Precocious and delayed puberty, amenorrhea, and PCOS with their underlying hormonal mechanisms tested on USMLE Step 1.
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- Precocious puberty in girls is generally defined as onset before age
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8 years- Precocious puberty in boys is generally defined as onset before age
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9 years- Central (GnRH-dependent) precocious puberty results from
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Early activation of the hypothalamic-pituitary-gonadal axis- Peripheral (GnRH-independent) precocious puberty results from
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A source of sex hormone outside of normal hypothalamic-pituitary-gonadal axis activation, such as an ovarian or adrenal tumor- The typical order of pubertal changes in girls (Tanner sequence)
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Thelarche (breast development), then pubarche (pubic hair), then menarche- Thelarche refers to
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The onset of breast development- Menarche refers to
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The first menstrual period- Delayed puberty in girls is generally defined as absence of breast development by age
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13 years- Primary amenorrhea is defined as
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Absence of menarche by age 15 in the presence of normal secondary sexual characteristics- Secondary amenorrhea is defined as
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Absence of menstrual periods for 3 or more months in a woman who previously menstruated- The most common cause of secondary amenorrhea to exclude first
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Pregnancy- Turner syndrome as a cause of primary amenorrhea presents with
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Streak ovaries and absent secondary sexual characteristics due to gonadal dysgenesis- Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) causes primary amenorrhea by
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Absent or underdeveloped uterus and upper vagina despite normal ovarian function- Functional hypothalamic amenorrhea is commonly caused by
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Excessive exercise, low body weight, or significant psychological stress- Asherman syndrome causes secondary amenorrhea through
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Intrauterine adhesions, often following uterine instrumentation such as dilation and curettage
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