A 15-year-old girl comes to the physician with her father for evaluation of short stature. She feels well overall but is concerned because all of her friends are taller than her. Her birth weight was normal. Menarche has not yet occurred. Her father says he also had short stature and late puberty. The girl is at the 5th percentile for height and 35th percentile for weight. Breast development is Tanner stage 2. Pubic and axillary hair is absent. An x-ray of the left hand and wrist shows a bone age of 12 years. Further evaluation of this patient is most likely to show which of the following sets of laboratory findings?
AHigh FSH, High LH, Normal Estradiol, Normal Prolactin
BNormal FSH, Normal LH, Normal Estradiol, Normal Prolactin
CNormal FSH, Normal LH, Low Estradiol, Normal Prolactin
DLow-normal FSH, Low-normal LH, Low Estradiol, Normal Prolactin
ELow FSH, Low LH, Low Estradiol, Normal Prolactin
A 16-year-old teenager presents to the pediatrician with his mother. After she leaves the room he tells the physician that he is worried about puberty. All of his friends have had growth spurts, started building muscle mass, and their voices have changed while he still feels underdeveloped. The physician takes a complete history and performs a thorough physical examination. He goes through the patient’s past medical records and growth charts and notes physical findings documented over the last five years, concluding that the patient has delayed puberty. Which of the following findings supports his conclusion?
AThe absence of testicular enlargement by age of 14 years
BThe absence of an adult type of pubic hair distribution by age of 16 years
CThe absence of linear growth acceleration by age of 13 years
DPresence of gynecomastia at age of 15 years
EThe absence of penile enlargement by age of 12 years
A 7-year-old boy is brought to the physician because his parents are concerned about his early sexual development. He has no history of serious illness and takes no medications. His brother was diagnosed with testicular cancer 5 years ago and underwent a radical orchiectomy. The patient is at the 85th percentile for height and 70th percentile for weight. Examination shows greasy facial skin. There is coarse axillary hair. Pubic hair development is at Tanner stage 3 and testicular development is at Tanner stage 2. The remainder of the examination shows no abnormalities. An x-ray of the wrist shows a bone age of 10 years. Basal serum luteinizing hormone and follicle-stimulating hormone are elevated. An MRI of the brain shows no abnormalities. Which of the following is the most appropriate next step in management?
ALeuprolide therapy
BTesticular ultrasound
CCortisol supplementation
DRadiation therapy
EObservation
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