Step I Evaluate clinical history

1. Signs of puberty may include a growth spurt, absence of axillary and pubic hair, or apocrine sweat glands, or absence of breast development. Lack of pubertal development suggests ovarian or pituitary failure or a chromosomal abnormality.

2. Family history of delayed or absent puberty suggests a familial disorder.

3. Short stature may indicate Turner syndrome or hypothalamic-pituitary disease.

4. Poor health may be a manifestation of hypothalamic-pituitary disease. Symptoms of other hypothalamic-pituitary disease include headaches, visual field defects, fatigue, or polyuria and polydipsia.

5. Virilization suggests polycystic ovary syndrome, an androgen-secreting ovarian or adrenal tumor, or the presence of Y chromosome material.

6. Recent stress, change in weight, diet, or exercise habits; or illness may suggest hypothalamic amenorrhea.

7. Heroin and methadone can alter hypothalamic gonadotropin secretion.

8. Galactorrhea is suggestive of excess prolactin. Some drugs cause amenorrhea by increasing serum prolactin concentrations, including metoclopramide and antipsychotic drugs.

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