Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Child with abnormal puberty

Clinical Discipline(s)/Organ System(s)
Endocrinology, Genitourinary System, Paediatrics
Progress Test Topic(s)
Child health
A mother brings her 13 year old NZ European daughter to see their GP. She is concerned that her daughter has no breast development and has not had menarche.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Role of nutrition in normal growth and development
   - Normal sequence of puberty: hypothalamic pituitary axis, pubarche vs menarche vs thelarche
Clinical and Communication Skills 
   - Elicit a history; attention to family history of growth delay/short stature/pubertal timing
   - Measure height, weight and head circumference, calculate height velocity, body mass index (BMI), midparental height, mean predicted final adult height
   - Use growth charts and Tanner stages of puberty
   - Recognition of normal patterns and variations of puberty, and clinical features of premature and delayed puberty
   - Utility of bone age in short stature of pubertal delay
   - Appropriate investigations and their indications in short stature, pubertal delay and precocious puberty
   - Clinical features of syndromic causes of pubertal delay (especially Turner's syndrome)
   - HEADSS assessment of the adolescent
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Perform examination in a manner that acknowledges the child's natural embarrassment
   - Talking to young people and adolescents without parents
   - Consent issues for young people <16 years (Gillick competence)
Conditions to be considered relating to this scenario
delayed puberty (constitutional), precocious puberty
Less common but 'important not to miss'
Hypothalamic/pituitary tumour, chronic disease (especially coeliac, inflammatory bowel disease)
chromosomal or genetic syndrome (Turner's syndrome), imperforate hymen, hypothyroidism