Precocious Puberty in Males - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 02-14-2012
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 59
Threads: 12
Thanked 10 Times in 10 Posts
Reputation: 20
Question Precocious Puberty in Males

Q1) 7 year old boy, sudden acceleration of growth, severe cystic acne, enlarged testicles and penis, coarse pubic and axillary hair. Height 88 %tile and weight 95%tile... likely dx:
A. hypothalamic dysfunction
B. 21 hydroxylase defeciency
C. severe hypothyroidism
D. abnormal karyotype 47 XXY
E. 47 XYY

Q2) 6 yr old boy with coarse, dark pubic hair. enlarged penis and testes and acne of face and upper back. mother notes that the body odor of the boy is similar to her teenage son after playing sports. height 99%tile,. Likely dx:

A. Congenital adrenal hyperplasia
B. Hypothalamic tumour
C. Klinefelter
D. Male pseudohermaphroditism
E. XYY

These questions are from different qbanks. If possible, plz explain ur answer....
Reply With Quote Quick reply to this message



  #2  
Old 02-14-2012
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

For q1 its B
Q2 Its B
Reply With Quote Quick reply to this message
  #3  
Old 02-14-2012
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 59
Threads: 12
Thanked 10 Times in 10 Posts
Reputation: 20
Default

how do u differentiate between precocious puberty of hypothalamic origin and that of CAH??
Reply With Quote Quick reply to this message
 
  #4  
Old 02-15-2012
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

what is the answer plz?
Reply With Quote Quick reply to this message
  #5  
Old 02-15-2012
doxorubicin's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 391
Threads: 98
Thanked 161 Times in 98 Posts
Reputation: 171
Default

for Q1 i would go with 47 XXY- AS ANDROGEN LEVELS ARE RAISED . for other options:
A. hypothalamic dysfunction- wouls lead to low androgens!!
B. 21 hydroxylase defeciency- no hyperkalemia
C. severe hypothyroidism- normal mental and physical development
D. abnormal karyotype 47 XXY- klinefelter! low androgen

Q2. WILL go with A. as high androgen levels
__________________
if ur ready to learn......world is ready to teach...take d leap!!
Reply With Quote Quick reply to this message
  #6  
Old 02-15-2012
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 566
Threads: 25
Thanked 524 Times in 263 Posts
Reputation: 534
Default

Q1 It should be E, because B as well would present Hipotension and hypokalemia which is not present on the clx stem.

Q2 i think is E as well..or could be A ...
__________________
Nothing is Impossible, the Word Itself says "I'm Possible"
Reply With Quote Quick reply to this message
  #7  
Old 02-15-2012
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 59
Threads: 12
Thanked 10 Times in 10 Posts
Reputation: 20
Default

Okay.. 1st i will take the Q2.
The answer is Hypothalamic tumour ... explanation given was that, enlarged gonads indicate that he had increased gonadotrpes(LH, FSH). An ectopic source of androgenic hormones such as CAH, causes gonadotropins to be shut off and the testes to be small.

Q1. The answer is CAH according to the qbank. The explanation given was, that precocious puberty presenting with signs of severe androgen excess (severe cystic acne, significant growth acceleration) suggests precosius pseudo-puberty caused by late onset CAH. Hypothalamic dysfunction leading to precocius puberty results in a less dramatic presentation. sequential development of testicular enlargement, penis enlargement, coarse pubic hair, and then growth spurt is typically present.

Also when a gland dysfunction is mentioned, it can be either increased or decreased dysfunction.

These 2 questions and explanations are from 2 different qbank. So at the end of it all, i am still not sure how to tackle a question regarding male precocius puberty. Anyone with a clear concept please help!!!!
Reply With Quote Quick reply to this message
The above post was thanked by:
rulz (02-15-2012)
  #8  
Old 02-15-2012
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

Quote:
Originally Posted by gargabhi2 View Post
Okay.. 1st i will take the Q2.
The answer is Hypothalamic tumour ... explanation given was that, enlarged gonads indicate that he had increased gonadotrpes(LH, FSH). An ectopic source of androgenic hormones such as CAH, causes gonadotropins to be shut off and the testes to be small.

Q1. The answer is CAH according to the qbank. The explanation given was, that precocious puberty presenting with signs of severe androgen excess (severe cystic acne, significant growth acceleration) suggests precosius pseudo-puberty caused by late onset CAH. Hypothalamic dysfunction leading to precocius puberty results in a less dramatic presentation. sequential development of testicular enlargement, penis enlargement, coarse pubic hair, and then growth spurt is typically present.

Also when a gland dysfunction is mentioned, it can be either increased or decreased dysfunction.

These 2 questions and explanations are from 2 different qbank. So at the end of it all, i am still not sure how to tackle a question regarding male precocius puberty. Anyone with a clear concept please help!!!!


In case of precocious puberty look for gnrh dependent or independent....

If gnrh independent it would be CAH is most common cause. Will have androgen excess clinical features but with hypogonadism

2. Mccune albright syn: skin pigmentation, bone, precocious puberty triad

3. severe hypothyroidism but will have hypothyroidism features

gnrh dependent precocious puberty: will have increased androgen with enlarge gonads. seen in hypothalamic tumor

hypothalmic dysfunction will have sequential development of secondary sexual characters seen
Reply With Quote Quick reply to this message
  #9  
Old 02-15-2012
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 59
Threads: 12
Thanked 10 Times in 10 Posts
Reputation: 20
Default

so in Q1. although there is no sequential development, but there are enlarged testicles (enlarged gonads) - so will that be gonadotropin independent or dependent process?????
Reply With Quote Quick reply to this message
  #10  
Old 02-15-2012
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

Quote:
Originally Posted by gargabhi2 View Post
so in Q1. although there is no sequential development, but there are enlarged testicles (enlarged gonads) - so will that be gonadotropin independent or dependent process?????
we have to do usg scan as a next step in management to see if gnrh dependent (hypothalamic axis tumor) or gnrh independent (CAH)...Since in CAH sac may be empty, or with small gonads or undescended ....Compaired to gnrh dependent will have large gonads..
Reply With Quote Quick reply to this message
The above post was thanked by:
doxorubicin (02-15-2012)
  #11  
Old 02-16-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 588 Times in 354 Posts
Reputation: 598
Default

rapid onset precocious puberty = late onset CAH

not sure of hypothalamic one...may be the big goand size..lolz...no idea..
Reply With Quote Quick reply to this message



Reply

Tags
Endocrinology-, Pediatrics-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Pineal Germinoma and Precocious Puberty rose USMLE Step 1 Forum 0 11-28-2011 04:03 PM
Work up for precocious puberty bangbong2000 USMLE Step 2 CK Forum 3 11-01-2011 11:28 AM
Precocious Puberty and Un-Controllable Laughter! usmleman2020 USMLE Step 1 Forum 2 08-15-2011 12:51 PM
The mecahnims of GnRH in precocious puberty! aghammoud85 USMLE Step 2 CK Forum 2 08-11-2011 05:41 PM
precocious puberty ricko335 USMLE Step 1 Forum 8 08-08-2011 05:19 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)