Precocious

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Precocious Puberty By: Maria , Taylor, Meghan Figure 2

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Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a girl, the testes in a boy. In response to the signals, the gonads produce hormones that stimulate libido and the growth, function, and transformation of the brain, bones, muscle, blood, skin, hair, breasts, and sex organs. Physical growth—height and weight—accelerates in the first half of puberty and is completed when an adult body has been developed. Until the maturation of their reproductive capabilities, the pre-pubertal physical differences between boys and girls are the external sex organs. On average, girls begin puberty around ages 10–11; boys around ages 11–12. Girls usually complete puberty around ages 15–17, while boys usually complete puberty around ages 16–17. The major landmark of puberty for females is menarche, the onset of menstruation, which occurs on average between ages 12–13; for males, it is the first ejaculation, which occurs on average at age 13. In the 21st century, the average age at which children, especially girls, reach puberty is lower compared to the 19th century, when it was 15 for girls and 16 for boys. This can be due to any number of factors, including improved nutrition resulting in rapid body growth, increased weight and fat deposition, or exposure to endocrine disruptor such as xenoestrogens, which can at times be due to food consumption or other environmental factors. Puberty which starts earlier than usual is known as precocious puberty. Puberty which starts later than usual is known as delayed puberty. Notable among the morphologic changes in size, shape, composition, and functioning of the pubertal body, is the development of secondary sex characteristics, the "filling in" of the child's body; from girl to woman, from boy to man. Derived from the Latin puberatum (age of maturity), the word puberty describes the physical changes to sexual maturation, not the psychosocial and cultural maturation denoted by the term adolescent development in Western culture, wherein adolescence is the period of mental transition from childhood to adulthood, which overlaps much of the body's period of puberty.

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Precocious puberty is defined as the development of pubertal signs at a younger age than the accepted lower limits for the onset of puberty. In girls, breast development before the age of 8 years, appearance of sexual pubic hair before the age of 8 years or beginning menses before the age of 9.5 years is traditionally considered as precocious puberty. This is accompanied by rapid growth rate, advanced skeletal maturation and increased levels of gonadotropins and/or sex steroids.

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Congenital hypothyroidism (CH) ranks very high among the most common disorders treated in a paediatric endocrinology clinic. In the Western world, CH is detected in 1:3,500 to 1:4,000 newborns (1) by the neonatal thyroid screening (NTS) programme. The main goal of NTS commenced in the 1970s is an early diagnosis of CH and prompt initiation of ongoing thyroxine replacement therapy, to be administered regularly for the affected infants. This measure is aimed to avoid the inevitable outcome of permanent neurological handicap in untreated children or in whom the onset of treatment was considerably delayed. When treated early, CH is also one of the most common preventable causes of mental retardation. In this regard, while emphasizing the role of NTS in early diagnosis, it is worthy of note that the incidence of CH reported from NTS carried out in various centers in India is much higher, viz., 1:1,200 to 1:1,500 newborns. (2). Naturally, it follows that NTS must be universally available in India to identify all affected infants by prompt diagnosis to begin regular replacement therapy in the initial two weeks of life (3).

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PHYSICAL AND COGNITIVE DEVELOPMENT IN ADOLESCENCE CHAPTER 11 Copyright © 2011 Pearson Education, Inc. All rights reserved. * Learning Objectives *Explain: These are the questions we will consider as we begin our study of adolescence. PHYSICAL MATURATION * Physical Manifestations of Puberty *Start of physical maturation:Begins when the pituitary gland in the brain signals other glands in children's bodies to begin producing the sex hormones, androgens (male hormones) or estrogens (female hormones), at adult levels. Males and females produce both types of sex hormones, but males have a higher concentration of androgens and females a higher concentration of estrogens.) Pituitary gland also signals body to increase production of growth hormones that interact with the sex hormones to cause the growth spurt and puberty. In addition, the hormone leptin appears to play a role in the start of puberty. Growth during Adolescence: The Rapid Pace of Physical and Sexual Maturation Adolescent growth spurtWeight increase Skeletal changes Accelerated Asynchronicity in growth *Adolescence is the developmental stage that lies between childhood and adulthood. It is generally viewed as starting just before the teenage years and ending just after them. It is a transitional stage. Adolescents are considered no longer children, but not yet adults. It is a time of considerable physical and psychological growth and change.One aspect of this transformation is the adolescent growth spurt, a period of very rapid growth in height and weight. On average, boys grow 4.1 inches a year and girls 3.5 inches a year. Some adolescents grow as much as 5 inches in a single year.Boys’ and girls’ adolescent growth spurts begin at different times. As you can see in Figure 11-1, girls begin their spurts around age 10, while boys start at about age 12. During the 2-year period starting at age 11, girls tend to be taller than boys. But by the age of 13, boys, on average, are taller than girls—a state of affairs that persists for the remainder of the life span. Wt and ht increase due to simultaneous release of growth hormone, thyroid hormones, and and androgens; peak height velocity at adolescence and toddler yearsIn general two years earlier in girls; girls taller between 11 and 13Changes in composition of skeletal structure; closing of long bones; ethnic differencesHeight changes in torso rather than leg lengthAccelerated growth spurtextremities first (head, hands, feet) arms and legs torso and shoulder growth Growth Pattern Patterns of growth are depicted in two ways. The first figure shows height at a given age, while the second shows the height increase occurs from birth through the end of adolescence. Notice that girls begin their growth spurt around age 10, while boys begin the growth spurt at about age 12. However, by the age of 13, boys ...

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In this lecture on circulatory shock, Dr. Faiza, an Assistant Professor of Physiology, delves into the profound implications of inadequate blood flow throughout the body, leading to tissue damage. The session begins by defining circulatory shock and elucidating its physiological causes, including decreased cardiac output, diminished blood volume, decreased vascular tone, obstruction to blood flow, excess metabolic rate, and abnormal perfusion patterns. Dr. Faiza categorizes shock into various types, such as cardiogenic shock, hypovolemic shock, neurogenic shock, obstructive shock, anaphylactic shock, and septic shock, and explores the pathophysiological basis of each. Furthermore, the lecture examines the stages of shock, from the non-progressive phase where compensatory mechanisms aim for full recovery to the progressive phase where shock worsens steadily without intervention, potentially leading to irreversible damage. Dr. Faiza discusses therapeutic interventions for shock, including replacement therapy, blood and plasma transfusion, sympathomimetic drugs, and other adjunctive treatments like head-down positioning, oxygen therapy, and glucocorticoids.

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