Adolescent Flashcards
If a girl has breast buds and no pubic hair, what is the problem?
Androgen insensitivity - testicular feminization (XY chromosome)
- Receptor insensitivity to androgens
- No male external genitalia
- Blind ending vagina, lack of uterus, lack of ovaries
- Testes in inguinal canal
If a girl has no breast buds but has pubic hair, what is the problem?
Androgen excess
OR
Low Estrogen
What is the first step in evaluation of a patient with pubic hair but no breasts or testicular enlargement?
Bone age films
If within 1-2 years of chronological age, observe.
If not -> endocrinologist
What is the first step in evaluation of precocious puberty?
Check for ovarian or testicular tumors
What tests would you do to differentiate between Central versus peripheral precocious puberty?
LH
FSH
Adrenal steroids
What are the features of gonadotropin independent precocious puberty?
- Normal LH and FSH levels
- Puberty occurring in the proper timeline except for one abnormality
- There is sex steroid production somewhere else in the body
How would you treat central precocious puberty in girls?
- Breasts + vaginal bleeding or accelerated growth
- If idiopathic (elevated LH and FSH)
- Tx: GnRH analogue
What feature must be present in order to diagnose a boy with precocious puberty?
Testicular enlargement
What can cause a boy to have signs of precocious puberty who does not yet have testicular enlargement?
- Evidence of extra hair, penile enlargement, growth spurt
- Non-Central and non-gonadal problem
- Late onset congenital adrenal hyperplasia, virilizing tumor, exogenous steroids
What is the definition of delayed puberty in girls?
No breast buds by the age of 13
OR
No menses within two years of the presence of both SMR 4 breasts and pubic hair
What are the features of Kallmann syndrome?
- Hypogonadotropic hypogonadism
- Anosmia
- Hypoplasia of the optic nerve
- Absence of septum pellucidum
- The only Disease with a smelling problem
What is the normal discrepancy between a bone age film and chronological age?
2 years
What is the formula for midparental height?
[Dad’s height + Mom’s height +/- 5 inches or 13 cm] / 2
Add length for boys
Subtract length for girls
How is growth hormone deficiency diagnosed?
Noting a lack of GH release following insulin or arginine stimulation.
Findings will include micropenis or clitoris and hypoglycemia.
Decelerated growth rate.
What stimulates the production of progesterone?
LH
What stimulates the production of estrogen?
FSH
What is the first step in an amenorrhea work up?
Rule out pregnancy, anatomic obstruction, malformation
What is the second step in an amenorrhea work up?
Progesterone Challenge:
- If positive (bleeding within 2 weeks of administration) = plenty of estrogen, missing progesterone -> get LH level
- High LH: PCOS
- Low LH: Get prolactin and TSH
- High PRL and TSH: hypothyroidism
- High PRL: prolactinoma
- If negative = not enough estrogen -> get FSH
- High FSH: Ovarian failure (Turner’s, autoimmune, chemo, premature menopause),
- Low FSH: central problem (mass, prolactinoma, craniopharyngioma, hypothyroid)
What is the definition of secondary amenorrhea?
- Six months without menses after a patient was regular
- 12 months without menses if the patient was previously irregular
What is the differential diagnosis for secondary amenorrhea?
Asherman's syndrome (intrauterine adhesions) Cystic fibrosis Sarcoidosis Phenothiazines Nutrition Brain tumor Tuberculosis
What percentage of suicide attempts are successful?
90%
How long are exogenous anabolic steroids detectable in the blood?
- If IM: 6 + months
- If PO: 1 month
