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    BY, Dr. Namrata Shirvastava

    Uploaded by

    Yash Sharma
    This document discusses puberty in girls. It defines puberty as the period linking childhood to adulthood involving biological, morphological, and psychological changes leading to sexual maturity and fertility. The five important physical changes are growth of breasts, pubic hair, underarm hair, increased height, and menstruation. Precocious puberty refers to signs of puberty before age 8 or menstruation before age 10 and has potential medical causes. Treatment depends on the underlying cause and aims to suppress premature activation of the hypothalamic-pituitary-ovarian axis. Delayed puberty refers to lack of secondary sex characteristics by ages 13-14 or menarche after age 16 and also has various medical causes requiring treatment.

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    BY, Dr. Namrata Shirvastava

    Uploaded by

    Yash Sharma
    53 views28 pages
    This document discusses puberty in girls. It defines puberty as the period linking childhood to adulthood involving biological, morphological, and psychological changes leading to sexual maturity and fertility. The five important physical changes are growth of breasts, pubic hair, underarm hair, increased height, and menstruation. Precocious puberty refers to signs of puberty before age 8 or menstruation before age 10 and has potential medical causes. Treatment depends on the underlying cause and aims to suppress premature activation of the hypothalamic-pituitary-ovarian axis. Delayed puberty refers to lack of secondary sex characteristics by ages 13-14 or menarche after age 16 and also has various medical causes requiring treatment.

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    puberty

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    Puberty New

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    This document discusses puberty in girls. It defines puberty as the period linking childhood to adulthood involving biological, morphological, and psychological changes leading to sexual maturity and fertility. The five important physical changes are growth of breasts, pubic hair, underarm hair, increased height, and menstruation. Precocious puberty refers to signs of puberty before age 8 or menstruation before age 10 and has potential medical causes. Treatment depends on the underlying cause and aims to suppress premature activation of the hypothalamic-pituitary-ovarian axis. Delayed puberty refers to lack of secondary sex characteristics by ages 13-14 or menarche after age 16 and also has various medical causes requiring treatment.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    53 views28 pages

    BY, Dr. Namrata Shirvastava

    Uploaded by

    Yash Sharma
    This document discusses puberty in girls. It defines puberty as the period linking childhood to adulthood involving biological, morphological, and psychological changes leading to sexual maturity and fertility. The five important physical changes are growth of breasts, pubic hair, underarm hair, increased height, and menstruation. Precocious puberty refers to signs of puberty before age 8 or menstruation before age 10 and has potential medical causes. Treatment depends on the underlying cause and aims to suppress premature activation of the hypothalamic-pituitary-ovarian axis. Delayed puberty refers to lack of secondary sex characteristics by ages 13-14 or menarche after age 16 and also has various medical causes requiring treatment.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 28

    BY,

    DR. NAMRATA SHIRVASTAVA


    DEFINITION-
    • Puberty in girls is the Period ,which links childhood to adulthood
    • Period of gradual development of secondary sexual characters
    • Profound biological,morphological,psychological changes that leads
    to full sexual maturity and eventually fertility.
    • 5 IMPORTANT PHYSICAL CHANGES
    • BREAST
    • PUBIC HAIR GROWTH
    • AXILLARY HAIR GROWTH
    • GROWTH IN HEIGHT
    • MENSTRUATION
    ENDOCRINOLOGY IN PUBERTY
    • Onset of first menstruation in life is called menarche.
    • Occur between 10 and 16 years , peak time being 13 years.
    • First period is usually Anovular.
    • OVARIES - Changes shape ,elongated shape becomes bulky and oval
    • UTERINE BODY AND CERVIX RATIO-
    At birth-1:2 becomes 1:1 when menarche
    .VAGINAL CHANGES- Vaginal pH becomes acidic
    VULVA - More reactive to steroid hormones
    MONS PUBIS AND LABIA MINORA increases in size
    BREAST CHANGES
    • Precocious puberty is reserved for girls who exhibit any secondary sex
    characteristics before the age of 8 or menstruate before the age of 10.
    • PREMATURE THELARCHE- Isolated development of breast tissue
    before age of 8

    • PREMATURE PUBARCHE- Isolated development of axillary &/or pubic


    hair prior to age of 8

    • PREMATURE MENARCHE- Isolated event of cyclic vaginal bleeding


    without any other signs of secondary sexual development.
    DIAGNOSIS-
    • TRUE PRECOCIOUS-
    • CONSTITUTIONAL- most common
    • History of early menarche of mothers and sisters
    • pubertal changes in orderly sequence
    • Tanner stages
    Basic investigations
    • Serum hCG,FSH LH, and Prolactin
    • Thyroid profile
    • Serum estradiol,testosterone, 17-OH progesterone,Dehydroepiandrosterone
    (DHEA)
    • USG ,CT or MRI of abdomen pelvis to rule out any pathology
    • Skull X ray, CT Scan or MRI brain
    • Electroencephalogram
    • Xray hand and wrist for bone age
    • GnRH STIMULATION TEST- 100 microgrm given subcutaneously and serum LH
    is measured.
    • LH > 15 mIU/ml suggests gonadotropin dependent precocious puberty.
    PREMATURE THELARCHE-
    • Breast bud enlarge 2-4 cm
    • Somatic growth pattern not accelerated
    • Bone age is not advanced
    • Nipple development is absent
    • Vaginal smear shows negative estrogen effect
    • As continnum of GnRH dependent precocious puberty
    PREMATURE PUBARCHE
    • USG, CT , MRI to detect ovarian or adrenal tumor
    • Estimation of serum 17- alpha -hydroxyorogesterone, DHEAS -S
    and serum testosterone.
    TREATMENT
    • Depends upon the cause and speed of progress of disease
    • Drugs used are-
    • GnRH agonist therapy- suppresses premature activation of HPO axis due to
    down regulation therefore diminishes oestrogen secretion.
    • It is drug of choice in GnRH dependent precocious puberty
    • DOSE- DEPOT FORMS (GOSERELIN OR LEUPROLIDE) once a month.
    • Dose is adjusted to maintain the serum estradiol below 10pg/ml
    • MEDROXYPROGESTERONE ACETATE-
    • 30 mg daily orally or 100-200mg IM weekly to supress gonadal steroids

    • DANAZOL- produces amenorrhea and arrest breast development


    DELAYED PUBERTY
    • Puberty is said to be delayed when breast tissue &/or
    pubic hair have not appeared by 13-14 years or
    menarche appears as late as 16 years.
    • more common in boys
    DIAGNOSIS
    • Detailed history
    • Examination of secondary sexual characters
    • Mature: to evaluate mullerian agenesis/dysgenesis
    • Asynchronus: development of breast ,pubic hair- Androgen insensitivity
    syndrome
    • Immature: increased FSH -Karyotype for Gonadal dysgenesis
    • Low /Normal FSH- sellar CT/MRI-normal-constitiutional/
    malnutrition
    • Abnormal CT/ MRI-Hypopituitarism/CNS tumor
    • TSH raised- HypothyroidisM
    • TREATMENT ACCORDING TO CAUSE
    TREATMENT-
    • ACCORDING TO CAUSE
    • Cases of HYPOGONADISM treated with cyclic estrogen .
    • Unopposed estrogen 0.3 mg (conjugated estrogen) daily given for first
    6 months then combined estrogen and progestin ,sequential regimen
    is started.
    • Chromosomal study to rule out intersexuality in hypogonadism.
    PUBERTY MENORRHAGIA
    • Menstual abnormality is common in adolescents.
    CAUSES-
    1. ABNORMAL UTERINE BLEEDING (95%)- Anovulatory cycles -unopposed
    estrogen -endometrial hyperplasia -prolonged and heavy periods.
    2. ENDOCRINE DYSFUNCTION-
    .PCOS ,HYPO/HYPERTHYROIDISM
    3. HEMATOLOGICAL-
    ITP , VON WILLEBRAND DISEASE, LEUKAEMIA
    4. PELVIC TUMORS-
    FIBROID ,SARCOMA BOTRYROIDES
    INVESTIGATIONS-
    • ROUTINE HEMATOLOGICAL TESTS-
    • BT,CT,PLATELET COUNT
    • THYROID PROFILE
    • COAGULATION PARAMETERS
    • ULTRASONOGRAPHY OF PELVIS
    MANAGEMENT-

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