history and physical examination
Last reviewed 01/2018
History:
- age of menarche and development of secondary sexual characteristics
- menstrual history - including regularity of cycle, any abrupt change
- personal or family history of hirsutism
- hot flushes
- galactorrhoea
- headaches
- visual symptoms (1)
- drug usage - especially, combined oral contraceptive pill, phenothiazines, metoclopramide, alpha-methyldopa, tricyclic antidepressants, Rauwolfia alkaloids
- psychological factors - recent emotional upset, new job, regularity of work hours
- recent weight change - up or down; exercise history
- presence of normal sense of smell
- symptoms of thyroid, adrenal, and pituitary disorders
- diabetes and it's control
- gynaecological operations
- menarche and menstrual history of mother and sisters
- genetic defects in family members
- previous CNS chemotherapy or radiation; pelvic radiation (2)
Examination:
- secondary sexual characteristics - breasts, pubic hair
- Tanner assessment of pubertal development may be used as a guide (2)
- height and weight - expressed as percentage of ideal; BMI (2)
- features of gonadal dysgenesis e.g. webbed neck of Turner's syndrome
- hirsutism
- evidence of thyroid, adrenal, pituitary disease
- breast examination - breast development indicates that some oestrogenic activity has occurred; galactorrhoea may suggest hyperprolactinaemia, breast feeding, neuroleptics
- abdominal and pelvic examination: - external genitalia - clitoromegaly - presence of uterus - palpable ovaries - pelvic masses or tenderness
- a bimanual examination is inappropriate in young girls who are not sexually active (1)
- features of androgen insensitivity syndrome - undescended testes; external genital appearance; pubic hair (2)
Reference: