1. PUBERTY

2. Definition: Hormonal changes during period of infancy and early childhood [Age 9-15] Mechanism: Separation of newly born infant from maternal and placental source of oestrogen. Release of FSH, LH from –ve feedback mechanism. Gn  at 3 months Follicular maturation and atresia – estradiol secretion -ve feedback mechanism is re-established. Gn  at 2 years till the age of puberty.

3. During period of puberty –Initiated –Release of pulsatile Gn-RH from –ve FM – Level of Gn [FSH-LH] at sleep and steroid hormone. –Appearance of secondary sexual characters and adult function [menarche and ovulation]

4. Menarche: the first menstruation Factors affecting the age of puberty : Genetic factor Nutritional factor Physical health Psychic condition and social

5. Stages of Puberty: Acceleration growth [growth hormone and gonadal estrogen. Breast development {Theiarce]  effect of estrogen. Public and axillary hair [Adrenarche]  effect of adrenal androgen. Menarche: menstruation. Abnormalities of puberty: Precocious puberty Delayed puberty.

6. Tanner Staging Breast Stage I -  prepubertal Stage II  breast bud [9.8 y] Stage III  breast elevation [11.2 y] Stage IV  areolar mound [12 y] Stage V  adult contour [14.5 y] Pubic Hair Stage I -  prepubertal Stage II  pre sexual hair [10.5 y] Stage III  sexual hair [11.5 y] Stage IV  mid escutecheon [12 y] Stage V  female escutecheon [13.5 y]

7. Age in Years At 9.8 years  breast bud At 10.5 years  onset of pubic hair At 11.4 years  maximal growth At 12.8 years  menarche At 14.6 years  adult breast At 13.7 years  adult pubic hair

8. Precocious Puberty Causes Premature Gn secretion Idiopathic CNS Lesion: ◦Neoplastic ◦Post inflammatory ◦Post traumatic ◦Abnormality of the skull ◦Albright’s syndrome

9. Abnormality of sex steroid ◦Estrogen secreting tumours as: ◦Gn secreting tumour of the ovary ◦Feminizing tumour of adrenal gland ◦Drug ingestion Heterosexual prcocious ouberty ◦Cong. Adrenal hyperplasia ◦Virilizing tumour of the adrenal ◦Virilizing tumour of the ovary

10. Delayed Puberty Causes 1. Constitutional 2. Secondary to chronic ill health as: ch. Neph. Du.J. diabetes, amonia, anorxio nervosa and malnutrition. 3. Hypergonadotrophic hypogonadism: Gonadal dysgenesis Insensitive ovary syndrome Autoimmune ovarian failure Agonadism 4. Hypogonadotrophic hypogonadism: Pan hypopituitrism Isolated Gn deficiency 5. Steroid hormone biosynthesis defect