Term
| what is going on in the HPA axis as a infant and child |
|
Definition
| it is very sensitive to estrogen, E2 is <10 and it suppresses the HPA even though its low |
|
|
Term
|
Definition
| thelarche, androgenarche, pubarche, gonadarche, menarche |
|
|
Term
| average bone age at thelarche |
|
Definition
|
|
Term
| average age of androgenarche |
|
Definition
|
|
Term
| what happens in androgenarche |
|
Definition
| it is independent of HPA, response to ACTH becomes more sensitive and favors DHEA production |
|
|
Term
| average age of pubic hair |
|
Definition
|
|
Term
| average age of axillary hair |
|
Definition
|
|
Term
| what happens in gonadarche |
|
Definition
| the HPA axis becomes less sensitive to estrogen negative feedback and more sensitive to GNRH so FHS/LH are made thus making E2/androgens |
|
|
Term
| average bone age at menarche |
|
Definition
|
|
Term
| how long is it usually between androgenarche and gonadarche |
|
Definition
|
|
Term
| #1 factor on when someone will go into puberty |
|
Definition
|
|
Term
| factors alterning when someone will go into puberty - 4 |
|
Definition
| genetics, location, light (differnt in blind people), BMI need 17% |
|
|
Term
| why does low BMI alter puberty timing |
|
Definition
| leptin is low with low BMI, we dont know why but in puberty leptin is supposed to be high, it is also involved in LH surge, ovulation, and menarche |
|
|
Term
| what is the gonadostat theory |
|
Definition
| in gonadarche the HPA axis becomes less senesitive to estrogen negative feedback and more sensitive to GNRH |
|
|
Term
|
Definition
1 - papilla
2 - bud
3 - enlarge, nipples dont separate
4 - secondary aerolar mound
5 - mature |
|
|
Term
|
Definition
1 - none
2 - sparse
3 - mons
4 - lateral spread
5 - thighs |
|
|
Term
| what is a GNRH suppression test |
|
Definition
| give lupron 20ug and in 40min test LH, if <6 the the precocious puberty is independent of GNRH, if >6 then it is dependent on GNRH |
|
|
Term
| define precocious puberty |
|
Definition
| breast or hair growth with menses at <8yo (or <7yo in while and <6yo in AA) |
|
|
Term
| when should you initiate a precocious puberty work up |
|
Definition
<6yo with hair growth OR breast development
<8yo with both hair growth AND breast development |
|
|
Term
| 4 signs the precocious puberty is likley pathological |
|
Definition
| bones are >2 fast, height is 2SD low, CNS symptoms, affecting emotional health |
|
|
Term
| 3 signs the precocious puberty is likely CNS |
|
Definition
| <6yo, rapid progression, CNS symptoms |
|
|
Term
| if you identify central precocious puberty with LH >6 on GNRH test what do you order next |
|
Definition
|
|
Term
| if you identify peripherial precocious puberty with LH <6 (<0.1) on GNRH test what do you order next |
|
Definition
|
|
Term
| when you do your GNRH test for precocious puberty and you get the FSH and LH, what does it mean if the FSH is high |
|
Definition
| it might be isolated premature thelarche |
|
|
Term
| 3 signs it might be central precocious puberty clinically |
|
Definition
| timing is the same as regular puberty just earlier, increased bone age and height are appropirate for that stage in puberty |
|
|
Term
| causes of central pecocious puberty - 5 |
|
Definition
| idiopathic, constitutional, rapid resumption of nutrition, brain tumors/infection/damage, conganital midline defects, NF1, struge webber |
|
|
Term
| what insults to the brain (tumors, infections, damage) can cause precocious puberty - 11 |
|
Definition
| encephalitis, meningitis, head trauma, hypothalamic harmatoma (of tuber cinereum), craniophaeyngoma, astrocytoma, penedyoma, pinealoma, optic gluoma, hydrocephalus, subarachnoid cyst |
|
|
Term
| #1 tumor that causes precocious puberty |
|
Definition
| hypothalamic harmatoma of tuber cinereum |
|
|
Term
| #1 cause of central precocious puberty |
|
Definition
| idiopathic and constitutional are 50% |
|
|
Term
| average age of constitutional precocious puberty |
|
Definition
|
|
Term
| signs of a hypothalamic harmatoma of tuber cinereum and cause |
|
Definition
| 1-2yo puberty, cells increased GFb which cause increased GNRH |
|
|
Term
| #1 cause of peripherial precocious puberty |
|
Definition
| simple functional ovarian cyst |
|
|
Term
| 3 causes of virilizing precocious puberty |
|
Definition
| sertoli leydig tumor, gonadoblastoma, 21-hydroxylase deficiency non-classical |
|
|
Term
| only cause of percocious puberty with normal (or even decreased) bone age |
|
Definition
|
|
Term
| management of central precocious puberty |
|
Definition
| suppress with GNRH analog (lupron) until appropirate puberty time |
|
|
Term
| causes of peripherial precocious puberty - 6 |
|
Definition
| ovarian tumors, mccune albright, 21hydroxylase non-classical, peutz jegher, silver russel, enviromental |
|
|
Term
| enviromental causes of peripherial precocious puberty - 6 |
|
Definition
| OCPs, premarin, cosmetics, biphenyls, pesticides, topical steroids |
|
|
Term
| ovarian masses that cause peripherial precocious puberty - 3 |
|
Definition
| simple functional cyst, granulosa cell tumor, gonadoblastoma |
|
|
Term
| management of peripherial precocious puberty - when to treat - 3 |
|
Definition
| >6 cm/y off growth, bone age >1y off, perdicted height < target |
|
|
Term
| management of peripherial precocious puberty |
|
Definition
| GNRH analogs (can do 1y implant called histerlin), need to monitor E2 to be <10 q3-6mo |
|
|
Term
| you have to start GNRH analog in precocious puberty before what age to increase height |
|
Definition
|
|
Term
| which cause of precocious puberty is associated gonadal disgenesys |
|
Definition
|
|
Term
| why does primary hypothyroidism cause precocious puberty |
|
Definition
| so much TSH it activates the FSH receptors (and PRL receptors) |
|
|
Term
| signs of primary hypothyroidism |
|
Definition
| big ovaries, TSH in 900s, elevated E2, elevated PRL, galactorrhea, NORMAL OR LOW BONE AGE |
|
|
Term
| McCune albright is what % of percocious puberty |
|
Definition
|
|
Term
|
Definition
| ovaries make E2 without FSH/LH due to GSA mutation |
|
|
Term
| signs McCune albright - 5 |
|
Definition
| infant puberty, cafe au lait spots that are irregular and stop at the midline, fibrous bone dysplasia and fracture, progressive scoliosis |
|
|
Term
| McCune albright associated diseases - 6 |
|
Definition
| GH/PRL tumors (Acromeagly), cushings, adrenal hyperplasia, hyperthyroid, ovarian cysts |
|
|
Term
| McCune albright treatment - 2 |
|
Definition
| AIs, bisphosphonates for bone dysplasia and fracture |
|
|
Term
| define precocious puberty |
|
Definition
| breast or hair growth with menses at <8yo (or <7yo in while and <6yo in AA) |
|
|
Term
| when should you initiate a precocious puberty work up |
|
Definition
<6yo with hair growth OR breast development
<8yo with both hair growth AND breast development |
|
|
Term
| 4 signs the precocious puberty is likley pathological |
|
Definition
| bones are >2 fast, height is 2SD low, CNS symptoms, affecting emotional health |
|
|
Term
| 3 signs the precocious puberty is likely CNS |
|
Definition
| <6yo, rapid progression, CNS symptoms |
|
|
Term
| if you identify central precocious puberty with LH >6 on GNRH test what do you order next |
|
Definition
|
|
Term
| if you identify peripherial precocious puberty with LH <6 (<0.1) on GNRH test what do you order next |
|
Definition
|
|
Term
| when you do your GNRH test for precocious puberty and you get the FSH and LH, what does it mean if the FSH is high |
|
Definition
| it might be isolated premature thelarche |
|
|
Term
| 3 signs it might be central precocious puberty clinically |
|
Definition
| timing is the same as regular puberty just earlier, increased bone age and height are appropirate for that stage in puberty |
|
|
Term
| causes of central pecocious puberty - 5 |
|
Definition
| idiopathic, constitutional, rapid resumption of nutrition, brain tumors/infection/damage, conganital midline defects, NF1, struge webber |
|
|
Term
| what insults to the brain (tumors, infections, damage) can cause precocious puberty - 11 |
|
Definition
| encephalitis, meningitis, head trauma, hypothalamic harmatoma (of tuber cinereum), craniophaeyngoma, astrocytoma, penedyoma, pinealoma, optic gluoma, hydrocephalus, subarachnoid cyst |
|
|
Term
| #1 tumor that causes precocious puberty |
|
Definition
| hypothalamic harmatoma of tuber cinereum |
|
|
Term
| #1 cause of central precocious puberty |
|
Definition
| idiopathic and constitutional are 50% |
|
|
Term
| average age of constitutional precocious puberty |
|
Definition
|
|
Term
| signs of a hypothalamic harmatoma of tuber cinereum and cause |
|
Definition
| 1-2yo puberty, cells increased GFb which cause increased GNRH |
|
|
Term
| #1 cause of peripherial precocious puberty |
|
Definition
| simple functional ovarian cyst |
|
|
Term
| 3 causes of virilizing precocious puberty |
|
Definition
| sertoli leydig tumor, gonadoblastoma, 21-hydroxylase deficiency non-classical |
|
|
Term
| only cause of percocious puberty with normal (or even decreased) bone age |
|
Definition
|
|
Term
| management of central precocious puberty |
|
Definition
| suppress with GNRH analog (lupron) until appropirate puberty time |
|
|
Term
| causes of peripherial precocious puberty - 6 |
|
Definition
| ovarian tumors, mccune albright, 21hydroxylase non-classical, peutz jegher, silver russel, enviromental |
|
|
Term
| enviromental causes of peripherial precocious puberty - 6 |
|
Definition
| OCPs, premarin, cosmetics, biphenyls, pesticides, topical steroids |
|
|
Term
| ovarian masses that cause peripherial precocious puberty - 3 |
|
Definition
| simple functional cyst, granulosa cell tumor, gonadoblastoma |
|
|
Term
| management of peripherial precocious puberty - when to treat - 3 |
|
Definition
| >6 cm/y off growth, bone age >1y off, perdicted height < target |
|
|
Term
| management of peripherial precocious puberty |
|
Definition
| GNRH analogs (can do 1y implant called histerlin), need to monitor E2 to be <10 q3-6mo |
|
|
Term
| you have to start GNRH analog in precocious puberty before what age to increase height |
|
Definition
|
|
Term
| which cause of precocious puberty is associated gonadal disgenesys |
|
Definition
|
|
Term
| why does primary hypothyroidism cause precocious puberty |
|
Definition
| so much TSH it activates the FSH receptors (and PRL receptors) |
|
|
Term
| signs of primary hypothyroidism |
|
Definition
| big ovaries, TSH in 900s, elevated E2, elevated PRL, galactorrhea, NORMAL OR LOW BONE AGE |
|
|
Term
| McCune albright is what % of percocious puberty |
|
Definition
|
|
Term
|
Definition
| ovaries make E2 without FSH/LH due to GSA mutation |
|
|
Term
| signs McCune albright - 5 |
|
Definition
| infant puberty, cafe au lait spots that are irregular and stop at the midline, fibrous bone dysplasia and fracture, progressive scoliosis |
|
|
Term
| McCune albright associated diseases - 6 |
|
Definition
| GH/PRL tumors (Acromeagly), cushings, adrenal hyperplasia, hyperthyroid, ovarian cysts |
|
|
Term
| McCune albright treatment - 2 |
|
Definition
| AIs, bisphosphonates for bone dysplasia and fracture |
|
|
Term
| define precocious puberty |
|
Definition
| breast or hair growth with menses at <8yo (or <7yo in while and <6yo in AA) |
|
|
Term
| when should you initiate a precocious puberty work up |
|
Definition
<6yo with hair growth OR breast development
<8yo with both hair growth AND breast development |
|
|
Term
| 4 signs the precocious puberty is likley pathological |
|
Definition
| bones are >2 fast, height is 2SD low, CNS symptoms, affecting emotional health |
|
|
Term
| 3 signs the precocious puberty is likely CNS |
|
Definition
| <6yo, rapid progression, CNS symptoms |
|
|
Term
| if you identify central precocious puberty with LH >6 on GNRH test what do you order next |
|
Definition
|
|
Term
| if you identify peripherial precocious puberty with LH <6 (<0.1) on GNRH test what do you order next |
|
Definition
|
|
Term
| when you do your GNRH test for precocious puberty and you get the FSH and LH, what does it mean if the FSH is high |
|
Definition
| it might be isolated premature thelarche |
|
|
Term
| 3 signs it might be central precocious puberty clinically |
|
Definition
| timing is the same as regular puberty just earlier, increased bone age and height are appropirate for that stage in puberty |
|
|
Term
| causes of central pecocious puberty - 5 |
|
Definition
| idiopathic, constitutional, rapid resumption of nutrition, brain tumors/infection/damage, conganital midline defects, NF1, struge webber |
|
|
Term
| what insults to the brain (tumors, infections, damage) can cause precocious puberty - 11 |
|
Definition
| encephalitis, meningitis, head trauma, hypothalamic harmatoma (of tuber cinereum), craniophaeyngoma, astrocytoma, penedyoma, pinealoma, optic gluoma, hydrocephalus, subarachnoid cyst |
|
|
Term
| #1 tumor that causes precocious puberty |
|
Definition
| hypothalamic harmatoma of tuber cinereum |
|
|
Term
| #1 cause of central precocious puberty |
|
Definition
| idiopathic and constitutional are 50% |
|
|
Term
| average age of constitutional precocious puberty |
|
Definition
|
|
Term
| signs of a hypothalamic harmatoma of tuber cinereum and cause |
|
Definition
| 1-2yo puberty, cells increased GFb which cause increased GNRH |
|
|
Term
| #1 cause of peripherial precocious puberty |
|
Definition
| simple functional ovarian cyst |
|
|
Term
| 3 causes of virilizing precocious puberty |
|
Definition
| sertoli leydig tumor, gonadoblastoma, 21-hydroxylase deficiency non-classical |
|
|
Term
| only cause of percocious puberty with normal (or even decreased) bone age |
|
Definition
|
|
Term
| management of central precocious puberty |
|
Definition
| suppress with GNRH analog (lupron) until appropirate puberty time |
|
|
Term
| causes of peripherial precocious puberty - 6 |
|
Definition
| ovarian tumors, mccune albright, 21hydroxylase non-classical, peutz jegher, silver russel, enviromental |
|
|
Term
| enviromental causes of peripherial precocious puberty - 6 |
|
Definition
| OCPs, premarin, cosmetics, biphenyls, pesticides, topical steroids |
|
|
Term
| ovarian masses that cause peripherial precocious puberty - 3 |
|
Definition
| simple functional cyst, granulosa cell tumor, gonadoblastoma |
|
|
Term
| management of peripherial precocious puberty - when to treat - 3 |
|
Definition
| >6 cm/y off growth, bone age >1y off, perdicted height < target |
|
|
Term
| management of peripherial precocious puberty |
|
Definition
| GNRH analogs (can do 1y implant called histerlin), need to monitor E2 to be <10 q3-6mo |
|
|
Term
| you have to start GNRH analog in precocious puberty before what age to increase height |
|
Definition
|
|
Term
| which cause of precocious puberty is associated gonadal disgenesys |
|
Definition
|
|
Term
| why does primary hypothyroidism cause precocious puberty |
|
Definition
| so much TSH it activates the FSH receptors (and PRL receptors) |
|
|
Term
| signs of primary hypothyroidism |
|
Definition
| big ovaries, TSH in 900s, elevated E2, elevated PRL, galactorrhea, NORMAL OR LOW BONE AGE |
|
|
Term
| McCune albright is what % of percocious puberty |
|
Definition
|
|
Term
|
Definition
| ovaries make E2 without FSH/LH due to GSA mutation |
|
|
Term
| signs McCune albright - 5 |
|
Definition
| infant puberty, cafe au lait spots that are irregular and stop at the midline, fibrous bone dysplasia and fracture, progressive scoliosis |
|
|
Term
| McCune albright associated diseases - 6 |
|
Definition
| GH/PRL tumors (Acromeagly), cushings, adrenal hyperplasia, hyperthyroid, ovarian cysts |
|
|
Term
| McCune albright treatment - 2 |
|
Definition
| AIs, bisphosphonates for bone dysplasia and fracture |
|
|
Term
| define premature adrenarche |
|
Definition
| pubic or axillary hair before 8yo without any other puberty signs |
|
|
Term
| define premature thelarche |
|
Definition
| breast <8yo, (or <7yo white, <6yo AA) without any other puberty signs |
|
|
Term
| define premature menarche |
|
Definition
| menarchal bleeding without thelarche androgenarche or any other puberty signs |
|
|
Term
| causes of premature andrenarche - 4 |
|
Definition
| #1 idiopathic, CAH, kallmann, gonadal dysgenesis |
|
|
Term
| management of premature andrenarche |
|
Definition
| rule out everything else, serial heights and bone age just to make sure |
|
|
Term
| prognosis of premature andrenarche - 6 |
|
Definition
| slight early puberty, normal adult height, increased PCOS/DM/HLD risk, 20% you were wrong its precocious puberty |
|
|
Term
| cause of premature thelarche |
|
Definition
| possible increased sensitivity of the breast tissue to normal estrogen |
|
|
Term
| signs of premature thelarche |
|
Definition
| usually tanner stage 2 and UL/BL |
|
|
Term
| 2 types of premature thelarche |
|
Definition
| type 1 6mo-2y (60%), type 2 5-7y |
|
|
Term
| management of premature thelarche |
|
Definition
| rule out everything else, folow up q4-6mo just to make sure it isnt anything else |
|
|
Term
| prognosis of premature thelarche - 3 |
|
Definition
| 50% regress, 35% persist, 15% you were wrong its precocious puberty |
|
|
Term
| causes of premature menarche - 5 |
|
Definition
| idiopathic, foreign body, infection, abuse, cancer |
|
|
Term
| if you suspect premature menarche you BETTER rule out what |
|
Definition
|
|
