Precocious pubertyDownloads

A 6-year-old girl is brought to the pediatrician by her father for an annual physical examination. The father reports that the patient is a happy and healthy child, but he sometimes worries about her weight. He says that she is a “picky” eater and only wants chicken nuggets and French fries. He also notes some mild acne on her cheeks and forehead but thinks it’s because she “doesn’t like baths.” The father says she has met all her pediatric milestones. She has recently started kindergarten, can tell time, and is beginning to read. Her teacher says she gets along with her classmates well. The patient was born at 38 weeks gestation. She has no chronic medical conditions and takes only a multivitamin. Height and weight are above the 95th percentile. Physical examination reveals scattered comedones on the patient’s forehead and bilateral cheeks. There is palpable breast tissue bilaterally with raised and enlarged areolae. Scant axillary hair and coarse pubic hair are also noted. A radiograph of the left hand shows a bone age of 9 years. Serum follicular stimulating hormone (FSH) level is 9.6 mU/mL (normal range 0.7-5.3 mU/mL) and luteinizing hormone (LH) level is 6.4 mU/mL (normal range < 0.26 mU/mL). Which of the following is the most appropriate diagnostic test?

A 6-year-old boy is brought to the physician by his mother who is concerned about his early sexual development. He has no history of serious illness and takes no medications. He is at the 99th percentile for height and 70th percentile for weight. His blood pressure is 115/78 mm Hg. Examination shows greasy facial skin and cystic acne on his forehead and back. There is coarse axillary and pubic hair. Serum studies show: Cortisol (0800 h) 4 μg/dL Deoxycorticosterone 2.5 ng/dL (N = 3.5–11.5) Dehydroepiandrosterone sulfate 468 mcg/dL (N = 29–412) Which of the following is the most likely underlying cause of this patient's symptoms?