Dickson Cv Akankwatsa is an ambitious 3rd year student at Bishop Stuart University, Uganda , pursuing a bachelor of Nursing science. More so, a HOSTEL councilor contestant 2016/17 in the same institution.
3. Physiologic Changes with
Puberty
physiologic transition from
childhood to sexual and
reproductive maturity.
10 sexual characteristics of
the hypothalamus, pituitary,
and ovaries initially undergo
an intricate maturation
process 20 sexual x-tics
4. Hypothalamic-Pituitary-Ovarian
Axis
A cascade of events unfolds in the neuro-endocrine system .
In utero, GnRH neurons develop in the olfactory placode.These
neurons migrate through the forebrain to the arcuate nucleus of the
hypothalamus by 11 weeks of gestation.
They form axons that extend to the median eminence and to the
capillary plexus of the pituitary portal system.
Gonadotropin-releasing hormone is influenced by higher cortical
centers .
Released in a pulsatile fashion into the pituitary portal plexus .
5. Cont…
GnRH "pulse generator" stimulates
secretion of gonadotropins, FSH and LH,
from the anterior pituitary by mid-
gestation
stimulates ovarian synthesis and release of
gonadal steroid hormones.
Concurrently, accelerated germ cell
division and follicular development begins,
6 to 7 million oocytes by 5 months'
gestation.
6. Cont…
By late gestation, gonadal steroids exert a
negative feedback upon both the pituitary
gonadotropins and hypothalamic GnRH
secretion.
During this time, the oocyte number
decreases through a process of gene-
related apoptosis to reach 1 to 2 million by
birth.
7. Cont…
At birth, FSH and LH levels rise abruptly in
response to the fall in placental estrogen.
And gradually decline within the first few
months of life to reach prepubertal levels by age
1 to 4 years.
This transient rise in gonadotropin levels vs
gonadal steroid levels, is thought to explain
instances of neonatal breast budding and minor
bleeding from endometrial shedding.
8. Cont…
Childhood years are thus characterized by
low plasma levels of FSH, LH, and estradiol.
However, studies suggest that the GnRH
pulse generator is exquisitely sensitive to
minute amounts of gonadal steroids.
True central precocious puberty may develop
as a result of premature activation of the
GnRH pulse generator.
9. Cont…
During childhood, the ovary
increases in size and undergoes
active follicular growth and
atresia.
As a result of this attrition, by
puberty only 300,000 to 500,000
oocytes remain.
10. Pubertal Changes
Initial pubertal changes occur between the ages of 8 and 13 years
in North America.
Changes before or after are categorized as either precocious or
delayed puberty and warrant evaluation.
At approximately age 10 to 12 years, breast budding, termed
thelarche.
This is followed by pubic hair growth, known as pubarche and then
Menarche.
Following breast and pubic hair growth, adolescents, during a 3-
year span from ages 10.5 to 13.5 years, undergo an accelerated
increase in height, termed a growth spurt.
11. Precocious Puberty
Early pubertal development may be seen
in both sexes.
For girls, precocious puberty has
historically been defined as the
development of breast or pubic hair in
girls younger than 8 years.
12. Cont…
Premature pubertal development may
result from a variety of etiologies.
These causes have been categorized based
on the site of pathogenesis and include:
central precocious puberty
peripheral precocious puberty
heterosexual precocious puberty
variations of normal puberty.
13. Central/true Precocious Puberty
(Gonadotropin-Dependent)
Early activation of the hypothalamic-pituitary-
ovarian axis leads to GnRH secretion, increased
gonadotropin formation, and in turn increased
gonadal sex steroid levels.
Central precocious puberty is rare and affects one in
5,000 to 10,000 individuals in the general population.
The most common cause of central precocious
puberty is idiopathic, however, central nervous
systems lesions must be excluded.
14. Common Etiologies of
Precocious Puberty
Central(GnRH-dependent)
Idiopathic
Central nervous system (CNS) tumors
CNS infection
Head trauma
Iatrogenic
Radiation
Chemotherapy
Surgical
15. Cont…
Malformations of the CNS
Arachnoid or suprasellar cysts
Septo-optic dysplasia
Hydrocephalus
Empty sella syndrome
18. Symptoms of central precocious
puberty are similar to those of
normal puberty, with breast
development, growth spurt, and
eventual menses.
However, these are seen at an
earlier age
.
19. DIAGNOSIS
Signs of sexual maturation
Blood and urine levels
Hormone levels
X-ray to show Bone maturation
CT/MRI to detect tumors in the
brain/ovary/testicle.
20. TREATMENT
There are 2 approaches
1) Treat the underlying cause or disease
2) Lowering the high levels of sex hormones
with medication to stop the progression of
sexual development
LHRH- synthetic hormones that block the
body production of sex hormones.
21. LHRH
Synthetic hormones
Dramatic results and no side effects
In boys penis and testicles shrink back to
the normal size or no further development.
In girls breast size may decrease / at least
there is no further development seen
Growth and behavior of the child will return
to normal and will reach an appropriate
level.
22. CARING
More compulsory than treatment and is very
necessary for the emotional support of the
child.
Important points at school
1. Poor grades
2. Problems at school
3. Loss of interest in daily activities
4. Depression
23. SUPPORT
To create a supportive environment,
try not to focus your comments on
your child's appearance; instead,
offer praise for achievements in
school or sports and support your
child's participation in other
activities.