7a. Given Esperanza’s history/physical exam/lab, which of the following categories best describe what is going on with her Choose one: 1. Isosexual or heterosexual puberty 2. Central precocious or peripheral precocious puberty
Accordingly to clinical signs, anamnesis, and data of lab analysis Esperanza’s health condition could be described as incomplete isosexual precocity. Because of the character of clinical changes the supposition about gonadotropin-releasing hormone (GnRH) independent mechanisms of pathogenesis which is characteristic for peripheral precocious puberty.
The differential is central precocious puberty, which could be idiopathic, related to intracranial tumors (e.g. hamartoma, craniopharyngioma, etc), hypothyroidism or to post-treatment effects for congenital adrenal hyperplasia (Reindollar &amp. Lalvani, 2002). Because of advanced bone age, the supposition about benignant premature thelarche should be declined. Furthermore, such symptoms as accelerated skeletal maturation and early fusion of bone epiphyses could argue for central precocious puberty. Nevertheless, other conditions resulting in peripheral precocious puberty, e.g. McCune-Albright syndrome should be discussed also.
If levels of F7bii. What additional test/procedures would you order
The program of diagnostic tests could include:
Lab test for prolactin level
LH and FSH test after infusing GnRH (e.g. Factrel)
Head MRI or CT
7ci. If Esperanza were to have prepubertal levels of FSH/LH and increased estradiol, what would be in your differential
If levels of FSH/LH are usual for prepubertal age and there are no response to GnRH loading than an increased level of estradiol could be explained by adrenal hyperplasia, ovarian cysts, iatrogenic influences, and some other endocrine disorders, e.g. McCune-Albright’s syndrome, which could be characterized by autonomous hyperproduction of estrogens. In other words, a differential diagnosis will be conducted between different types of gonadotropic independent precocious puberty.

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