GROWTH AND PUBERTY Anna Kosmowska

MEASUREMENT WEIGHT

CENTILE CHARTS

HEIGH

HEAD CIRCUMFERENCE

MICROCEPHALY A head circumference below the 2nd centile.

MACROCEPHALY Head circumference above the 98th centile.

PUBERTY In females the features of puberty are:-breast development – first sign 8.5-12.5 years-pubic hair growth and a rapid heigh spurt -menarche – occurs on average 2.5 years after the start of puberty and signals that growth is coming to an end

PUBERTY

Female breast changes BI – PREPUBERTALBII – BREAST BUDBIII – JUVENILE SMOOTH CONTOURBIV – AREOLA AND PAPILLA PROJECT ABOVE BREASTBV - ADULT

IN MALES TESTICULAR ENLARGEMENT TO >4ml VOLUME MEASURED USING AN ORCHIDOMETER – the first sign of pubertyPUBIC HAIR GROWTH – FOLLOWS TESTICULAR ENLARGEMENT, USUALLY BETWEEN 10 AND 14 YEARS OF AGEHEIGH SPURT – when the testicular volume is 12-15ml, after a delay of around 18 months

ORCHIDOMETER

PUBIC HAIR CHANGES – FEMALE AND MALE PHI – PRE-ADOLESCENT NO SEXUAL HAIRPHII – SPARSE, PIGMENTED, LONG, STRAIGHT, MAINLY ALONG LABIA OR AT BASE OF PENISPHIII – DARK, COARSER, CULIERPHIV – FILLING OUT TOWARDS ADULT DISTRIBUTIONPHV – ADULT IN QUANTITY AND TYPE WITH SPREAD TO MEDIAL THIGS IN MALE

MALE GENITAL STAGES

In both sexes, there will be development of: AcneAxillary hairBody odourMood changes

X-ray of the wrist and hand to determine bone ages.

SHORT STATURE As a height below the second centileFamilialIUGRConstitutional delay of growth and pubertyHypothyroidismGrowth hormone deficiencyCorticosteroids excess, Cushing syndromeChronic illness – Crohn disease, chronic renal failure

Psychosocial deprivationChromosomal disorder / syndromes-Down syndrome-Turner syndrome- Noonan syndrome-Russell-Silver syndrome

Growth hormone deficiency is treated with biosynthetic growth hormone, which is given by subcutaneous injection, usually daily.

TALL STATURE CAUSES OF EXCESSIVE GROWTH OR TALL STATURE-FAMILIAL-OBESITY-TRUE GIGANTISM (excess GH secretion)-Marfan Syndrome-Klinefelter Syndrome-Sotos Syndrome

PREMATURE SEXUAL DEVELOPMENT The development of secondary sexual characterists before 8 years old in females and 9 years old males-precocious puberty when it is accompanied by a growth spurt-prematur breast development (thelarche)-premature pubic hair development (pubarche)

THELARCHE

PRECOCIOUS PUBERTY May be categorised according to the levels of FSH and LHGonadotropin-dependent – central, true PPGonadotropin-independent – pseudo, false PP

Gonadotropin-dependent – central, true PP Idiopathhic/familialCNS abnormalities- hydrocephalus-post-irradiation-infection-tumours

Gonadotropin-independent – pseudo, false PP Adrenal disorders – tumours, congenital adrenal hyperplasiaOvarian – tumourTesticular - tumour

PREMATURE BREAST DEVELOPMENT (THELARCHE) Females between 6 months and 2 years of ageUsually non-progrssive and self-limiting

DELAYED PUBERTY Absence of pubertal development by 14 years of age in females and 15 years in males.

CAUSES OF DELAYED PUBERTY Constitutional delay of grrowth and puberty/familialHypogonadotropic hypogonadism (low gonadotropin secretion) – CF, severe asthma, Crohn disease, anorexia nervosa, intracranial tumours, Kallmann syndromeHypergonadotropic hypogonadism (high gonadotropin secretion) – Klinefelter syndrome, Turner syndrome.