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Old 07-10-2012
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ObGyn Diagnosing Primary Amenorrhea

17 year old female presents to you with primary amenorrhea. She is short for her age with poor breast development. On further examination , you note that there is high arched palate, wide spaced nipples and short fourth metacarpal.
What is your next step in workup of this patient ?
1. Serum LH, FSH, TSH and GH.
2. Karyotype analysis
3. Progesterone Challenge test
4. Echocardiography

i dont have answer and explanation for this q
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Old 07-10-2012
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Next best step- FSH, LH, TSH and GH
Most accurate- Karyotype analysis.

As far as I have seen most que stems with Turner syndrome provide us with FSH and LH values, however Karyotype is not always mentioned.
Hence Im assuming FSH and LH are the initial tests followed by a karyotype for confirmation.
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Old 07-11-2012
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I think that's a sneaky question. Technically, you'd want to start with FSH/LH/TSH/GH levels in any girl with primary amenorrhea. But when the history/exam is so strongly suggestive of Turner's syndrome, I think it's perfectly reasonable to just go straight to the karyotype, especially since Turner's is also the most common cause of primary amenorrhea.

So I agree that the right answer is FSH/LH/TSH/GH, but I think that this question is too debatable to show up on the USMLE.
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Old 07-11-2012
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Quote:
Originally Posted by shan564 View Post
I think that's a sneaky question. Technically, you'd want to start with FSH/LH/TSH/GH levels in any girl with primary amenorrhea. But when the history/exam is so strongly suggestive of Turner's syndrome, I think it's perfectly reasonable to just go straight to the karyotype, especially since Turner's is also the most common cause of primary amenorrhea.

So I agree that the right answer is FSH/LH/TSH/GH, but I think that this question is too debatable to show up on the USMLE.
yup thats true. i read in kaplan pediatrics in side column, [turners section genetics] that next step in suspected turners is karyotype...
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