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Pubertal disorders

Pubertal disorders. Dr Olcay Evliyaoğlu Pediatric Endocrinology Department. Puberty. Sexual differentiation begins on 4-5th week of gestational age. ADOLE SENCE. Phy s ical, sexual, physcological development. Transition to adulthood from childhood Not an adult nor child

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Pubertal disorders

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  1. Pubertal disorders Dr Olcay Evliyaoğlu Pediatric Endocrinology Department

  2. Puberty Sexual differentiation begins on 4-5th week of gestational age.

  3. ADOLESENCE • Physical, sexual, physcological development. Transition to adulthood from childhood • Not an adult nor child • Time of transition • Establishment of individualism.

  4. PUBERTY • Secondary sex characteristics are developed • Includes • Physical growth • Sexual development • Psychological development

  5. Growth spurt, disturbution of muscle and fat • bone maturation and fusion of epiphysical centers • Adult height • At the end of this periodspermatogenesis in boys, ovulation in girls occur

  6. STRESS What makes HHG axis work - + + MATURATİON NUTRİTİON CENTRAL NERVOUS SYSTEM LEPTIN GLUTAMAT GABA ENDROFIN + + - - + HYPOTHALAMUS - - GnRH - - - + + PİTUİTARY PRL - - - LH FSH - - - + + OVARY TEKA GRANULOZA ESTROGEN INHIBIN ANDROGEN

  7. Gonadarche Hypothalamus GnRH pulse frequency and amplitude increase Pituitary LH pulse frequency and amplitude increase At early stages at nights With progression of puberty pulses occur during day

  8. Gonadarche LH Teca cells androstenedion Granulosa cells FSH Estradiol (E2)

  9. Gonadarche Leydig cells LH testosteron

  10. Adrenarche • Increase in the secretion of adrenal androgens • Appearance of pubic hair (pubarche) • Axillary hair

  11. Adrenarche CRH Hypothalamus Pituitary ACTH Adrenal cortex Adrenal androgens

  12. Genetic and environmental conditions effect timing of puberty · Environmental factors: • Socioeconomic factors • Nutrition • General health • Geographical place lived

  13. Nutrition and puberty • Menarche is earlier in obese girls • Malnutrition , chronic diseases, and excessive physical activity delay pubertyand menarche

  14. LEPTİN • Codes Ob gene • Synthesized in adipose tissue. • Leptin signals stimulatecentral nervous system • Leptin levels are decreased in excessive physical activity, anorexia nevrosa and amenorea.

  15. hypothalamus LHRH secreting neurons Leptin LHRH pituitary gonadotrophs Leptin mRNA Adipose cells LH, FSH

  16. Timing of puberty is related to bone age rather than chronological age • BA< CY ------------- delay in puberty • BA = CA ------------- puberty on expected age • BA>CA --------------early puberty (puberty precocous)

  17. · In girls the first sign of puberty is telarche, generally observed on 10 - 11ages, menarche is observed 2-3 years after telarche. • In girls growth spurt occurs 2 years earlier than boys. Growth spurt in girls is at the time of telarche, • In boys growth spurt occur at the time when testes volumes are 10 ml. • Telarche Pubarche Menarche

  18. Pubertal development in girls breast development (tanner staging) 1. Prepubertal 2. Palpation of breat bud 3. Palpation of breat tissue with out any changes in contures 4. Development of breast tissue 5. Adult type breast

  19. Pubic hair 1.No hair 2. Appearance of short hair on labium majora 3. Black and thic hair on mons pubis 4. Adult type hair but not spread to inguinal area 5. Adult type with the shape of inverted triangle

  20. Tanner staging Girls pubic hair Stage 1: no pubic hair Stage 2: lightly pigmented localized on labiums Stage 3: coarser, darker , more curved, increased in amount spread to pubis Stage 4: curved and increased still less than an adult. Stage 5: adult women triangle spread to thighs

  21. Tanner staging Breast development Stage 1: prepubertal Stage 2: breast budding Stage 3: enlargement of breast tissue and areola Stage 4: Areola and papilla forms secondary mound . Stage 5: Mature

  22. Tanner stage 4 2-3years after telarche Menarche

  23. Tanner stage 4 2-3years after telarche Menarche

  24. FSH secretion Dominant follicule Follicular phase estrogen LH secretion Ovulation corpus luteum Progesterone Endometrium prepared Luteal phase If no implantation uterine bleeding

  25. Pituitary hormones Ovarian hormones ovulation corpus albicans follicule corpus luteum ovary İstihdam dominant Seçim istihdam Endometrium Follicular /proliferative phase Luteal /secretuary phase

  26. Luteal phase + LH estrogen estrogen + - Ovulation corpus luteum Progesterone endometrium is prepared for implantation

  27. Corpus luteum regression If no implantation occurs Progesterone levels decline Endometrium can not hold itself-desquamation Luteal phase 14+2 days Spiral arteriols in the functional and basal layers of endometriumun contracts and approx in 7 gün days bleeding stops

  28. ·In boys initial finding of puberty is enlargement of testes. This is followed by scrotum pigementation and thinning of scrotal skin. Penis enlarges. Pubic hair develops. Growth spurt occurs at 14-16 years and usually continues until 18 years.

  29. Pubertal development in boys Tanner staging Prepubertal testes diameter < 2.5 cm= 4 ml • Testes volumes • 1-3 ml  P1 • 4-9 ml  P2 • 10-14 ml P3 • 15-20 ml P4 • > 20 ml  P5

  30. Tanner staging Pubic hair stage 1: no pubic hair Stage 2: little pubic hair Stage 3: pubic hair on pubis Stage 4: adult type hair but no invasion on tighs Stage 5 : adult type hair spread to thighs

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