Diagnostic Tests for Puberty
Puberty Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Puberty:
Puberty Diagnosis: Book Excerpts
Diagnosis of Puberty: medical news summaries:
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Diagnostic Tests for Puberty: Online Medical Books
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PRECOCIOUS PUBERTY:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine diagnostic studies include a CBC, sedimentation rate, urinalysis, chemistry panel, VDRL test, rapid ACTH test, serum testosterone, dihydrotestosterone, dehydroepiandrosterone, and a flat plate of the abdomen. If a brain tumor is suspected, a CT scan of the brain may be done. If an adrenal tumor is suspected, a CT scan of the abdomen and pelvis may be performed. Pelvic ultrasound or a CT scan of the pelvis may identify an ovarian tumor. Ultrasound may help evaluate a testicular mass. It is best to consult an endocrinologist, urologist, or gynecologist before ordering these expensive diagnostic tests.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
DELAYED PUBERTY:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Before proceeding with an expensive diagnostic workup, it is perhaps best to consult an endocrinologist. If one is not available, routine tests would be a CBC, chemistry panel, and thyroid profile. Blood tests for a serum FSH, LH, and testosterone or estradiol may be done, although urine gonadotrophins may be a cheaper screening test.
Pelvic ultrasound and CT scans of the abdomen and pelvis will help identify ovarian and adrenal tumors and abnormal configuration of the uterus. CT scans of the brain will help identify pituitary tumors. If all these studies are negative, a psychiatrist may need to be consulted. Remember, the family may be in more need of the psychiatrist than the child.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Precocious Puberty:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Normal Variations vs Precocious Puberty
Importantto distinguish normal variations (premature thelarche, premature adrenarche,premature menarche) from precocious puberty.Premature thelarche and adrenarcheare much more common than precocious puberty, and if one or theother is suspected and bone age is normal, no further investigationneeds to be made. Growth velocity should be reassessed in 4–6mos. Only if other signs of puberty develop or if bone age becomes advancedis further investigation needed. Evaluation of Precocious Puberty in Boys
In boys,testicular exam is especially important to help distinguish betweenvarious causes of precocious puberty. Bilateral enlarged testesindicate GnRH-dependent precocious puberty, whereas bilateral smalltestes indicate GnRH-independent precocious puberty.To confirm presence of GnRH-dependentor -independent puberty, GnRH stimulation test may be performed.Intravenous infusion of GnRH (100 μg) is given, and serum LHand FSH concentrations are measured at 30 and 60 mins. PredominantLH response signifies pubertal response and indicates presence ofGnRH-dependent puberty. MRI should be performed to search for CNSlesion, particularly a tumor.With GnRH-independent precocious puberty,history and physical exam can determine whether there has been exposureto exogenous sex steroids. Serum 17-OH progesterone levels at baseline andafter ACTH stimulation can diagnose 21-hydroxylase deficiency. Measurementof serum androgens (testosterone, dehydroepiandrosterone sulfate)and adrenal imaging can establish diagnosis of adrenal tumor. TesticularU/S should be performed with suspected testicular tumor.Elevated serum hCG indicates hCG-secreting tumor, and further imagingis required to locate and define tumor. Evaluation of Precocious Puberty in Girls
GnRH stimulationtest is performed in girls with isosexual precocious puberty toestablish whether precocious puberty is caused by activation ofthe hypothalamic-pituitary axis. Individuals with positive responsesto GnRH undergo MRI to determine whether there is a lesion in CNS,even though idiopathic precocious puberty is much more common. Whenresponse to GnRH is absent or blunted, sex steroid secretion isindependent of hypothalamic-pituitary axis, and ovarian abnormality(cyst or tumor) or McCune-Albright syndrome is likely. Pelvic U/Sis performed to assess ovarian structure.In girls with contrasexual precociouspuberty (pubic or axillary hair but no breast development), evaluationmust focus on ovary or adrenal as abnormal source of androgens.Again, pelvic U/S is especially helpful along with measurementof adrenal androgens and androgen precursors. In some cases, ACTHstimulation test is needed to diagnose nonclassical 21-hydroxylasedeficiency.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
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