History and Physical Exam
History
A 6-year-old boy presents with 6 month history of pubic hair growth. For the past 4 years, he
has had a history of rapid somatic growth.
The obstetric history was unremarkable. He was a full-term infant born to a 34-year-old healthy mom
by normal vaginal delivery after an uncomplicated gestation. His birth weight was normal and there
were no neonatal problems. At 9 - 18 months, his growth was at the 95th percentile for his age; his
height at age 2 1/2 was average for 4 1/2 years (his parents were tall). His penis appeared larger
than those of his peers at 3 years, he developed some facial acne at 4 years, and pubic hair was seen
at 5 1/2 years.
Physical Exam
His height was average for 10 years and 3 months and his weight was average for 9 years and 10 months.
The blood pressure was normal. He was tall, well-proportioned, and muscular with mild facial acne.
The penis was large for his age and there was fine pubic hair (Tanner stage II of puberty). The testes
were estimated to be 3 ml volume each (small for puberty stage). The neurological exam normal.
Questions
- What do you think the primary problem might be?
- What laboratory tests would you ask for?