psychological factors - recent emotional upset, new job, regularity of work hours
recent weight change - up or down; exercise history
presence of normal sense of smell
symptoms of thyroid, adrenal, and pituitary disorders
diabetes and it's control
gynaecological operations
menarche and menstrual history of mother and sisters
genetic defects in family members
previous CNS chemotherapy or radiation; pelvic radiation (2)
Examination:
secondary sexual characteristics - breasts, pubic hair
Tanner assessment of pubertal development may be used as a guide (2)
height and weight - expressed as percentage of ideal; BMI (2)
features of gonadal dysgenesis e.g. webbed neck of Turner's syndrome
hirsutism
evidence of thyroid, adrenal, pituitary disease
breast examination - breast development indicates that some oestrogenic activity has occurred; galactorrhoea may suggest hyperprolactinaemia, breast feeding, neuroleptics
abdominal and pelvic examination: - external genitalia - clitoromegaly - presence of uterus - palpable ovaries - pelvic masses or tenderness
a bimanual examination is inappropriate in young girls who are not sexually active (1)
features of androgen insensitivity syndrome - undescended testes; external genital appearance; pubic hair (2)
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