Precocious Puberty

Appearance of the secondary sexual characteristics before 8 years of age is referred to as precocious puberty.

Causes

Manifestation

Causes

Manifestation

Idiopathic (most common)

Thelarche/pubarche/menarche

Tumors (of the hypothalamic-pituitary stalk; prevent negative feedback)

Thelarche/pubarche/menarche

Inflammation of the hypothalamus (leads to T GnRH)

Thelarche/pubarche/menarche

21-Hydroxylase deficiency (cortisol pathway is blocked, leading to excess androgens)

Pubarche

Average thelarche—10 years old due to T estradiol Average pubarche—11 years old due to T adrenal hormones

Average menarche—12 years old due to T estradiol

Tanner stages: Stage 1: Prepubertal child Stages 2-4: Developmental stages

Stage 5: Adult

Causes

Manifestation

Excess estrogens from:

Thelarche and menarche

■ Exogenous sources (e.g., oral

contraceptives)

■ Estrogen-secreting tumors

The menstrual cycle is the cyclical changes that occur in the female reproductive system (see Figure 15-1): The hypothalamus, pituitary, ovaries, and uterus interact to cause ovulation approximately once per month (average 28 days [+/- 7 days]).

Many follicles are stimulated by FSH, but the follicle that secretes more estrogen than androgen will be released. This dominant follicle releases more and more estradiol so that its positive feedback causes an LH surge.

Average menses = 3 to 6 days

Blood loss in menstruation averages 30 to 50 mL, should not form clots. > 80 mL is an abnormal amount of blood loss.

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