Physiology of puberty.pptx from Dutta textbook

The physiology of puberty is explained with data taken from dc dutta

1. physiology of puberty Puran mal bunkar Roll no.72

2. Common disorders of puberty - . precocious puberty .Delayed puberty . Menstrual abnormalities . Others (infections, neoplasm,hirsutism)

3. Precocious puberty Definition- Girls who exibit any secondary sexual characteristics before the age of 8(before age of 7in whites) or Menstruate before the age of 10 Isosexual-excess estrogen Heterosexual-excess production of androgen

4. Premature thelarche- .It is the isolated development of breast tissue before the age of 8and commonly between 2 and 4years of age. Premature pubarche- . Isolated development of axillary and or public hair prior to the age of 8 without any other signs of secondary sexual development. Premature menarche - . Isolated event of cyclic vaginal bleeding without any other signs of secondary sexual development .

5. Diagnosis Meticulous history taking and physical examination. True precocious: . The diagnosis is made by: . During puberty - accelerated growth, skeletal maturation and epiphyseal closure. .Tanner stages. Basic investigation:- . serum HCG,FSH,LHand prolactin. . Thyroid profile . serum estradiol, testosterone,17- OH progesterone,DHEA. .USG, CT or MRI brain . .X-ray GNRH stimulation test- 100 microgramof GnRH

6. Treatment Goals - . To reduce gonadotropin secretion. .To supress gonadal steroidogenesis .To decrease the growth rate to normal and slowing the skeletal maturation. Drugs used :- . GnRH agonist therapy - drug of choice in GnRH dependent precocious puberty . Other drugs - Medroxyprogesterone acetate - 30 mg daily orally or 100-200mg IM weekly. Duration of treatment- drugs should be used upto the age of 11 years.

7. Puberty menorrhagia Causes:- . Dysfunctional uterine bleeding . Endocrine Dysfunction- polycystic ovary syndrome, hypothyroidism or hyperthyroidism. . Hematological Idiopathic thrombocytopenic purpura Von willebrand’ s disease Leukemia .pelvic tumor Fibroid Sarcoma botryoides Estrogen producing ovarian tumor . pregnancy complications

8. Diagnosis .By careful history taking and examination Investigation:- . Routine hematological examination- . Bleeding time, clotting time, platelets count. .Thyroid profile . Coagulation parameters

9. Hirsutism . It is a manifestation of hypergonandrogenism. . Excessive growth of androgen dependent sexual hair- terminal hair and central part of the body - male pattern. Physiologic vaginal discharge (Leukorrhoea):- Diagnostic criteria - . Gray- white or yellowish in colour .Nonpurulent .Thick in nature,seen to be ‘pasted’ to undergarments . Irritation and erythema may be present.

10. Acne- . Concerns due to cosmetic reason. .cause- Excessive androgen secretion . Therapy - lower the androgen levels. .Drigs- a) Combined oral contraceptives b)Antiandrogens-spironolactone C) 5alpha-reductase inhibitors -finastride. Topical retinoids-tazarotene (cream/gel) Antibiotics -erythromycin or dlindomycin Miscellaneous problems

11. Obesity . Best assessed-calculating body mass index. BMI=Weight (kg)/Height (m2) Causes -Overeating,and constitutionaland rarely PCOS Diagnosis- . By elevate BMI and waist-hip ratio.

12. .May present -central distribution of body fat- Apple shaped body pattern. . Excessive fat deposition in the hips and buttocks- pear shaped. Choice of treatment - Weight reduction, excercise, with or without insulin sensitising agent Associated morbidities- hypertension,DM,dyslipidemia etc.

13. Abnormal height Due to: Hypersecretion- growth hormone from anterior pituitary due to - pituitary eosinophilic adenoma Treatment- excision of pituitary adenoma.

14. Thankyou Reference: Dc dutta’ s textbook of gyenecology