Gynecomastia
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· Physiology of Pubescence
· Pubescence results from the decreased sensitivity of the axis to negative feedback
· GnRH stimulates production of LH and FSH, which stimulates the ovaries and testes to make estrogen and testosterone
· Bone age (skeletal maturity) may be disparate by as much as two years from chronological age and still be normal
· Pubescence is a dynamic process that can take 2.5 to 5 years to complete
· Individuals who begin growth spurt early are initially taller than peers, but they will ultimately be relatively shorter than those who begin their growth spurt later
· The first sign of pubescence in males in usually testicular enlargement (normal age of onset is 11.5 years with a range of 9-14 years)
· The first sign of pubescence in females is usually breast bud formation (normal age of onset has a range of 8-14 years)
· Males - testicular growth, pubarche, penile growth, peak height velocity
· Females - breast budding, pubarche, peak height velocity, menarche
· Menarche usually occurs around 2 years after thelarche (usually SMR 4)
· The height of girls will rarely increase more than two inches after menarche
· Stage 1 - no palpable glands
· Stage 2 - breast bud develops directly below areola
· Stage 3 - gland is larger than areola
· Stage 4 - "mound on mound" configuration with glands in areolar region elevated separately from the other glands
· Stage 5 - mature breast with flat areola
Gynecomastia· Gynecomastia occurs very commonly in pubertal males.
· Pubertal gynecomastia can be asymmetric and not indicate pathology.
· Gynecomastia can cause a change in dressing habits and physical activity.
· Usually resolves in 1 to 2 years, and it rarely needs plastic surgery for correction.
· Stage 1 - no hair
· Stage 2 - few straight hairs around base of penis or on labia majoris
· Stage 3 - dense hair in circumscribed limits
· Stage 4 - dense, curly hair in mons pubis area out to thighs
· Stage 5 - hair extending laterally onto thighs or upwards toward umbilicus
· Stage 1 - prepubescent, child-like, < 4 mL volume
· Stage 2 - enlargement, usually first sign of pubescence, 4 to 6 mL volume
· Stage 3 - proliferation of seminiferous tubules, 8 to 10 mL volume
· Stage 4 - 10 to 15 mL volume
· Stage 5 - 15 to 25 mL volume
Psychosocial Development· Characteristics of Adolescent Psychosocial Development
· Emancipation from parents and adults
· Self identity based in reality
· Psychosexual differentiation
· Intellectual development with economic independence
· Rapid body changes affect self esteem.
· Evaluation of family dynamics requires one to look for sources of stress and also predominant modes of coping with stress.
· Family influence influences early modeling health behaviors, such as smoking, drinking, conflict resolution and violence.
Characteristics of Early Adolescence· 11-13 through 14-15 years of age
· Preoccupation with body changes in search for identity
· Minor parental conflicts and rebellion common
· Peers are usually same sex and age, peer acceptance paramount
· Concrete cognition
· Beginning to seek independence
· Limited dating
· Limited ability to imagine the consequences of risky behavior
· Limited ability to link cause and effect in regard to health behavior (eg, smoking, reckless driving, overeating)
· Attachment to non-parental adults is common