{"id":181,"date":"2020-08-13T16:04:10","date_gmt":"2020-08-13T16:04:10","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=181"},"modified":"2021-05-09T20:48:48","modified_gmt":"2021-05-09T20:48:48","slug":"42-puberty","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/42-puberty\/","title":{"rendered":"42. Puberty"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/r40HPAiybWg\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 7:33<\/p>\n<input type='hidden' bg_collapse_expand='69e9b56aa745d7036003863' value='69e9b56aa745d7036003863'><input type='hidden' id='bg-show-more-text-69e9b56aa745d7036003863' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b56aa745d7036003863' value='Hide Transcript'><button id='bg-showmore-action-69e9b56aa745d7036003863' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b56aa745d7036003863' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 42 puberty<br \/>\n00:03<br \/>\nmeet Tina Tanner this video will discuss<br \/>\n00:06<br \/>\npuberty the endocrine process that will<br \/>\n00:08<br \/>\ninvolve Tina&#8217;s physical emotional and<br \/>\n00:10<br \/>\nsexual transition from childhood to<br \/>\n00:12<br \/>\nadulthood the objectives of this video<br \/>\n00:14<br \/>\nto describe the changes in the<br \/>\n00:15<br \/>\nhypothalamic pituitary ovarian axis and<br \/>\n00:18<br \/>\ntarget organs during normal puberty<br \/>\n00:19<br \/>\nexplain the normal sequence of pubertal<br \/>\n00:22<br \/>\nevents and ages at which these changes<br \/>\n00:24<br \/>\noccur discuss the psychological issues<br \/>\n00:27<br \/>\nassociated with puberty and finally<br \/>\n00:29<br \/>\ndefine precocious and delayed puberty<br \/>\n00:30<br \/>\nand describe the steps the initial<br \/>\n00:32<br \/>\nevaluation of these conditions let&#8217;s<br \/>\n00:34<br \/>\nstart our discussion with the<br \/>\n00:35<br \/>\nhypothalamic pituitary ovarian or hpo<br \/>\n00:38<br \/>\naxis this has been quiet and all<br \/>\n00:40<br \/>\nthroughout Tina&#8217;s childhood and it<br \/>\n00:42<br \/>\nstarts to become active during puberty<br \/>\n00:44<br \/>\nthe arcuate nucleus and the hypothalamus<br \/>\n00:46<br \/>\nreleases GnRH this will stimulate the<br \/>\n00:50<br \/>\nanterior pituitary to release the<br \/>\n00:51<br \/>\ngonadotropins FSH and LH these will<br \/>\n00:54<br \/>\nstimulate the ovary to produce estradiol<br \/>\n00:56<br \/>\nand progesterone the ovary is not the<br \/>\n00:59<br \/>\nonly source of sex hormone production<br \/>\n01:00<br \/>\nand women adren are key the production<br \/>\n01:03<br \/>\nof androgens from the adrenal glands<br \/>\n01:04<br \/>\nbegins at approximately six to eight<br \/>\n01:06<br \/>\nyears for girls this involves the<br \/>\n01:08<br \/>\nincreased production of<br \/>\n01:09<br \/>\ndehydroepiandrosterone which can be<br \/>\n01:11<br \/>\nconverted to the more potent and Rajan&#8217;s<br \/>\n01:13<br \/>\ntestosterone and dihydrotestosterone<br \/>\n01:16<br \/>\nTina&#8217;s sexual maturation will take<br \/>\n01:18<br \/>\napproximately four years and occurs in a<br \/>\n01:20<br \/>\npredictable sequence first there is<br \/>\n01:22<br \/>\ngrowth acceleration then the larkey or<br \/>\n01:25<br \/>\nbreast development puberty or pubic hair<br \/>\n01:27<br \/>\ndevelopment a period of maximum growth<br \/>\n01:29<br \/>\nrate and then menarchy the onset of<br \/>\n01:31<br \/>\nmenses and ovulation estradiol from the<br \/>\n01:34<br \/>\novaries will stimulate the larkey and<br \/>\n01:36<br \/>\nandrogens from the adrenal gland will<br \/>\n01:38<br \/>\nstimulate pube Archy there is a strong<br \/>\n01:40<br \/>\nrelationship between body fat content<br \/>\n01:42<br \/>\nand the onset of puberty mild to<br \/>\n01:44<br \/>\nmoderate obesity results in an earlier<br \/>\n01:46<br \/>\npuberty there is also ethnic variation<br \/>\n01:49<br \/>\nin the onset of puberty this table<br \/>\n01:51<br \/>\ndemonstrates the mean ages of theall our<br \/>\n01:53<br \/>\nkey pew bar key and monarchy and African<br \/>\n01:55<br \/>\nAmerican Mexican American and white<br \/>\n01:57<br \/>\ngirls the United States note that the<br \/>\n02:00<br \/>\nmean ages for theall are key and puberty<br \/>\n02:02<br \/>\nare almost a full year earlier for<br \/>\n02:04<br \/>\nafrican-american girls compared to white<br \/>\n02:06<br \/>\ngirls the mean age for men our key is<br \/>\n02:08<br \/>\ncloser for the three different<br \/>\n02:09<br \/>\nethnicities the sequence of breast and<br \/>\n02:12<br \/>\npubic hair development<br \/>\n02:13<br \/>\n\/ the Tanner classification of sexual<br \/>\n02:15<br \/>\nmaturity this quantifies five stages<br \/>\n02:18<br \/>\nstarting with stage one being<br \/>\n02:20<br \/>\npre-pubertal to stage 5 which is adult<br \/>\n02:22<br \/>\ndevelopment let&#8217;s now move to<br \/>\n02:24<br \/>\npsychological changes prior to puberty<br \/>\n02:27<br \/>\nthere is no gender difference in<br \/>\n02:28<br \/>\ndepression rates between boys and girls<br \/>\n02:30<br \/>\nduring puberty however the prevalence of<br \/>\n02:33<br \/>\ndepression is twice as great in girls<br \/>\n02:35<br \/>\ncompared to boys during puberty girls<br \/>\n02:37<br \/>\ncan become less satisfied with their<br \/>\n02:39<br \/>\nphysical appearance and develop a<br \/>\n02:40<br \/>\ndiminished self-worth these tendencies<br \/>\n02:43<br \/>\nhave been reported to be more pronounced<br \/>\n02:44<br \/>\nin white adolescents and this transition<br \/>\n02:46<br \/>\nis especially difficult if there is an<br \/>\n02:48<br \/>\nearly onset of puberty let&#8217;s move now to<br \/>\n02:51<br \/>\nprecocious puberty this is the onset of<br \/>\n02:53<br \/>\nsecondary sexual development prior to<br \/>\n02:55<br \/>\nage 6 for african-american girls and age<br \/>\n02:57<br \/>\n7 for white girls let&#8217;s quickly diagram<br \/>\n03:00<br \/>\nthe hpo axis again here is the<br \/>\n03:02<br \/>\nhypothalamus which secretes GnRH which<br \/>\n03:04<br \/>\nstimulates the pituitary which will then<br \/>\n03:06<br \/>\nstimulate the ovary to make sex hormones<br \/>\n03:08<br \/>\nthere are GnRH dependent and G and Rh<br \/>\n03:11<br \/>\nindependent causes of early sex hormone<br \/>\n03:14<br \/>\nproduction GnRH dependent causes result<br \/>\n03:17<br \/>\nfrom early activation of the HPA axis<br \/>\n03:20<br \/>\nthis is most commonly idiopathic other<br \/>\n03:22<br \/>\nideologies are infection or inflammation<br \/>\n03:24<br \/>\nof the central nervous system and rarely<br \/>\n03:27<br \/>\na tumor of the hypothalamic pituitary<br \/>\n03:29<br \/>\nstalk will cause this for the gnrh<br \/>\n03:32<br \/>\nindependent causes there is sex hormone<br \/>\n03:34<br \/>\nproduction independent of HP o axis<br \/>\n03:37<br \/>\nstimulation MacEwan albright syndrome<br \/>\n03:39<br \/>\nresults from a defect in cellular<br \/>\n03:41<br \/>\nregulation that results in the ovary<br \/>\n03:42<br \/>\nproducing estrogen without FSH<br \/>\n03:44<br \/>\nstimulation this syndrome is also<br \/>\n03:46<br \/>\ncharacterized by multiple bone fractures<br \/>\n03:48<br \/>\nand cafe au lait spots other causes of<br \/>\n03:52<br \/>\nGnRH independent precocious puberty<br \/>\n03:54<br \/>\ninclude ovarian tumors such as a<br \/>\n03:56<br \/>\ngranulosa cells 2 mer adrenal tumors or<br \/>\n03:59<br \/>\nenzyme secreting defects such as<br \/>\n04:00<br \/>\ncongenital adrenal hyperplasia and<br \/>\n04:02<br \/>\nantigenic causes such as ingestion of<br \/>\n04:05<br \/>\noral contraception the evaluation of<br \/>\n04:08<br \/>\nprecocious puberty should start with a<br \/>\n04:09<br \/>\ncareful history and first ask<br \/>\n04:11<br \/>\nspecifically how quickly puberty is<br \/>\n04:13<br \/>\nprogressing a rapid progression of<br \/>\n04:16<br \/>\npuberty symptoms suggest the GnRH<br \/>\n04:18<br \/>\nindependent cause such as an ovarian<br \/>\n04:19<br \/>\ntumor the history can also help you<br \/>\n04:22<br \/>\ndiscern if the symptoms seem to be more<br \/>\n04:24<br \/>\nfrom estrogen or androgen stimulation<br \/>\n04:26<br \/>\nthe next step will be physical<br \/>\n04:28<br \/>\nexamination with pubertal staging they<br \/>\n04:30<br \/>\nshould also be radiographic evaluation<br \/>\n04:32<br \/>\nof bone age the next step will be to<br \/>\n04:35<br \/>\ncheck a serum LH level first you check a<br \/>\n04:37<br \/>\nbaseline knowledge if this level is<br \/>\n04:39<br \/>\nmarkedly high then the diagnosis of GnRH<br \/>\n04:41<br \/>\ndependent precocious puberty can be made<br \/>\n04:43<br \/>\nfor an elevated LH shows that the hpo<br \/>\n04:45<br \/>\naxis is active if the baseline LH level<br \/>\n04:48<br \/>\nis lower intermediate the next step is<br \/>\n04:50<br \/>\nto administer a gnrh agonist if the<br \/>\n04:53<br \/>\nlevel increases then you know that you<br \/>\n04:55<br \/>\nhave a gnrh dependent etiology for the<br \/>\n04:57<br \/>\nprecocious puberty if there is no<br \/>\n04:59<br \/>\nincrease in the LH level with GnRH<br \/>\n05:01<br \/>\nstimulation then a gnrh independent<br \/>\n05:04<br \/>\ncause of the precocious puberty can be<br \/>\n05:05<br \/>\nmade the next step in the evaluation of<br \/>\n05:08<br \/>\na GnRH dependent cause of precocious<br \/>\n05:10<br \/>\npuberty will be brain imaging the<br \/>\n05:13<br \/>\nevaluation with a GnRH independent cause<br \/>\n05:15<br \/>\ninvolves looking for a peripheral cause<br \/>\n05:17<br \/>\nof the precocious puberty with<br \/>\n05:19<br \/>\nlaboratory testing and pelvic ultrasound<br \/>\n05:21<br \/>\nlet&#8217;s now discuss the opposite spectrum<br \/>\n05:23<br \/>\nwith delayed puberty this is when there<br \/>\n05:25<br \/>\nis no secondary sex characteristic<br \/>\n05:27<br \/>\ndevelopment by age 13 no evidence of<br \/>\n05:29<br \/>\nmenarche by age 15 to 16 or if menses<br \/>\n05:32<br \/>\nhave not occurred within five years of<br \/>\n05:34<br \/>\ntheall Archy there are hyper<br \/>\n05:35<br \/>\ngonadotropic and hypokinetic tropic<br \/>\n05:38<br \/>\nideologies for the hypogonadism as<br \/>\n05:40<br \/>\nassociated with delayed puberty with<br \/>\n05:43<br \/>\nhyper gonadotropic ideologies there will<br \/>\n05:45<br \/>\nbe an elevated FSH level for the hpo<br \/>\n05:48<br \/>\naxis is activated the most common causes<br \/>\n05:51<br \/>\nTurner syndrome the abnormality in our<br \/>\n05:54<br \/>\nabsence of one of the X chromosomes<br \/>\n05:56<br \/>\npatients with Turner syndrome can<br \/>\n05:58<br \/>\npresent with primary amenorrhea and<br \/>\n05:59<br \/>\nstreak ovaries they can often have<br \/>\n06:01<br \/>\nassociated short stature web neck and a<br \/>\n06:04<br \/>\nsolid chest treatment in this situation<br \/>\n06:07<br \/>\nwill involve administration of estrogen<br \/>\n06:08<br \/>\nwhich will stimulate breast development<br \/>\n06:10<br \/>\nand genital tract maturation in<br \/>\n06:12<br \/>\nhypokinetic tropic hypogonadism the<br \/>\n06:15<br \/>\narcuate nucleus does not secrete GnRH<br \/>\n06:17<br \/>\nthe most common etiology is<br \/>\n06:19<br \/>\nconstitutional delay which accounts for<br \/>\n06:21<br \/>\n20% of all cases of delayed puberty this<br \/>\n06:24<br \/>\ntends to be familial with calman<br \/>\n06:26<br \/>\nsyndrome there is hypoplastic olfactory<br \/>\n06:28<br \/>\ntracks and the arcuate nucleus does not<br \/>\n06:30<br \/>\nsecrete gnrh young women will have<br \/>\n06:33<br \/>\nlittle or no sense of smell and will<br \/>\n06:34<br \/>\nhave delayed puberty<br \/>\n06:35<br \/>\nother ideologies include anorexia<br \/>\n06:38<br \/>\nexercise or stress<br \/>\n06:39<br \/>\nand craniopharyngioma is the most common<br \/>\n06:42<br \/>\ntumor associated with delayed puberty<br \/>\n06:44<br \/>\nlastly there are anatomic causes that<br \/>\n06:46<br \/>\ncan result in primary amenorrhea in<br \/>\n06:48<br \/>\ngirls with normal breast development<br \/>\n06:50<br \/>\nmullerian a Genesis or Myer rokitansky<br \/>\n06:53<br \/>\nkustra Hauser syndrome is congenital<br \/>\n06:55<br \/>\nabsence of the vagina and often uterus<br \/>\n06:57<br \/>\nand fallopian tubes there are normal<br \/>\n06:59<br \/>\novaries since the ovaries are not<br \/>\n07:01<br \/>\nderived from mullerian structures and if<br \/>\n07:03<br \/>\na patient has an imperforate hymen there<br \/>\n07:05<br \/>\nis obstruction of menstrual blood<br \/>\n07:06<br \/>\npatients will present with uterine pain<br \/>\n07:09<br \/>\nand a bulging vaginal introitus this<br \/>\n07:11<br \/>\nconcludes the aapko video on puberty we<br \/>\n07:14<br \/>\nhave discussed Tina&#8217;s transition through<br \/>\n07:15<br \/>\nthis process and ideologies for why she<br \/>\n07:17<br \/>\ncould have precocious or delayed puberty<\/p>\n<p><\/div>\n<hr \/>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 7:33<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":42,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-181","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/181","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=181"}],"version-history":[{"count":2,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/181\/revisions"}],"predecessor-version":[{"id":2847,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/181\/revisions\/2847"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=181"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}