Stages of Female Maturation: - Growth Acceleration - Thelarchy∵E2: breast development - Pubarch∵As∵Andrenarche: begins @ 7yo (increases DHEA precursor to T&DHT - Max Growth Rate - Menarchy: menstrual cycle onset Precocious Puberty: before age 6/7 - GnRH-dependent causes: early/idiopathic HPO activtion -- steady progression -- confirmed if baseline LH is high. and otherwise, if giving GnRH increases it ---> BRAIN MRI - GnRH-independent causes: sex hormones independent of HPO: McCune Albright Syndrome: ovaries make E on their own, oral contraception -- or tumor) -- rapid progression -- confirmed if GnRH given after not-high LH doesn't increase LH --> Labs+Pelvic_US Delayed Puberty: no 2°sex char by 13/ menarche by 15 or within 5 years of thelarche. - hypergonadotrophic (1°) -- if baseline FSH is high (∵ Turner's XO) -- Tx: E2 to stimualte breast development & genital tract maturation - hypogonadotrophic (2°) -- no arctuate (∵ Kallman's Syn/ weight loss/ chaniopharyngioma) Anatomical Causes of Primary Amenorrhea: - Mullerian Agenesis - Imperforate Hymen
Stages of Female Maturation:
- Growth Acceleration
- Thelarchy∵E2: breast development
- Pubarch∵As∵Andrenarche: begins @ 7yo (increases DHEA precursor to T&DHT
- Max Growth Rate
- Menarchy: menstrual cycle onset
Precocious Puberty: before age 6/7
- GnRH-dependent causes: early/idiopathic HPO activtion
-- steady progression
-- confirmed if baseline LH is high. and otherwise, if giving GnRH increases it ---> BRAIN MRI
- GnRH-independent causes: sex hormones independent of HPO: McCune Albright Syndrome: ovaries make E on their own, oral contraception -- or tumor)
-- rapid progression
-- confirmed if GnRH given after not-high LH doesn't increase LH --> Labs+Pelvic_US
Delayed Puberty: no 2°sex char by 13/ menarche by 15 or within 5 years of thelarche.
- hypergonadotrophic (1°)
-- if baseline FSH is high (∵ Turner's XO)
-- Tx: E2 to stimualte breast development & genital tract maturation
- hypogonadotrophic (2°)
-- no arctuate (∵ Kallman's Syn/ weight loss/ chaniopharyngioma)
Anatomical Causes of Primary Amenorrhea:
- Mullerian Agenesis
- Imperforate Hymen