性早熟及gnrha治疗教学课件.pptVIP

生殖器官及性征的发育成熟;青春发育分期 Tanner stages;青春发育的神经内分泌调控;青春发育的正常年龄范围;青春启动年龄呈下降趋势;月经初潮年龄呈下降趋势;哥本哈根地区 正常儿童青春发育 15年比较;青春发育期注意事项;参考标准 遗传身高 生长趋势 生长潜能 体型 ;性早熟（Precocious puberty）;性早熟的分类;性早熟发病趋势;单纯乳房早发育;单纯乳房发育转归;肾上腺功能早现;单纯性阴毛早现;外周性性早熟peripheral precocious puberty, PPP;中枢性性早熟central precocious puberty,CPP;CPP的发病机制;常规辅助检查及流程;CPP诊断依据;垂体MRI评估指证 确诊为中枢性性早熟 男性（必选） 女性（治疗者）;ICPP治疗目的;GnRHa治疗机制;GnRHa应用指证;不需治疗指征;GnRHa应用方法;GnRHa对线性生长的影响----生长速率减慢;生长速度减慢的原因;GnRHa联合GH治疗中枢性性早熟;GnRH治疗其他效应;GnRHa新制剂及用药方式;病例一;诊断及治疗经过;病例二;GnRHa治疗安全性; GnRHa治疗安全性 肥胖症 卵巢囊肿，多囊卵巢 代谢综合征 生殖生育能力 ;儿童和青少年GnRHa治疗有效性和安全性（长期随访研究）;92例 A 组 ICPP 47 例（33 GnRHa， 14 未治疗 ） B组 GHD 24 （15 GH+GnRHa; 9 GH C组 ISS 21 （ 7 GH+GnRHa; 7 GnRHa ； 7 未治 ） 结论 GnRHa治疗者BMD、BMI及成年早期卵巢功能正常 8岁左右开始治疗的ICPP儿童 成年身高无明显改善 没有证据显示GnRHa有增加多囊卵巢综合症及月经紊乱倾向 ;Clin Endocrinol (Oxf). 2013 Aug 29. doi: 10.1111/cen.12319. [Epub ahead of print] Treated and untreated women with idiopathic precocious puberty: long-term follow-up and reproductive outcome between the third and fifth decades. Lazar L1, Meyerovitch J, de Vries L, Phillip M, Lebenthal Y. Author information 1The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Childrens Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Abstract CONTEXT: Central precocious puberty (CPP), treated or untreated, may have implications in adulthood. OBJECTIVE: To assess the reproductive outcome and social adjustment of former CPP women between the 3rd and 5th decades of life. ;对象及分组 214 CPP women aged 25-56?years 135 GnRHa-treated, 18 cyproterone acetate (CyA)-treated, 61 untreated CPP and of 446 controls with normal puberty, matched for age and year of birth, were recorded in a structured interview. ?? ;结果： 婚姻、教育、子女数：CPP与对照组相同 高雄激素表现 ：CPP↑ GnRHa 组 29·6% vs 17·4% (P