EndocrinologyTier 2Topic

Processes of sexual differentiation, growth, development, puberty, reproduction, and ageing

Sexual differentiation

Chromosomal -> gonadal -> phenotypic sex, in that order
SRY (Yp11.3) -> testis -> Sertoli + Leydig
- Sertoli: AMH -> Mullerian regression
- Leydig: testosterone -> Wolffian (epididymis, vas, seminal vesicle)
- 5-alpha-reductase -> DHT -> external virilisation (phallus, scrotum, prostate)
No SRY -> ovary; needs two intact X
- Ovary is an active WNT4/RSPO1 pathway, not a default
- No AMH -> Mullerian persists (tubes, uterus, upper vagina)
Internal ducts follow the ipsilateral gonad; external genitalia follow circulating androgen

Puberty

Growth

Reproductive ageing

Timing of puberty

Trigger of puberty

Precocious puberty - central (GnRH-dependent)

Precocious puberty - peripheral (GnRH-independent)

CPP progression patterns

Staging

Precocious puberty - assessment

Delayed puberty - assessment

Central precocious puberty - management

Peripheral precocity - treat the source

Growth - treatment

Reproductive ageing - management

Associations

Outcomes

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