Precocious puberty OBG 3rd year.pptx.pptx

Precocious puberty 3rd year OBG presentation

1. PRECOCIOUS PUBERTY Mohammed Farhan K B (138)

2. Precocious puberty

3. Types Types

4. Central,True,GnRH dependent TRUE PRECOCIOUS PUBERTY

5. Etiology of central precocious puberty Idiopathic: - most girls(90%) Secondary: - most boys(70-80%)

6. CNS disorders ETIOLOGY

7. Etiology of peripheral type

8. GnRH independent causes-unprovoked by hypothalamus

9. DIAGNOSIS Family History: Important for diagnosing early puberty; may be familial. Clinical Clues: Rarely available but may include: -Hyperpigmentation in congenital adrenal hyperplasia. -Cafe-au-lait spots in McCune-Albright syndrome. Bone Age: Advanced in both central and peripheral precocious puberty; near normal in incomplete forms. History and examination

10. FSH Oestrogen Testosterone and DHEAS in heterosexual precocious puberty 17-OH progesterone in late onset CAH Thyroid function tests Hormonal tests

11. Pelvic and abdominal ultrasound to image ovaries and adrenals MRI brain for hamartomas Imaging

12. MANAGEMENT Goals: Reverse/Prevent progression of puberty, arrest skeletal maturation, address emotional and psychological issues. Protection: Guard against sexual abuse. Treatment - Long-acting GnRH agonists (e.g., Leuprolide). - Administered subcutaneously or intranasally daily, or as a long-acting preparation every 3-4 weeks. Central type

13. GnRH Agonists: • Downregulate/desensitize GnRH receptors on pituitary gonadotropes. • Suppression of gonadotropin release, followed by decreased sex steroids. • Withdrawal at expected normal age of puberty. Alternative Therapies: • Surgery, radiation, or chemotherapy for CNS tumors. • Medroxyprogesterone acetate for true precocious puberty if GnRH-independent.

14. Treatment Basis depends on the cause. GnRH agonists are ineffective for sexual precocity. Tumor: Remove if present. Stop any offending drug. Medications: • Tamoxifen: Antagonizes estrogen; effective for incomplete/precocious puberty. • Testolactone: Aromatase inhibitor; used in selected cases. Peripheral type

15. Incomplete or partial forms of pseudoprecocious puberty include premature thelarche, premature adrenarche, and the rare condition of premature isolated menarche. These conditions are benign and self-limiting. Follow-up is required to monitor for any progression. Incomplete type

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