4 Social and family history StudentNon-smokerHis older brother had spontaneous puberty at the age of 13 yearsHis mother’s menarche occurred at the age of 15 yearsHe was born after an uncomplicated deliveryHe has always been healthyAt present , he is in his last year of high school
18 Medical historyWhat further information from his medical history would be relevant in dealing with his complaint?
19 surgery or medical treatment for undescended testes Member of his family has experienced fertility problemsNormal sense of smellHeadachesvisual disturbancespsychosocial situation
20 His mother recalls that at birth His testes were undescended Medical historyHis mother recalls that at birthHis testes were undescended.After 2years, his testes had not descended spontaneously, and needed orchiopexy
21 bear child Investigation His family history revealed that one of his maternal aunts was not able tobear child
25 Investigation To exclude : Hypergonadotropic hypogonadism Why would you collect basal levels of LH and FSH?To exclude :Hypergonadotropic hypogonadismHypogonadotropic hypogonadismTo make a distinction between HH & CDGP
33 InvestigationsWhat additional test would be useful in making a diagnosis?
34 An olfactometric (smell) test An MRI or CT of hypothalamic/ pituitary regionfamily history
35 What is your opinion about induction of his puberty?
36 For psychosocial reasons , induction of puberty is indicated Further delay of pubertal development would compromise normal development of bone mass.
37 TherapyHe asks you what his options are with respect to pubertal induction and fertility
38 Therapy Long –term treatment for fertility If he has intact LH&FSH producing pituitary cellsLong –term treatment for fertilityHCG and HMGBiosynthetic LH /FSH preparationpulsatile GnRHCould be used to induce gonadal development and spermatogenesis .
39 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