Women's Corner
Women's Corner
Management of patients with delayed puberty demands a knowledge of :
1. Normal sexual diffrentiation and female development .
2. Endocrinology of puberty .
Normal sexual diffrentiation and development :
· Chromosomal sex determination : Despite initial chromosomal sex diffrentiation into either XY or XX conceptus, the early embryo (up to 6 weeks) is morphologically of indifferent sex with mullerian and wolfian ducts and undifferentiated genital ridge .
· Gonadal sex determination (after the 6th week):
- In the presence of a Y chromosome , H-Y antigen and TDF are produced and are responsible for the critical induction of the testis
- In the absence of a Y chromosome e.g. XX conceptus a female phenotype is the result , thus XX chromosomes are only needed for normal development of the ovaries at the genital ridge
· Internal and external sex determination :
- Testis :
1. MIF from Sertoli cells leading to disappearance of mullerian derivatives
2. Testosterone : leads to
a. Wolffian development
b. Conversion to DHT by 5 -reductase leading to musulinization of the cloaca
- Abnormal or ectopic androgenic stimuli during cloacal development leads to variable effects in female cloacal development .
dr. Hisham Al-Inany Lecturer in Obstetrics and Gynecology Department, Cairo University, Egypt Dr. Amr Hussein Lecturer in Obstetrics and Gynecology Department, Cairo University, Egypt