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Puberty Physiology Problems Management

Puberty is defined as the period of developing secondary sexual characteristics and achieving reproductive maturity, driven by the hypothalamo-pituitary-gonadal axis. Abnormal puberty can manifest as precocious or delayed puberty, with various underlying causes and management strategies including hormonal treatments and psychological support. Common issues during puberty include menstrual disorders, hirsutism, acne, and psychological problems, each requiring specific investigations and management approaches.

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6 views3 pages

Puberty Physiology Problems Management

Puberty is defined as the period of developing secondary sexual characteristics and achieving reproductive maturity, driven by the hypothalamo-pituitary-gonadal axis. Abnormal puberty can manifest as precocious or delayed puberty, with various underlying causes and management strategies including hormonal treatments and psychological support. Common issues during puberty include menstrual disorders, hirsutism, acne, and psychological problems, each requiring specific investigations and management approaches.

Uploaded by

drmksaini28
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Puberty: Physiology, Abnormalities and Management

1. Physiology of Puberty & Features of Abnormal Puberty

(Reference: DC Dutta's Textbook of Gynecology, Chapter 4)

Definition:

Puberty is the period during which secondary sexual characteristics develop and reproductive

maturity is attained. It is the result of complex interactions between the hypothalamus, pituitary,

ovaries, and adrenal glands.

Physiology of Puberty:

- Hypothalamo-pituitary-gonadal axis activation:

- The hypothalamus increases pulsatile release of GnRH (Gonadotropin-Releasing Hormone).

- Stimulates the anterior pituitary to secrete FSH and LH.

- These act on the ovaries to produce estrogen, initiating pubertal changes.

- Hormonal Effects:

- Estrogen: Causes breast development (thelarche), growth of genital organs, and fat distribution.

- Androgens: Promote pubic and axillary hair (adrenarche).

- Growth hormone and IGF-1: Contribute to growth spurt.

- Normal sequence of pubertal events (Tanner staging):

1. Thelarche (breast budding)

2. Pubarche (pubic hair)

3. Peak height velocity

4. Menarche (onset of menstruation)


Features of Abnormal Puberty:

1. Precocious Puberty: Onset before 8 years. Can be central (GnRH-dependent) or peripheral.

2. Delayed Puberty: No thelarche by 13 years or menarche by 16 years. Causes include

hypothalamic/pituitary dysfunction or gonadal dysgenesis.

3. Disorders of Progression: Asynchronous or arrested development indicates endocrine or genetic

abnormalities.

2. Common Problems of Puberty & Their Management

(Reference: DC Dutta's Textbook of Gynecology, Chapter 4)

1. Precocious Puberty:

- Causes: CNS lesions, ovarian/adrenal tumors.

- Investigations: Bone age, pelvic USG, hormone profile, MRI brain.

- Management: GnRH analogs for central causes; surgery for tumors; psychological support.

2. Delayed Puberty:

- Causes: Constitutional delay, Turner's syndrome, hypothalamic dysfunction.

- Investigations: Bone age, karyotype, hormone profile, USG.

- Management: Treat underlying cause; initiate estrogen therapy.

3. Menstrual Disorders:

- Common in early puberty due to anovulation.

- Presentation: Irregular bleeding, menorrhagia.

- Management: Reassurance, iron therapy, hormonal regulation if needed.

4. Hirsutism & Acne:

- Causes: PCOS, CAH, adrenal tumors.


- Investigations: Serum testosterone, DHEAS, 17-OH progesterone.

- Management: OCPs, anti-androgens; treat specific cause.

5. Psychological Problems:

- Include eating disorders, depression, body image issues.

- Management: Counseling, psychotherapy, family support.

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