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Dr Olcay Evliyaoğlu Pediatric Endocrinology Department

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Presentation on theme: "Dr Olcay Evliyaoğlu Pediatric Endocrinology Department"— Presentation transcript:

1 Dr Olcay Evliyaoğlu Pediatric Endocrinology Department
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 period spermatogenesis in boys, ovulation in girls occur

6 What makes HHG axis work

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 FSH Granulosa cells
Estradiol (E2)

9 Gonadarche LH Leydig cells 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 puberty and menarche

14 LEPTİN Codes Ob gene Synthesized in adipose tissue.
Leptin signals stimulate central 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 ages, 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 Follicular /proliferative phase Luteal /secretuary phase
Pituitary hormones Ovarian hormones ovulation corpus albicans follicule corpus luteum ovary İstihdam dominant Seçim istihdam Endometrium Follicular /proliferative phase Luteal /secretuary phase 25

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

27 If no implantation occurs Corpus luteum regression
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
·       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 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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