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Beginning of Presentation
Puberty- A Review
Evolution of Development
Learning
Puberty
Case
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Bone Age
Pelvic Ultrasound
Pelvic Ultrasound
Skull Radiograph
Case
Puberty is caused by hormonal secretions
Adrenarche
Gonadarche
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FSH/LH Secretion Patterns
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Age at Menarche
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Age of onset of puberty
Recommendations Concerning Children Needing Evaluation for Early Puberty
Recommendations Concerning Children Needing Evaluation for Early Puberty
Problems...
Ethnic Differences in the Presence of Secondary Sex Characteristics and Menarche Among US Girls:
Ethnic Differences in the Presence of Secondary Sex Characteristics and Menarche Among US Girls: The Third National Health and Nutrition Examination Survey, 1988-1994
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National Estimates of the Timing of Sexual Maturation and Racial Differences Among US Children
National Estimates of the Timing of Sexual Maturation and Racial Differences Among US Children
Prevalence of Overweight Children
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Is Obesity Associated with Early Sexual Maturation? A Comparison of the Association in American Boys Versus Girls
Leptin and Puberty
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Despite the new guidelines,
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Not Much Has Changed Since Then!!!
Evaluation of Puberty
Evaluation of Puberty
Evaluation of Puberty
Causes of Precocious Puberty
Causes of Precocious Puberty
Interpretation of Stimulation Testing with 100 mcg of GnRH
There is no single level of LH, FSH, or E2 with 100%specificity and sensitivity
Management
GnRH Administration
Assessment of candidates for
Outcomes from GnRHa Therapy
GnRHa Therapy
Case
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In Conclusion...
Q & A
CHMC

Deborah Elder, M.D.

Pediatric Grand Rounds - "Puberty - A Review" - 11/26/02