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REPRODUCTIVE ENDOCRINOLOGY . . . CONT.

Notes

Ovulatory Phase LH surge leads to ovulation (14 days before the onset of menses) temperature rise (0.5º - 1º) increased cervical, acellular mucous with spinnbarkeit (long stretchy threads) and ferning with KOH, seen under the microscope

Secretory/Luteal Phase ovulation to onset of menses fixed in length: 14 days corpus luteum formation progesterone and estrogen secreted from corpus luteum progesterone prepares endometrium for embryo implantation without pregnancy —> progesterone withdrawal —> constriction of spiral arteries —> ischemia and endometrial necrosis —> menses while lining is being shed, surface epithelium is already beginning to regenerate

PRECOCIOUS PUBERTY

Definition onset of puberty before age eight 1/10,000 incidence

Isosexual Precocious Puberty (see Table 1) sexual maturation appropriate to genotypic sex of individual true vs. pseudopuberty due to increased gonadotropin production secondary to premature activation of hypothalamic-pituitary-gonadal axis (HPG-A) normal adult hormone levels with development of all secondary sexual characteristics

Table 1. Classification of Isosexual Precocious Puberty

Constitutional (90%)

  • Idiopathic premature activation of

HPG-A

  • F:M = 5:1

Central (10%)

  • Tumour, obstructive lesion, granulomatous disease, infection, neurofibromatosis, head trauma

  • All interfere with normal inhibition of hypothalamic GnRH release

Pseudopuberty

  • Exogenous estrogen or estrogen producing tumour, hypothyroidism, McCune Albright syndrome, Peutz-Jegher Syndrome **no development of normal

reproductive function

diagnosis • obtain LH and FSH levels • if increased —> central pathology • if low/normal —> exogenous estrogen • TSH, DHEAS • bone age • CT scan treatment • GnRH agonist (Lupron) (negative feedback to downregulate GnRH receptors)

Heterosexual Precocious Puberty development of secondary sexual characteristics opposite to genotypic sex e.g. virilizing tumour (ovarian, adrenal), congenital adrenal hyperplasia, exogenous androgen exposure

DELAYED PUBERTY

Definition absence of normal pubertal events at an age 2.5 SD from the mean • absence of thelarche by age 13 • absence of menarche by age 15

MCCQE 2000 Review Notes and Lecture Series

Gynecology 9

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