Signs and symptoms of women with pcos may change over

more PCOS symptoms. Signs and symptoms of women with PCOS may change over time, with
metabolic syndrome becoming more prominent with age. In addition, polycystic ovaries may be
associated with Cushing syndrome, acromegaly, premature ovarian failure, simple obesity,
congenital adrenal hyperplasia, thyroid disease, androgen-producing adrenal tumors or ovarian
tumors, and syndromes with hyperprolactinemia. Thus, diagnosing PCOS can be difficult.
10. Precocious puberty p.803-804 is a rare event in boys, affecting less than 1 in 50,000.
Precocious puberty in boys has been redefined as sexual maturation before age 9. One study has
noted observed mean ages of beginning male genital and pubic hair growth and early testicular
volumes tending toward younger ages than earlier studies have suggested, although this seems to
be dependent on race and ethnicity. For instance, black boys are showing significantly earlier
mean ages for stages 2 to 4 genital development and stages 2 to 4 pubic hair than white and His-
panic boys. All cases of precocious puberty require thorough evaluation. Precocious puberty may
be partial, complete, or mixed (heterosexual) types and can be further categorized into central
(GnRH-dependent) and peripheral (GnRH- independent). Central precocious puberty is GnRH-
dependent and occurs when the HPG axis is working normally but prematurely. Besides the
premature development of secondary sex characteristics, precocity causes premature closure of
the epiphysis of long bones, which results in shorter stature. Central precocious puberty results
from failure of central inhibition of the GnRH pulse generator (the gonadostat). The diagnosis of
central precocious puberty is one of exclusion. Because a CNS lesion may be missed, children
with presumed central precocious puberty require long-term surveillance. Peripheral puberty is
GnRH-independent and develops when sex hormones are produced by some mechanism other
than stimulation by the gonadotropins. Sex steroid–producing tumors (i.e., gonadal tumors),
testotoxicosis, and exposure to exogenous sex steroids (hormonal contraceptives and
environmental endocrine disruptors) are some of the causes.

ASSIGNMENT 12.1 WORKBOOK 5
Reference
McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in
adults and children (7
th
ed.). St. Louis, MO: Elsevier.