Siklus Hidup Pemicu 3

Siklus Hidup Pemicu 3Hendry Agustian405130102LO ITumbuh Kembang Remaja (Faktor, Tahap, Ciri-ciri)http://web.stanford.edu/group/mood/cgi-bin/wordpress/wp-content/uploads/2014/02/blanton_puberty_2012.pdf2PubertasGirls 8 -13 14 (ends) Breasts start to develop Pubis & Axilla hair Menstruation (bout 2 years after breast development)Boys 10 14 15-16 (ends) Testes & Penis start to develop Voice deepens Pubis, Axilla, & Facial hairBody composition starts to change (girls >fat, boys >muscles)Height & Weight Most girls reach full sexual maturity within four years of starting puberty.3Faktor Faktor yang mempengaruhi PubertasInternalEksternalRas / Etnik / Bangsa (Black vs White)KeluargaUmurJenis KelaminKelainan Genetik (GPR54 and KiSS1)Kelainan Kromosom Hormonal (Endokrin)

Lingkungan (fisik, sosial, ekonomi)Asupan makananStress (psikologis)Zat kimiaTumor, KankerPenyakit kronik(Inflammatory bowel disease,chronic renal failure)

GenetikGPR54 and KiSS1, are responsible for the onset ofpuberty.The GPR54 lies dormant (inactive) for many years until it's suddenly activated by special chemicals called kisspeptins that are produced by the KiSS1 gene.The process of puberty starts when kisspeptins turn on the GPR54 gene, sending signals to your brain and triggering a chain reaction in your body.http://www.nhs.uk/Conditions/Puberty/Pages/Causes.aspxGenetik CYP17 + CYP lainnyaCYP17 mengatur biosintesis androgenblack girls start puberty earlier than white girls

Kelainan kromosom tuner, klinefelter & kallman syndrome delayed puberty4Tahapan PubertasSS Nussey andSAWhitehead, Endocrinology:An IntegratedApproach. Taylor & Francis Group 2001. www.ncbi.nlm.nih.gov/bookshelf/

http://www.nhs.uk/Conditions/Puberty/Pages/symptoms.aspxhttp://pediatrics.uchicago.edu/chiefs/cliniccurriculum/documents/pubertyhandout-mcdonnell.pdfhttp://www.healthychildren.org/English/ages-stages/gradeschool/puberty/pages/Stages-of-Puberty.aspxhttp://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Puberty.pdf5

Tahapan Pubertashttp://www.bristol.ac.uk/alspac/external/interactive/tanner.png

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Tahapan Pubertashttp://accesspediatrics.mhmedical.com/data/Books/kapp/kapp_c007f003.gif

9Tahapan Pubertashttp://www.ufrgs.br/imunovet/molecular_immunology/Tanner_stages.jpg

10Ciri ciri pubertasCiri ciri seksual primerCiri ciri seksual sekunderTerjadi perubahan emosional dan perilaku(Mood Swings perubahan emosional Behaviour Rebellion)

Pubic hair begins to appear, usually within 6 to 12 months after the start of breast development.11Ciri ciri seksual PrimerLaki lakiPerempuanTestis dan penis mulai berkembangOrgan organ reproduksi mulai berfungsi (Spermatogenesis)Uterus, vagina, labia, dan clitoris mulai berkembangOrgan Reproduksi mulai berfungsi (Ovogenesis)Produksi dan Sekresi Hormon Ciri ciri seksual SekunderLaki lakiPerempuanTumbuh rambut di daerah pubis, axilla, muka, dan di daerah lainnyaSuara menjadi dalamTumbuh jakunKomposisi tubuh mulai berubah (mulai terbentuknya otot otot)Tumbuh rambut di daerah pubis & axillaPayudara mulai berkembangKomposisi tubuh mulai berubah (terjadi penimbunan lemak di daerah daerah tertentu)MenstruasiBertambahnya TB dan BBTimbulnya bau badan yang khas

http://pediatrics.uchicago.edu/chiefs/cliniccurriculum/documents/RWPubertyNormalanddelayed.pdfTiming of pubertal milestones14Pyschological& Behaviour changesOften feel very angry or very worriedUsealcohol/ drugsExercise,diet and/or binge-eat obsessivelyHurt other people or destroy propertyDo reckless things that could harm you or others

LO IIPsikososial Remaja (PSUD)http://pubs.ext.vt.edu/350/350-850/350-850.htmlhttp://www.yale.edu/ynhti/curriculum/units/1991/5/91.05.07.x.htmlteenager psychosocial developmenthttp://www.wrh.on.ca/webbuild/site/wrh-internet-upload/file_collection/theories%20of%20development.pdfhttp://www.siskiyous.edu/class/ece3/eriksonsstagesthroughidentity.pdfhttp://info.psu.edu.sa/psu/maths/Erikson's%20Theory%20of%20Psychosocial%20Development%20(2).pdfhttp://smhp.psych.ucla.edu/pdfdocs/psysocial/entirepacket.pdf

17E. Erikson

http://info.psu.edu.sa/psu/maths/Erikson's%20Theory%20of%20Psychosocial%20Development%20(2).pdf18

Freud Physcosexual

http://www.enmu.edu/services/tsi/documents/psychology_sociology/Freud%20Psychosexual.pdf20LO IIIHormon pada masa pubertashttp://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Puberty.pdfhttp://en.wikipedia.org/wiki/Androgenhttp://en.wikipedia.org/wiki/Endocrine_system21GnRHGnRH FSH & LH Testosteron & Estrogen progesteron (adrogen) androgen steroid?

22Hypothalamic Pituitary gonadal axishttp://embryology.med.unsw.edu.au/embryology/images/7/77/HPG_female_axis.jpg

Women and girls also have testosterone in their body, which is produced in small amounts by the ovaries to help maintain muscle and bone strength.Oestrodiol is the main sex hormone in girls. It's produced by the ovaries and stimulates growth of the breasts and reproductive system, and helps regulate the monthly menstrual cycle (periods).

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Boys and men also have oestrodiol in their body. It's produced in small amounts by the brain and testes to help maintain bone density.

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http://faculty.weber.edu/nokazaki/Human_Biology/chp%2016-%20reproductive-system_files/image009.jpgGHRHGHRH & IGF + Insulin26http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/gh_action.gif

Both insulin and IGF-I can stimulate protein synthesis in skeletal muscle (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2439518/)27

Insulin

Liver and muscles glycogen (5% of its mass)Inhibiting fats break down & signaling to store TG (Triglycerides)30Thyroid

Stimulate the development and growth of the body; Raise blood pressure; Increase heat production; Increase motor activity; Accelerate thinking; Improve mental activity; Accelerate the uptake of oxygen by all organs except spleen, testes and brain; Support the respiratory center; Increase strength and frequency of the heart rhythmic contractions; Stimulate formation of kidney hormone - erythropoietin and formation of erythrocytes; Stimulate protein digestibility

T3 & T4 Functionhttp://www.abc.net.au/health/library/img/thyroid_hormones_diag.gif(http://www.probirka.co.uk/female-infertility/1743-hormones-t4-thyroxin-t3-and-tsh-diagnostics-and-analysis-of-thyroid-gland-diseases.html)

32T3 & T4 FormationIodide take up Iodination (Oxidation) Thyroglobulin MIT / DITOrganification (Koupling Reaction) T3 & T4

High iodine levels inhibit iodide oxidation and organification. Additionally, iodine excess inhibits thyroglobulin proteolysis (this is the principal mechanism for the antithyroid effect of inorganic iodine in patients with thyrotoxicosis).Thyrotoxicosis Hyperthyroidism

(http://fitsweb.uchc.edu/student/selectives/Luzietti/Thyroid_hormones.htm)

Thyroxin binding globulin (TBG)33Parathyroid, Calcitriol & Calcitonin

http://lpi.oregonstate.edu/infocenter/minerals/phosphorus/phospth.jpg

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PTH & Calcitriol Ca 2+ in blood PTH secretion is controlled by Ca2+ level in serum (+ vit D n neurotransmitters)PTH Kidneys to excrete phosphate in urine Magnesium in blood Calcitonin Ca2+ in blood

Parathyroid kidneys, slows down the amount of calcium and magnesium filtered from the blood into the urine. stimulates the kidneys to make calcitriol, the active form of vitamin D. Calcitriol helps to increase the amount of calcium, magnesium and phosphorus absorbed from your intestines (guts) into the blood.37Leptin hormone

http://www.umanitoba.ca/dnalab/med/adr3.gif42

https://wiki.brown.edu/confluence/download/attachments/74847911/leptin+path.jpg?version=1&modificationDate=129143414200046

http://openi.nlm.nih.gov/imgs/512/92/1513065/1513065_nrs04011.f1.png50LO IVSiklus Menstruasihttp://www.nlm.nih.gov/medlineplus/menstruation.htmlhttp://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Menstrual_cycle?open51

http://embryology.med.unsw.edu.au/embryology/images/2/2b/Menstrual_cycle.jpg

http://www.sportsmd.com/Portals%5C0%5Caltman2%5CMenstrual_cycle.jpg

LO VGangguan pada masa pubertashttp://pediatrics.uchicago.edu/chiefs/cliniccurriculum/documents/pubertyhandout-mcdonnell.pdfhttp://www.nhs.uk/Conditions/Puberty/Pages/Complications.aspx http://www.nichd.nih.gov/health/topics/puberty/conditioninfo/Pages/default.aspxhttp://www.nlm.nih.gov/medlineplus/ency/article/001168.htm55Precocious PubertyBoys (9years) & Girls (6-8 years)

Pubertas prekooksDelayed pubertas

Malnutrisi Delayed pubertyStress fisik dan psikologis akibat olahraga memperlambat pubertasStress akibat adaptasi lingkungan & ortu asuh baru Pubertas diniPerkotaan lbh cpt daripada orang pedesaan56Precocious puberty causes

Precocious Puberty PeripheralCongenitalAcquiredCongenital Adrenal Hyperplasia (CAH)McCune-Albright Syndrome (MAS)Familial Male Precocious Puberty (FMPP)Exposure to sex steroids :EndogenousExogenoushttp://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/PediatricAdvisoryCommittee/UCM168546.pdf59

McCune-Albright Syndrome (MAS)Fibrous dysplasia of the boneCaf-au-lait spotsHyperfunction of endocrine tissues

Endogenous Sex SteroidsSex steroid-secreting tumors Ovary Testis Adrenal Germ cell tumorsDelayed PubertyIn General : Lack of pubertal development in girls (13) and boys (14)In girls, delayed puberty is defined as Lack of breast development (12-13),Lack of pubic hair (14), Lack of menarche (16), or > 5 years between Thelarche and Menarche. In boys, puberty is considered delayed if No testicular enlargement (14), Lack of pubic hair (15), or > 5 years are required to complete genital enlargement.Delayed SD 2/-2 dari mean (rerata)64CentralIntact hypothalamo-pituitary axis:Constitutional delay in growth and puberty (CDGP) - sporadic or familial; see also separate articleShort Stature.Chronic illness, egkidney disease,Crohn's disease.Malnutrition, eganorexia nervosa,cystic fibrosis,coeliac disease.Excessive physical exercise, particularly athletes or gymnasts.Psychosocial deprivation.Steroid therapy.Hypothyroidism.Impaired hypothalamo-pituitary axis:Tumours adjacent to the hypothalamo-pituitary axis, egcraniopharyngioma,optic glioma, germinomas, astrocytomas, pituitary tumours (includinghyperprolactinaemia).Congenital anomalies, egsepto-optic dysplasia, congenitalpanhypopituitarism.Irradiation treatment.Trauma: surgery,head injury.Gonadotrophin-releasing hormone (GnRH)/luteinising hormone (LH)/follicle-stimulating hormone (FSH) deficiency, eg congenital idiopathic,Prader-Willi syndrome,Bardet-Biedl syndrome,Kallmann's syndrome.

PeripheralBoys:Bilateral testicular damage: cryptorchidism, failed orchidopexy, atresia,testicular torsion, infection (mumps rarely causes prepubertal damage).Syndromes associated with cryptorchidism: Noonan's syndrome, Prader-Willi syndrome.Gonadal dysgenesis:Klinefelter's syndromeother XY aneuploidy syndromes, XO/XY.Irradiation, total or testicular.Drugs, egcyclophosphamide.Girls:Gonadal dysgenesis:Turner's syndrome, pure gonadal dysgenesis.Irradiation, total or abdominal.Drugs, eg cyclophosphamide, busulfan.Intersexdisorders, eg completeandrogen insensitivity syndrome(primaryamenorrhoeamay be the presenting symptom),congenital adrenal hyperplasia.Polycystic ovarian syndrome.Toxic damage:galactosaemia, iron overload (thalassaemia).http://www.patient.co.uk/doctor/delayed-puberty66

http://www.aafp.org/afp/1999/0701/p209.html67

Puberty disorders detectionPhysical exam : Pubic hair, axillary hair, acne, oily skin/hair Phallic length and width Testicular volume Breast development Clitoromegaly, labial fusionBone ageImaging Pituitary MRI, Testicular Ultrasound, adrenal ultrasoundBloodwork pituitary hormones (LH and FSH), sex steroids, hCG and AFPEffectPrecocious Puberty :Physical deformityShort statureIf a childexperiences puberty earlier than normal it's known as early or precocious puberty. Delayed puberty is where puberty occurs later than normal.In some cases, early or delayed puberty may be caused by an underlying condition. If there's no obvious cause, such as a long-term illness, tests may be needed to help diagnose any problems.

71Daftar pustakahttp://www.nhs.uk/Conditions/Pubertyhttp://www.nlm.nih.gov/medlineplus/puberty.htmlhttp://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000651.htmhttp://pediatrics.uchicago.edu/chiefs/cliniccurriculum/documents/pubertyhandout-mcdonnell.pdfhttp://www.gfmer.ch/Medical_education_En/PGC_RH_2004/Pdf/Puberty.pdfhttp://www.nlm.nih.gov/medlineplus/ency/article/002003.htmhttp://info.psu.edu.sa/psu/maths/Erikson's%20Theory%20of%20Psychosocial%20Development%20(2).pdfhttp://pediatrics.uchicago.edu/chiefs/documents/precociouspuberty-brian.pdfhttp://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/PediatricAdvisoryCommittee/UCM168546.pdfEugster E: Peripheral Precocious Puberty: Causes and Current Mangement. Hormone Research 2009;71:64-67http://pediatrics.uchicago.edu/chiefs/cliniccurriculum/documents/RWPubertyNormalanddelayed.pdf