Social and family history Student Non-smoker His older brother had spontaneous puberty at the age of 13 years His mother’s menarche occurred at the age of 15 years He was born after an uncomplicated delivery He has always been healthy At present, he is in his last year of high school
Sense of smell Unremarkable past medical history
Investigations What additional test would be useful in making a diagnosis?
An olfactometric (smell) test An MRI or CT of hypothalamic/ pituitary region family history
What is your opinion about induction of his puberty ?
For psychosocial reasons, induction of puberty is indicated Further delay of pubertal development would compromise normal development of bone mass.
Therapy He asks you what his options are with respect to pubertal induction and fertility
Therapy If he has intact LH&FSH producing pituitary cells Long –term treatment for fertility HCG and HMG Biosynthetic LH /FSH preparation pulsatile GnRH Could be used to induce gonadal development and spermatogenesis.
Therapy He was treated with testosterone He was pleased with his pubertal development. He reached a final height of 199 cm at the age of 21 years