Pocket ObGyn – Puberty

Dec 8, 2019 admin PHỤ KHOA, SẢN KHOA, SINH DỤC 0

Pocket ObGyn – Puberty
See Abbreviations

Definitions
  • Puberty: Nml physiologic transition from childhood to reproductive & sexual maturity
  • Adrenarche: Onset of increased adrenal androgen production, leads to pubarche
  • Gonadarche: Pulsatile GnRH secretion & activation of HPO axis
  • Thelarche: Onset of breast dev
  • Pubarche: Onset of pubic & axillary hair dev
  • Menarche: Onset of menstruation
  • PHV: Growth spurt characterized by acceleration in growth rate age 9–10, leading to peak height velocity (PHV) around age 11–12
Physiology
  • Requires intact HPO axis. Re-emergence of GnRH secretion ® ­ LH ­ FSH ®

gonadal maturation & sex-steroid production.

Sequence of puberty
Sequence Thelarche Æ Pubarche Æ PHV Æ Menarche
Age* AA 9.5 9.5 10.8 12.1
Age H 9.8 10.3 — 12.2
Age C 10.3 10.5 11.5 12.7
*Mean age in years at indicated stage.

AA, African american; H, Hispanic; C, Caucasian; PHV, Peak hight velocity. From J Pediatr 2006;148:234; Pediatrics 2002;110:911; Stat Med 1993;12:403.

 
Tanner stages
Stage Breast dev Pubic hair
1 Prepubertal: Papilla elevation only Prepubertal: No pubic hair
2 Breast bud: Elevation of breast & papilla; enlargement of areola Sparse, long, slightly pigmented hair on labia majora
3 Further enlargement of breast & areola; no separation of contour Dark, coarse, curled hair, spreading sparsely over mons
4 Areola & papilla form secondary mound above level of breast Adult-type hair, abundant, limited to mons
5 Projection of papilla only, recession of areola to contour of breast Adult-type hair, distribution to the medial thigh
From Arch Dis Child 1969;44:291; J Pediatr 1985;107:317.

 
  • 20% pubarche precedes thelarche (esp AA). Avg thelarche ® menarche, 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 6.1 Tanner staging, female developmental stages

 

 

 

 

 

Stage 1

 

 

 

 

 

Stage 2

 

 

 

 

 

Stage 3

(continued)

Figure 6.1 (Continued )

 

 

 

 

 

Stage 4

 

 

 

 

 

Stage 5

Modified From Strasburger VC, Brown RT. Adolescent Medicine: A Practical Guide. Boston, MA: Little, Brown & Co.; 1991:4

See Abbreviations

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