Case-task. History

1.

Medical Academy named after S.I. Georgievsky
Department of obstetrics, gynecology and perinatology №1
CLASS № 13
Abnormalities of female genital organs.
CASE-TASK
Teacher
Asst. Puchkina Galina Anatolievna
Begin
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2.

History
Examination
Investigations
Questions

3.

HISTORY
A 14-year-old girl is seen by her general practitioner because her mother is worried that
her periods have not started. Her older sister started at 13 years and her younger sister has
just started her periods at 12 years, and she is now embarrassed at school as her friends
are always discussing their periods and she has not told them that she has not had one.
Her mother is also concerned because she has not developed pubic and axillary hair or
breast enlargement.
She was born at 38 weeks by spontaneous vaginal delivery and has never had any particular
medical problems. She reached all her developmental milestones as a child although
has not started a teenage growth spurt and is the second shortest girl in her class.
She eats normally with her family and denies any eating disorder. She takes part in school
sport but does not exercise to excess.
She is sociable with her friends but has never had a boyfriend.
Her school academic performance is about average, although she does not do as well as
her siblings who are all in the top streams of their years.
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4.

EXAMINATION
On examination she is 120 cm and weighs 59 kg. She
has no abnormal facial features but
has a wide carrying angle (cubitus valgus) and a
wide neck. There is no apparent breast
development and the nipples appear widely
spaced. No axillary hair growth is apparent.
Abdominal examination is unremarkable. The
external genitalia are normal though no
pubic hair is visible. Internal examination is not
performed.
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5.

INVESTIGATIONS
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6.

QUESTIONS
• What is the most likely diagnosis and how might
this be confirmed?
• What are the principles of management for this
girl?
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