1. GROWTH AND PUBERTY
Anna Kosmowska

2. MEASUREMENT
WEIGHT

3. CENTILE CHARTS

4. HEIGH

5. HEAD CIRCUMFERENCE

6. MICROCEPHALY
A head circumference below the 2nd centile.

9. MACROCEPHALY
Head circumference above the 98th centile.

10. PUBERTY
In females the features of puberty are:-breast development – first sign years-pubic hair growth and a rapid heigh spurt -menarche – occurs on average 2.5 years after the start of puberty and signals that growth is coming to an end

11. PUBERTY

12. Female breast changes
BI – PREPUBERTALBII – BREAST BUDBIII – JUVENILE SMOOTH CONTOURBIV – AREOLA AND PAPILLA PROJECT ABOVE BREASTBV - ADULT

13. IN MALES
TESTICULAR ENLARGEMENT TO >4ml VOLUME MEASURED USING AN ORCHIDOMETER – the first sign of pubertyPUBIC HAIR GROWTH – FOLLOWS TESTICULAR ENLARGEMENT, USUALLY BETWEEN 10 AND 14 YEARS OF AGEHEIGH SPURT – when the testicular volume is 12-15ml, after a delay of around 18 months

14. ORCHIDOMETER

15. PUBIC HAIR CHANGES – FEMALE AND MALE
PHI – PRE-ADOLESCENT NO SEXUAL HAIRPHII – SPARSE, PIGMENTED, LONG, STRAIGHT, MAINLY ALONG LABIA OR AT BASE OF PENISPHIII – DARK, COARSER, CULIERPHIV – FILLING OUT TOWARDS ADULT DISTRIBUTIONPHV – ADULT IN QUANTITY AND TYPE WITH SPREAD TO MEDIAL THIGS IN MALE

17. MALE GENITAL STAGES

18. In both sexes, there will be development of:
AcneAxillary hairBody odourMood changes

19. X-ray of the wrist and hand to determine bone ages.

20. SHORT STATURE
As a height below the second centileFamilialIUGRConstitutional delay of growth and pubertyHypothyroidismGrowth hormone deficiencyCorticosteroids excess, Cushing syndromeChronic illness – Crohn disease, chronic renal failure

21. Psychosocial deprivationChromosomal disorder / syndromes-Down syndrome-Turner syndrome- Noonan syndrome-Russell-Silver syndrome

22. Growth hormone deficiency is treated with biosynthetic growth hormone, which is given by subcutaneous injection, usually daily.

24. TALL STATURE
CAUSES OF EXCESSIVE GROWTH OR TALL STATURE-FAMILIAL-OBESITY-TRUE GIGANTISM (excess GH secretion)-Marfan Syndrome-Klinefelter Syndrome-Sotos Syndrome

25. PREMATURE SEXUAL DEVELOPMENT
The development of secondary sexual characterists before 8 years old in females and 9 years old males-precocious puberty when it is accompanied by a growth spurt-prematur breast development (thelarche)-premature pubic hair development (pubarche)

26. THELARCHE

27. PRECOCIOUS PUBERTY
May be categorised according to the levels of FSH and LHGonadotropin-dependent – central, true PPGonadotropin-independent – pseudo, false PP

28. Gonadotropin-dependent – central, true PP
Idiopathhic/familialCNS abnormalities- hydrocephalus-post-irradiation-infection-tumours

29. Gonadotropin-independent – pseudo, false PP
Adrenal disorders – tumours, congenital adrenal hyperplasiaOvarian – tumourTesticular - tumour

30. PREMATURE BREAST DEVELOPMENT (THELARCHE)
Females between 6 months and 2 years of ageUsually non-progrssive and self-limiting

31. DELAYED PUBERTY
Absence of pubertal development by 14 years of age in females and 15 years in males.

32. CAUSES OF DELAYED PUBERTY
Constitutional delay of grrowth and puberty/familialHypogonadotropic hypogonadism (low gonadotropin secretion) – CF, severe asthma, Crohn disease, anorexia nervosa, intracranial tumours, Kallmann syndromeHypergonadotropic hypogonadism (high gonadotropin secretion) – Klinefelter syndrome, Turner syndrome.