••• Chapter 40^ Pediatric and Adolescent Gynecology^401
❍ What percentage of precocious puberty is caused by idiopathic (constitutional) development?
70%.
❍ What are the goals of medical therapy in precocious puberty?
(1) Reduce gonadotropin secretion.
(2) Reduce or counteract peripheral actions of sex steroids.
(3) Decrease the growth rate to normal.
(4) Slow skeletal maturation.
❍ What percentage of all cases of sexual abuse of children involve a family member as the perpetrator?
80%.
❍ What nonhormonal diagnoses should be in the differential for heavy bleeding at menarche?
(1) Blood dyscrasias (von Willebrand disease, prothrombin deficiency).
(2) Platelet dysfunction (leukemia, idiopathic thrombocytopenic purpura, hypersplenism).
❍ If a pediatric patient has an asymptomatic transverse vaginal septum, what condition might occur at the
time puberty?
Hematocolpos or hematometrium.
❍ If a pediatric patient has an asymptomatic imperforate hymen, what condition might occur at the time of
puberty?
Hematometra and hematosalpinx, causing a menstrual blood bulge behind the imperforate hymen.
❍ What complaints might a pubertal patient with an imperforate hymen describe?
Cyclic cramping but no menstrual flow.
❍ You are examining a neonate. Labial fusion is noted. What other portion of the physical examination may
most likely assist you in your analysis of this condition?
Groins and labial folds should be palpated for evidence of gonads.
❍ What is the most common cause of labial fusion?
Congenital adrenal hyperplasia. The most common form is caused by an inborn error of metabolism involving
21 hydroxylase.
❍ Name a rare variant of embryonal rhabdomyosarcoma that most often presents in infancy and adolescence.
Sarcoma botryoides is a rare tumor of the vagina that most often presents before 8 years of age, although cases
have been reported among adolescents. The tumor grossly forms multiple polypoid masses resembling a cluster of
grapes. Histologically, they appear as malignant pleomorphic cells in a loose myxomatous stroma and occasional
“strap cells,” eosinophilic rhabdomyoblasts with characteristic cross striations. To confuse matters further, there is a
benign entity called pseudosarcoma botryoides found in infants that resembles sarcoma botryoides. Grossly, these
polyps do not have a grape-like appearance, and histologic examination demonstrates an absence of strap cells.