Averil Tam
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Averil Tam
Created by Averil Tam over 1 year ago
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Question Answer
1. TRUE/FALSE - definitions and normal puberty. A. The onset of puberty in females is defined as stage 1 breast development. False. Thelarche (palpable breast buds) is usually the first marker of puberty but B1 is pre-pubertal breast development.
1. TRUE/FALSE - definitions and normal puberty. B. The onset of puberty in males is defined as the appearance of pubic hair. False. Achievement of testicular volume 4ml.
1. TRUE/FALSE - definitions and normal puberty. C. Females enter puberty earlier than males. True. Mean age of onset 10.9 years compared to 11.75 years for males.
1. TRUE/FALSE - definitions and normal puberty. D. Peak height velocity occurs at stage 4 breasts in girls. False. Occurs at B3.
2. TRUE/FALSE - precocious puberty. A. Central precocious puberty (CPP) is rarely pathological in males. False. ~75% have a pathological CNS lesion.
2. TRUE/FALSE - precocious puberty. B. Low or undetectable gonadotropins in the presence of pubertal signs suggest pseudo (peripheral) precocious puberty. True. In pseudo precocious puberty, there is peripheral activation rather than central hence low/pre-pubertal LH and FSH but elevated/pubertal sex steroids for age. Examples are CAH, Gn-independent (McCune-Albright, testotoxicosis, adrena/testes/ovarian tumours, iatrogenic).
2. TRUE/FALSE - precocious puberty. C. CNS tumours can cause CPP. True.
2. TRUE/FALSE - precocious puberty. D. The definition of CPP in females is stage 2 breast development before the 9th birthday. False. Lower limit of normal is puberty is breast development at 8 years. For CPP, need to confirm hormonal status (pubertal gonadotropins) +/- bone age +/- USS pelvis (uterus:cervix >1, endometrial echo present, ovarian volume >1.5ml, follicles >6mm).
3. TRUE/FALSE - normal variants. A. Medical treatment is often required for premature thelarche. False. Most common during first two years of life, breasts often fluctuate in size. May have second peak ~6yo. Need follow up as may be the first manifestation of central precocious puberty.
3. TRUE/FALSE - normal variants. B. Congenital adrenal hyperplasia (CAH) is often detected on routine baseline investigations for premature adrenarche. False.
3. TRUE/FALSE - normal variants. C. Gynaecomastia always requires extensive investigation. False. Generally limited work up required. Education, counselling, clinical follow up for typical cases. If atypical/progressing, consider bone age, pelvic USS, LH, FSH, oestradiol, prolactin +/- GnRH test.
4. TRUE/FALSE - delayed puberty. A. Pubertal delay may be associated with poor sense of smell. True.
4. TRUE/FALSE - delayed puberty. B. High gonadotropins are suggestive of a primary gonadal problem. True. High LH and FSH levels, low testosterone or oestradiol levels.
4. TRUE/FALSE - delayed puberty. C. Constitutional delay of growth usually requires medical treatment. False. Generally reassure, watch and wait. GH therapy not indicated but consider if there are psychological consequences (short course of low dose androgen).