Chapter 12 Miscellaneous cases in adolescence
Case 12.1
1. What questions do you need to ask, prior to making your differential diagnosis?
The aim will be to determine if her problem is being caused by:
3. What information would you need regarding her physical appearance in order to make a differential diagnosis?
• Presence of fine lanugo hair on her body, dry skin and poor skin turgor (may be found in anorexia nervosa).
6. Explain the possible mechanisms by which athletes often have a delayed menarche.
The relative absence of adipose tissue alters levels of leptin, which influences the hypothalamic-pituitary axis. Leptin affects levels of gonadotrophin regulating factor (released from the hypothalamus), and hence levels of follicle stimulating hormone (FSH) and luteinising hormone (LH) (released from the anterior pituitary gland). Consequently, the menstrual cycle may be altered.[1]
Case 12.2
2. Which investigation is required in order to choose the most appropriate medication for her problem?
Case 12.3
3. What questions would be relevant to ask Faith and her mother?
• Was her height relatively normal as a child, and then slowed down dramatically? (Adolescent growth spurt often fails to occur.)
• Is there a history of serous otitis media, squints, swollen hands and/or feet at birth or congenital hip dislocation?
Case 12.4
2. What is your differential diagnosis?
Infection with either Neisseria gonorrhoea or Chlamydia trachomatis.
4. What investigations does he need?
• A gram-stained smear of urethral discharge can usually demonstrate abundant leukocytes and gonococci. Alternatively, gonococci can be identified in culture. Rapid diagnostic tests based on genetic probes for gonococcal DNA are available.
5. Compile a table which lists the most common sexually transmitted infections (STIs), their causative agents and their clinical features.
