Question

The parents of 14 year old boy are concerned about his short stature and lack of sexual development. Body weight= 3 kg, birth length= 50 cm. His physical examination was normal. Upper segment/Lower segment ratio =0.98. Pre-pubertal with small amount of fine axillary and pubic hair were present. In this situation you should do the following except:

A. Measure pituitary gonadotropin

B. Obtain a CT scan of the pituitary area

C. Biopsy his testes

D. Measure serum testosterone levels

E. Reassure the parents that the boy is normaL

choose one answer

Answer 1

Most boys begin puberty between the ages of 9 and 14. Actually puberty starts when a boy's body is ready, and everyone grows at his own pace.

In this case, birth height and weight of the boy is normal. Physical examinations also shows no abnormality. Upper segment/Lower segment ratio is 0.98 ,which is also normal.

But to find any hormonal problem, I will Measure pituitary gonadotropin (Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are called gonadotropins because stimulate the gonads - in males, the testes, and in females, the ovaries.).

I will Obtain a CT scan of the pituitary area because it secrets gonadotrophin. Any abnormality in pituitary gland can lead to hormonal disbalance.

I will also Measure serum testosterone levels because Serum testosterone play an important role in the clinical evaluation of a number of very common endocrine disorders. In males, Testosterone level are used primarily to confirm the diagnosis of hypogonadism, and also to evaluate boys with delayed or precocious puberty and monitor the adequacy of T therapy.

I will assure Reassure the parents that the boy is normal to reduce their tension.

But I will not suggest Biopsy of his testes because Testicular biopsy was considered the cornerstone of male infertility diagnosis for many years in men with unexplained infertility and azoospermia. Recent guidelines for male infertility have limited the indications for a diagnostic testicular biopsy to the confirmation of obstructive azoospermia in men with normal size testes and normal reproductive hormones. Nowadays, testicular biopsies are mainly performed for sperm harvesting in men with non-obstructive azoospermia, to be used for intracytoplasmic sperm injection.

So, the answer is  In this situation I will do the following except C.   Biopsy his testes.