14-year-old girl is brought to the office by her mother for evaluation of lack of menstruation. The patient has no headaches, nipple
discharge, or abdominal or pelvic pain She takes a topical retinoid and an oral antibiotic for acne and was recently prescribed
glasses for myopia Her last office visit was 3 months ago for evaluation of gastroenteritis. Vaccinations are up to date, including
human papillomavirus. Her mother has hypothyroidism; family history is otherwise unremarkable. The patient has 2 older sisters,
both of whom underwent menarche at age 13. The patient is not sexually active and does not use tobacco, alcohol, or illicit drugs.
Since her last appointment, height has increased from 152 cm (5 ft) to 155 cm (5 ft 1 in, 10th percentile) and weight is unchanged at
45.4 kg (100 lb, 15th percentile) Blood pressure is 118/72 mm Hg and pulse is 68/min. Physical examination shows nodulocystic
acne on the face; the skin on the chest and back is clear. The thyroid is soft with no palpable nodules. Breast development is Tanner
stage 4 and pubic hair is Tanner stage 3. Which of the following is the best next step in management of this patient?
- QA CT scan of the abdomen
- 0 B. Karyotype analysis
- 0 C. MRI of the brain
- 0 D. Pelvic ultrasound
- 0 E. Reassurance and reevaluation
- 0 F. Thyroid-stimulating hormone level
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