes during period of infancy and early childhood [Age 9-15]

Mechanism:• Separation of newly born infant from maternal and placental source of oestrogen.

• Release of FSH, LH from –ve feedback mechanism.

• Gn at 3 months

• Follicular maturation and atresia – estradiol secretion

• -ve feedback mechanism is re-established.

• Gn at 2 years till the age of puberty.

During period of puberty– Initiated

– Release of pulsatile Gn-RH from –ve FM

– Level of Gn [FSH-LH] at sleep and steroid hormone.

– Appearance of secondary sexual characters and adult

function [menarche and ovulation]

Menarche: the first menstruation

Factors affecting the age of puberty: Genetic factor

Nutritional factor

Physical health

Psychic condition and social

Stages of Puberty: Acceleration growth [growth hormone and gonadal estrogen.

Breast development {Theiarce] effect of estrogen.

Public and axillary hair [Adrenarche] effect of adrenal

androgen.

Menarche: menstruation.

Abnormalities of puberty: Precocious puberty

Delayed puberty.

Tanner StagingTanner Staging

Breast Stage I - prepubertal Stage II breast bud [9.8 y] Stage III breast elevation [11.2 y] Stage IV areolar mound [12 y] Stage V adult contour [14.5 y]

Pubic Hair Stage I - prepubertal Stage II pre sexual hair [10.5 y] Stage III sexual hair [11.5 y] Stage IV mid escutecheon [12 y] Stage V female escutecheon [13.5 y]

Age in YearsAge in Years

At 9.8 years breast budAt 10.5 years onset of pubic hairAt 11.4 years maximal growthAt 12.8 years menarcheAt 14.6 years adult breastAt 13.7 years adult pubic hair

Precocious PubertyPrecocious Puberty

Causes Premature Gn secretion

Idiopathic

CNS Lesion:

◦ Neoplastic

◦ Post inflammatory

◦ Post traumatic

◦ Abnormality of the skull

◦ Albright’s syndrome

Abnormality of sex steroid

◦ Estrogen secreting tumours as:

◦ Gn secreting tumour of the ovary

◦ Feminizing tumour of adrenal gland

◦ Drug ingestion

Heterosexual prcocious ouberty

◦ Cong. Adrenal hyperplasia

◦ Virilizing tumour of the adrenal

◦ Virilizing tumour of the ovary

Delayed PubertyDelayed Puberty

Causes1. Constitutional2. Secondary to chronic ill health as: ch. Neph. Du.J.

diabetes, amonia, anorxio nervosa and malnutrition. 3. Hypergonadotrophic hypogonadism:

• Gonadal dysgenesis • Insensitive ovary syndrome • Autoimmune ovarian failure • Agonadism

4. Hypogonadotrophic hypogonadism: • Pan hypopituitrism • Isolated Gn deficiency

5. Steroid hormone biosynthesis defect