A mother of a 4 year old girl brings her daughter to see you because the girl developed breasts 6 months ago. The girl has had no vaginal bleeding, and there is no pubic hair. She takes no medication.
1-Which of the following is the most appropriate next diagnostic step?
A) Ultrasound of the pelvic.
B) pelvic examination under anaesthesia.
C) CT scan of her head.
D) serum estradiol concentration.
E) serum FSH concentration.
2- The tests you ordered are normal for a prepubertal girl.
Which of the following is the most likely diagnosis?
A) Ingestion of mother's COCs.
B) A granulosa cell tumor.
C) 21 hydroxylase deficiency.
D) Polycyctic ovary syndrome.
E) Premature thelarche.
