Answer:USMLE step 2 Mcq 140:A 14 year old is concerned about his height. He says he is too short and is teased about this at school




Correct Answer: A

the features described in this question are characteristic of constitutional (familial) delay . Reassurance would be appropriate. Hypogonadotropic hypogonadism is established in adults by the finding of normal or low serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the presence of low concentrations of testosterone in males and estradiol in females. In younger patients, these measurements cannot differentiate individuals with gonadotropin deficiency from those with constitutional delay of puberty. This distinction is very difficult. Failure to initiate puberty by age 14 in boys and 13 in girls defines delayed puberty. No reliable test discriminate reliably these two entities. Prolonged observation is the only way to distinguish Idiopathic Hypogonadotropic Hypogonadism (IHH) from delayed puberty. Once hypogonadotropic hypogonadism is established, the positive famial history and the presence of anosmia or associated abnormalities strongly suggests the diagnosis of the syndrome, IHH remains a diagnosis of exclusion


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