Sexual characteristics

Question 1

Steps in examination in a Girl with Breast developement

Answer 1

1. Check growth parameters
2. Note if child with Goitre
3. General examination:
   • Skin for pigmentation
   • Secondary sexual characteristics
4. Abdo examination:
   • Mass
   • External genitalia, vagina mucosa
   • PR for pelvic mass
5. Check visual field and fundi for defect and papilloedema respectively
   • Complete neurological examination if necessary
6. Ask mother for
   • drug intake
   • previous hx of CNS infection
   • family hx of precocious puberty

7. Investigations
•  TSH & Thyroxine level
•  Skeletal survey and bone age
•  Oestrogen level
•  LHRH stimulation 
•  USG for pelvis for ovarian mass
Do first 2, if normal bone age --> stop and observe