Examination finding | Potential diagnosis |
Vital signs | |
Tachycardia, hypotension, orthostasis | Life-threatening pregnancy complication (eg, ectopic pregnancy); bleeding disorder; severe anovulatory uterine bleeding; eating disorder |
Fever | Infection (PID, endometritis) |
Growth parameters | |
Short stature | Turner syndrome, hypothalamic-pituitary disease |
Obesity (BMI >30 kg/m2) | PCOS |
Underweight (BMI <18.5) | Hypothalamic amenorrhea secondary to eating disorder, exercise, or weight loss from systemic disease |
Arm span > height plus 5 cm | Delayed epiphyseal closure secondary to hypogonadism |
Eyes | |
Visual field defects | Pituitary tumor |
Lymph nodes | |
Lymphadenopathy | Malignancy |
Skin and hair | |
Acanthosis nigricans | PCOS, insulin resistance |
Abnormal bleeding (bruises, petechiae) | Bleeding diathesis |
Striae | Cushing syndrome |
Hyperpigmentation, vitiligo | Adrenal insufficiency |
Dry skin, excessive sweating, thin hair | Thyroid dysfunction |
Low hair line | Turner syndrome |
Hirsutism, acne, male-pattern balding | Hyperandrogenism (PCOS, CAH, androgen-secreting tumor, presence of Y chromosome) |
Neck | |
Thyroid enlargement | Hypothyroidism, hyperthyroidism |
Webbed neck | Turner syndrome |
Thorax/breasts | |
Shield chest, widely spaced nipples | Turner syndrome |
Galactorrhea | Hyperprolactinemia |
Abdomen | |
Abdominal/pelvic mass | Ovarian tumor, hematocolpos |
Tanner staging | |
Low for both breast and pubic hair | Delayed sexual development (ie, constitutional delay of puberty) |
High for both breast and pubic hair | Normal progression of puberty |
Divergent | Asynchrony between estrogen- and androgen-dependent aspects of puberty (eg, androgen excess) |
External genitalia | |
Imperforate hymen | May be the cause of primary amenorrhea |
Clitoromegaly | Hyperandrogenism (PCOS, CAH, androgen-secreting tumor, presence of Y chromosome) |
Perineal trauma | Sexual abuse/assault |
Vaginal discharge, genital ulcer, condyloma lata | Sexually transmitted infection |
Pelvic examination | |
Depth of vagina, presence of cervix, uterus, ovaries | Congenital vaginal or uterine anomalies |
Uterine enlargement | Pregnancy or mass (eg, leiomyoma) |
Ovarian enlargement | Ovarian cyst, possibly related to PCOS; ovarian mass |
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