TEALE FENNING

docsubhi · Joined: 03 Sep 2007 Posts: 59 Location: london

A- Adrenelectomy
B. Aromatase inhibitors
C. Bromocryptine
D. Combined oral contraceptive pill
E. Corticosteroids
F. Cyproterone acetate
G. Danazol
H. Estrogens
I. Finasteride
J. GnRH agonist
K. Growth hormones
L. Medroxyprogesterone acetate
M. Neurosurgical excision
N. Ovarian cystectomy
O. Reassurance
P. Testicular tumour removal
Q. Thyroxine

4.A 10 year old presents with an 8 months history of regular menstruation and well developed secondary sexual characteristics. Her sisters attained menarche at the age of 13 and 14 years. Investigations did not demonstrate any abnormal hormone profile.

5.A 11 year old presenting with well developed secondary sexual characteristics since the age of 7 years is investigated and found to fusion of labioscrotal folds and raised 17-OH progesterone.

6.A 10 year old girl presenting with short stature and failure of development of any secondary sexual characteristics. She is found on examination to have wide carrying angle of the arms and a short neck. A transabdominal ultrasound of the pelvis is reported as demonstrating “normal pelvic organs”.

Nick Raine-Fenning · Posted: Tue Aug 19, 2008 11:49 am Post subject:

Excellent stems and questions docsubhi.

I'll give the others a chance to answer Wink

They are too hard for me.

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

4 O This is not precocious puberty, because it's occurred after 8 years age, so reassurance and no treatment indicated (suppression with GnRH analogues offered if at younger age, to prevent psycosocial problems and reduction in final adult height)

5 E. She's got congenital adrenal hyperplasia (due to 21-hydroxylase deficiency, cortisol pathway blocked, leads to increase in ACTH secretion, overproduction of androgens and 17-OHP). Presumably she's got mainly premature adrenarche, am not aware this can cause premature menarche or telarche (?) Steroids will replace glucocorticoid deficit and decrease ACTH and androgen production.

6. H. Turner's. She needs karyotyping before anything else, but that option isn't given. Most common cause of gonadal dygenesis. They do often have hypothyroidism as well. Treatment initially with low dose estrogens to promote breast development without disturbing linear growth. Cyclical estrogen plus progestogen as maintenance therapy.

docsubhi · Joined: 03 Sep 2007 Posts: 59 Location: london

for the last one are'nt oestrogens started after the growth is completes around 12 years as they cause premature fusion of epiphysis

i went with reassurance for first one

and ? steroids for second but not sure

Nick Raine-Fenning · Posted: Tue Aug 19, 2008 7:34 pm Post subject:

Quite - some advocate Growth Hormone and avoidance of oestrogen (see MCQ Past Paper Book from the one and only RCOG) however is it possible to attain a normal height with Turner's?

Key is to remember that E2 prematurely causes epiphyseal fusion so avoid this in precocious puberty and consider enahncing it with delayed puberty if excessive height an issue (is it ever an issue?).

One the other side E2 is needed for normal pubertal development: breasts essentially as the external genitalia and pubic and axiallry hair will develop anyway

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

Ah, yes, had forgotten that she was only 10 years old and definitely need to wait a few years before giving oestrogen. These girls normally present a bit later if it's for failure of developing 2nd characteristics.