Normal Pubertal Development
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Novel Ways of Assessing Puberty
NOVEL WAYS OF ASSESSING PUBERTY Findings from the Adolescent Rural Cohort Study of Hormones, Health, Education, Environments and Relationships Ben W.R. Balzer B.Med.Sc., M.B., B.S. (Syd.) A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney Primary Supervisor: Professor Katharine S. Steinbeck Medical Foundation Chair in Adolescent Medicine, The University of Sydney 2019 STATEMENT OF AUTHENTICATION This thesis is submitted to the University of Sydney in fulfilment of the requirement is for the Degree of Doctor of Philosophy. The work presented in this thesis is, to the best of my knowledge and belief, original except as acknowledged in the text. I hereby declare that I have not submitted this material, either in full or in part, for a degree at this or any other institution. Signature: Ben W.R. Balzer Date: 3 June 2019 i ACKNOWLEDGEMENTS I would like to thank Professor Kate Steinbeck for her role as my primary supervisor. I have worked with Kate since 2010, when I first joined the Academic Department of Adolescent Medicine as a Summer Research Scholar. Her expertise, supervision and support have been inspiring and have brought this thesis to fruition. Thank you also to my associate supervisors, Professor David Handelsman and Associate Professor Catherine Hawke, whose time and input have benefitted me greatly and been vital to this project’s success. I wish to acknowledge the National Health and Medical Research Council Project Grant awarded to Professor SteinbecK and I am grateful for personal support from the University of Sydney Faculty of Medicine through the Postgraduate Research Support Scheme and the Dean’s Scholarship Fund Conference Grant. -
Female Tanner Stages (Sexual Maturity Rating)
Strength of Recommendations Preventive Care Visits – 6 to 17 years Bold = Good Greig Health Record Update 2016 Italics = Fair Plain Text = consensus or Selected Guidelines and Resources – Page 3 inconclusive evidence The CRAFFT Screening Interview Begin: “I’m going to ask you a few questions that I ask all my patients. Please be honest. I will keep your Screening for Major Depressive Disorder -USPSTF answers confidential.” Age 12 years to 18 years 7 to 11 yrs No Yes Part A During the past 12 months did you: Screen (when systems in place for diagnosis, treatment and Insufficient 1. Drink any alcohol (more than a few sips)? □ □ follow-up) evidence 2. Smoked any marijuana or hashish? □ □ Risk factors- parental depression, co-morbid mental health or chronic medical 3. Used anything else to get high? (“anything else” includes illegal conditions, having experienced a major negative life event drugs, over the counter and prescription drugs and things that you sniff or “huff”) □ □ Tools-Patient Health Questionnaire for Adolescent(PHQ9-A) Tools For clinic use only: Did the patient answer “yes” to any questions in Part A? &Beck Depression Inventory-Primary Care version (BDI-PC) perform less No □ Yes □ well Ask CAR question only, then stop. Ask all 6 CRAFFT questions Treatment-Pharmacotherapy – fluoxetine (a SSRI) is Part B Have you ever ridden in a CAR driven by someone □ □ efficacious but SSRIs have a risk of suicidality – consider only (including yourself) who was ‘‘high’’ or had been using if clinical monitoring is possible. Psychotherapy alone or alcohol or drugs? combined with pharmacotherapy can be efficacious. -
Inside Front Cover October 7.Pmd
Early Female Puberty: A Review of Research on Etiology and Implications Eileen Daniel and Linda F. Balog Abstract Though the age of menarche has not decreased signifi cantly over the past 40 years, on average, girls began The age of female puberty appears to have decreased in to develop breasts one to two years earlier during the same the United States and western countries as child health time frame. African American girls typically begin thelarche and nutrition have improved and obesity has become more by age 9 compared to age 10 for White girls, though prevalent. Also, environmental contaminants, particularly approximately 15% of African American girls and 5% of endocrine disruptors, may also play a role in lowering the age White girls begin breast budding between the ages of 7 and of puberty. Puberty at an early age increases the risk of stress, 8 (Slyper, 2006). Currently, around 50% of all girls in the poor school performance, teen pregnancy, eating disorders, U.S. have begun to develop breasts by age 10 and 14% by substance abuse, and a variety of health issues which may ages 8 and 9. appear later in life including breast cancer and heart disease. The typical age range for the onset of puberty is between Articles for this literature review were located using a 8 and 14 years in girls while early puberty occurs between 7 computerized search of the databases Health Reference and 9, and precocious puberty generally takes place before Center, Medline, PsycINFO, and ScienceDirect from 2000 the age of 6 or 7 (Carel & Leger, 2008). -
Pubertal Timing and Breast Density in Young Women: a Prospective Cohort Study Lauren C
Houghton et al. Breast Cancer Research (2019) 21:122 https://doi.org/10.1186/s13058-019-1209-x RESEARCH ARTICLE Open Access Pubertal timing and breast density in young women: a prospective cohort study Lauren C. Houghton1* , Seungyoun Jung2, Rebecca Troisi3, Erin S. LeBlanc4, Linda G. Snetselaar5, Nola M. Hylton6, Catherine Klifa7, Linda Van Horn8, Kenneth Paris9, John A. Shepherd10, Robert N. Hoover2 and Joanne F. Dorgan3 Abstract Background: Earlier age at onset of pubertal events and longer intervals between them (tempo) have been associated with increased breast cancer risk. It is unknown whether the timing and tempo of puberty are associated with adult breast density, which could mediate the increased risk. Methods: From 1988 to 1997, girls participating in the Dietary Intervention Study in Children (DISC) were clinically assessed annually between ages 8 and 17 years for Tanner stages of breast development (thelarche) and pubic hair (pubarche), and onset of menses (menarche) was self-reported. In 2006–2008, 182 participants then aged 25–29 years had their percent dense breast volume (%DBV) measured by magnetic resonance imaging. Multivariable, linear mixed-effects regression models adjusted for reproductive factors, demographics, and body size were used to evaluate associations of age and tempo of puberty events with %DBV. Results: The mean (standard deviation) and range of %DBV were 27.6 (20.5) and 0.2–86.1. Age at thelarche was negatively associated with %DBV (p trend = 0.04), while pubertal tempo between thelarche and menarche was positively associated with %DBV (p trend = 0.007). %DBV was 40% higher in women whose thelarche-to-menarche tempo was 2.9 years or longer (geometric mean (95%CI) = 21.8% (18.2–26.2%)) compared to women whose thelarche-to-menarche tempo was less than 1.6 years (geometric mean (95%CI) = 15.6% (13.9–17.5%)). -
Clinical Potential and Putative Risks of Fertility Preservation in Children Utilizing Gonadal Tissue Or Germline Stem Cells
0031-3998/06/5904-0040R PEDIATRIC RESEARCH Vol. 59, No. 4, Pt 2, 2006 Copyright © 2006 International Pediatric Research Foundation, Inc. Printed in U.S.A. Clinical Potential and Putative Risks of Fertility Preservation in Children Utilizing Gonadal Tissue or Germline Stem Cells KIRSI JAHNUKAINEN, JENS EHMCKE, OLLE SO¨ DER, AND STEFAN SCHLATT Department of Cell Biology and Physiology [K.J., J.E., S.S.], Center for Research in Reproductive Physiology, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15261; Department of Pediatrics [K.J], University of Turku, FIN-20520 Turku, Finland; Department of Woman and Child Health [K.J., O.S], Pediatric Endocrinology Unit, Karolinska Institute and University Hospital, SE-171 76 Stockholm, Sweden ABSTRACT: Rapid progress in the development of novel experi- a finite stock of oocytes at birth. Only a few oocytes will be mental strategies to generate fertile gametes from cryo-preserved released during ovulation during reproductive life. The ma- ovarian and testicular tissue motivates oncologists to investigate jority will be lost due to atretic degeneration, and replenish- ways in which gonadal tissue might be preserved. Childhood cancer ment of the oocyte pool from germline stem cells does not patients remain the major pediatric group which can benefit from occur (3–5) (Fig. 1). However, recent reports have challenged these techniques. Other potential candidates include patients with this concept. It has been shown that primordial germ cells in systemic diseases, which require gonadotoxic chemotherapy, patients undergoing gonadectomy, patients with Turner or Kleinefelter’s syn- culture dishes are capable of forming oogonia and follicle-like drome, and boys with cryptorchid testes. -
A Review of the Incidence and Survival of Childhood and Adolescent Cancer and the Effects of Treatment on Future Fertility and Endocrine Development
REVIEW A review of the incidence and survival of childhood and adolescent cancer and the effects of treatment on future fertility and endocrine development M H Botha, MMed (O&G), PhD Unit for Gynaecological Oncology, Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, Western Cape T F Kruger, MB ChB, MPharmMed (Clin Pharm), MMed (O&G), FCOG (SA), FRCOG (Lond), MD Unit for Reproductive Biology, Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Academic Hospital Cancer is not uncommon in children. The reproductive system is an important site for late effects of cancer treatment, and normal pubertal development depends on an undamaged hypothalamic-pituitary-gonadal axis. Fertility compromise can occur due to chemotherapy, radiotherapy to the hypothalamic-pituitary-gonadal axis, or surgery. Cryopreservation techniques of germ cells are improving and may offer hope for fertility preservation. S Afr J OG 2012;18(2):48-53. Cancer is not an uncommon diagnosis in children. The incidence Older children and young adults have historically not been of childhood cancer (generally referring to children up to the age of studied to the same extent as young children with regard to 15) is 110 - 130 per million children per annum.1 It is estimated that cancer incidence. The age range for adolescence for the purpose the cumulative risk of a child being diagnosed with cancer is slightly of scientific reporting has been set at 15 - 19 years.6 More recently higher in boys (1:444) compared with girls (1:594).2 In South Africa the concept of ‘young adult oncology’ has referred to a larger group accurate figures for childhood cancer are not available. -
Preservation of Fertility in Patients with Cancer (Review)
ONCOLOGY REPORTS 41: 2607-2614, 2019 Preservation of fertility in patients with cancer (Review) SOFÍA DEL-POZO-LÉRIDA1, CRISTINA SALVADOR2, FINA MARTÍNEZ-SOLER3, AVELINA TORTOSA3, MANUEL PERUCHO4,5 and PEPITA GIMÉNEZ-BONAFÉ1 1Department of Physiological Sciences, Physiology Unit, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, IDIBELL, L'Hospitalet del Llobregat, 08907 Barcelona; 2Department of Gynecology, Gynecological Endocrinology and Reproduction Unit, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona; 3Department of Basic Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, IDIBELL, L' Hospital et del Llobregat, 08907 Barcelona, Spain; 4Sanford Burnham Prebys Medical Discovery Institute (SBP), La Jolla, CA 92037, USA; 5Program of Predictive and Personalized Medicine of Cancer (PMPPC), of the Research Institute Germans Trias i Pujol (IGTP), Badalona, 08916 Barcelona, Spain Received January 18, 2019; Accepted March 6, 2019 DOI: 10.3892/or.2019.7063 Abstract. Survival rates in oncological patients have been techniques evaluated. Emerging techniques are promising, steadily increasing in recent years due to the greater effec- such as the cryopreservation in orthotopic models of ovarian tiveness of novel oncological treatments, such as radio- and or testicle tissues, artificial ovaries, or in vitro culture prior chemotherapy. However, these treatments impair the reproduc- to the autotransplantation of cryopreserved tissues. However, tive ability of patients, and may cause premature ovarian failure oocyte vitrification for female patients and sperm banking for in females and azoospermia in males. Fertility preservation male patients are considered the first line fertility preserva- in both female and male oncological patients is nowadays tion option at the present time for cancer patients undergoing possible and should be integrated as part of the oncological treatment. -
A Guide for Teaching About Adolescent Sexuality and Reproductive Health
CHRISTIAN FAMILY LIFE EDUCATION: A Guide for Teaching about Adolescent Sexuality and Reproductive Health Written by Shirley Miller for Margaret Sanger Center International © 2001 ~ This guide was written especially for Christians and others who value the importance of talking comfortably and effectively with young people and adults about issues related to healthy sexuality and reproductive health. It provides state of the art information on a variety of topics related to human sexuality, gender, adolescents, growth and development, parenting, domestic violence, STIs, HIV/AIDS, sexual abuse, substance abuse, conflict resolution, goal setting and other important life issues. ~ Margaret Sanger Center International, Copyright 2001 2 CONTENTS Page PREFACE..............................................................................................9 INTRODUCTION: Why Christian Family Life Education? .............10 Important Issues Concerning Adolescents.....................................13 PART ONE: CHRISTIAN FAMILY LIFE EDUCATION About This Guide..................................................................................16 Objectives of the Christian Family Life Education Programme............18 Characteristics of an Effective Christian Family Life Educator ...........20 Providing Support for Parents ..............................................................22 Communicating with Young People about Sex....................................23 Clarifying Values ..................................................................................25 -
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1 184 A B Hansen and others Sex steroids in adolescencel 184:1 R17–R28 Review DIAGNOSIS OF ENDOCRINE DISEASE Sex steroid action in adolescence: too much, too little; too early, too late A B Hansen 1, D Wøjdemann1, C H Renault1, A T Pedersen 2, K M Main1, L L Raket3,4, R B Jensen1 and A Juul 1 Correspondence 1Department of Growth and Reproduction, 2Department of Gynecology and Fertility Clinic, Rigshospitalet, University should be addressed of Copenhagen, Copenhagen, Denmark, 3H. Lundbeck A/S, Valby, Hovedstaden, Denmark, and 4Clinical Memory to A Juul Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden Email [email protected] Abstract This review aims to cover the subject of sex steroid action in adolescence. It will include situations with too little sex steroid action, as seen in for example, Turners syndrome and androgen insensitivity issues, too much sex steroid action as seen in adolescent PCOS, CAH and gynecomastia, too late sex steroid action as seen in constitutional delay of growth and puberty and too early sex steroid action as seen in precocious puberty. This review will cover the etiology, the signs and symptoms which the clinician should be attentive to, important differential diagnoses to know and be able to distinguish, long-term health and social consequences of these hormonal disorders and the course of action with regards to medical treatment in the pediatric endocrinological department and for the general practitioner. This review also covers situations with exogenous sex steroid application for therapeutic purposes in the adolescent and young adult. This includes gender-affirming therapy in the transgender child and hormone treatment of tall statured children. -
Kristen Cain, MD, FACOG Reproductive Medicine Institute Sanford Health, Fargo, ND
Kristen Cain, MD, FACOG Reproductive Medicine Institute Sanford Health, Fargo, ND s Nothing to Disclose s Reproductive age patients value their fertility Survival of childhood and adult cancers is increasing Treatment and preservation options continue to evolve Failure to discuss fertility issues with young cancer patients can have lasting negative consequences Duffy C et al, Cancer J 2009, 15;27-33. Simon B et al CA Cancer J Clin 2005 55;211-228 Annually more than 130,000 cancer patients are diagnosed in their reproductive years (up to 45) 1 More than 11,000 breast cancer patients are diagnosed under the age of 40 each year 2 21% of gynecologic cancer patients are diagnosed under the age of 45 3 12,000 children (0-19) are diagnosed with cancer each year 4 5-7% invasive breast cancer cases occur in women under the age of 40 (www.seer.cancer.gov.2008 ) 1 American Cancer Society & U.S. Census Bureau 2 Young Survival Coalition 3 Liou WS, Yap S, et al., Fertility and Sterility, 2005. 4 Goodwin T, Ooosterhuis BE, et al., Pediatric Blood Cancer,s 2007. Increasing Cancer Survival Rates Increased Emphasis on Quality of Life + Many Successful Fertility Preservation & Post-treatment Parenthood Options = Patients Need Information About Fertility Risks & Options s Cancer Survivorship Rates are High 77% percent of patients under 45 survive at least five years 1 US Trend: Delayed Childbearing Average age for first child is 25.2 – an all time high 2 More patients have not had children when diagnosed Nearly ¼ of first-time live births occur to women over the age of 30 1 SEER Cancer Statistics Review, 1997-2004. -
Precocious Puberty Dominique Long, MD Johns Hopkins University School of Medicine, Baltimore, MD
Briefin Precocious Puberty Dominique Long, MD Johns Hopkins University School of Medicine, Baltimore, MD. AUTHOR DISCLOSURE Dr Long has disclosed Precocious puberty (PP) has traditionally been defined as pubertal changes fi no nancial relationships relevant to this occurring before age 8 years in girls and 9 years in boys. A secular trend toward article. This commentary does not contain fi a discussion of an unapproved/investigative earlier puberty has now been con rmed by recent studies in both the United use of a commercial product/device. States and Europe. Factors associated with earlier puberty include obesity, endocrine-disrupting chemicals (EDC), and intrauterine growth restriction. In 1997, a study by Herman-Giddens et al found that breast development was present in 15% of African American girls and 5% of white girls at age 7 years, which led to new guidelines published by the Lawson Wilkins Pediatric Endocrine Society (LWPES) proposing that breast development or pubic hair before age 7 years in white girls and age 6 years in African-American girls should be evaluated. More recently, Biro et al reported the onset of breast development at 8.8, 9.3, 9.7, and 9.7 years for African American, Hispanic, white non-Hispanic, and Asian study participants, respectively. The timing of menarche has not been shown to be advancing as quickly as other pubertal changes, with the average age between 12 and 12.5 years, similar to that reported in the 1970s. In boys, the Pediatric Research in Office Settings Network study recently found the mean age for onset of testicular enlargement, usually the first sign of gonadarche, is 10.14, 9.14, and 10.04 years in non-Hispanic white, African American, and Hispanic boys, respectively. -
Onset of the Release of Spermatozoa (Spermarche) in Chinese Male Youth
AMERICAN JOURNAL OF HUMAN BIOLOGY 12:577–587 (2000) Onset of the Release of Spermatozoa (Spermarche) in Chinese Male Youth CHENG-YE JI1* AND SEIJI OHSAWA2 1Department of Health Care Epidemiology, Beijing Medical University, Beijing, China 2Institute of Human Living Sciences, Otsuma Women’s University, Tokyo, Japan ABSTRACT Data on the prevalence of the first ejaculating emission for 83,902 Chinese boys 9 through 18 years were collected using interviews. Median spermarcheal ages (MSAs) were calculated by using the status quo data and probit analysis. Subjects consisted of 61,812 Han boys from urban and rural areas in 29 provinces, and 22,090 minority boys from 17 minority ethnic groups. Median spermarcheal ages were 14.24 years for urban Han boys and 14.85 years for rural Han boys, and ranged from 13.46 to 16.32 years for the 17 minority ethnic groups. The differences in MSAs between urban and rural Han boys in each province were significant and the correlation ,0.83 ס between MSA of urban and rural boys in each province was high (r P < 0.001). For both urban and rural Han boys, there were significant geo- graphic variations. MSAs of boys living in north China were generally higher than those living in the south, while those living in the west were higher than those living in the east. Variation in MSA may be related to ecological con- ditions in the Chinese Han populations. The different estimates of spermar- cheal ages with two approaches, periodical urine sample analysis vs. inter- view, and their effect on estimating male puberty are discussed.