Puberty OME

Question 1

kid <8 yo has breast buds or axially hair. 1st test you do to work this up?

Answer 1

xray to check bone age! if >2 yrs older than you need to do GnRH test

Question 2

leuprolide stim test shows elevated LH in <8 yo kid with breast buds. what you thinking? ddx?

Answer 2

central prob! needs MRI to look for tumor or constitutional

Question 3

leuprolide stim test shows no change in LH in <8 yo kid with breast buds. what you thinking? ddx?

Answer 3

peripheral = do U/S, testosterone, DHEA, 17OH progest all looking for tumor, CAH, or cysts

Question 4

kid who is 16 and never started puberty. what do you do?

Answer 4

measure FSH and LH

Question 5

17 yo kid who has never started puberty with an elevated FSH. whatcha thinking?

Answer 5

due to hypergonadotropic = karyotype to check for turners, resistant ovaries

Question 6

17 yo kid who has never started puberty with an normal FSH. whatcha thinking?

Answer 6

hypogonadism = check prolactin, TSH, T4, CBC, ESR, LFT, MRI