Beth is a 13 y/o girl whose parents are concerned about Beth’s short stature and lack of development. They claim that she has always been “the shortest in the class” but “eats good” and is not underweight for her height. No h/o of eating disorders. She has a good energy level and appetite. She is a B+ student and active in sports. She has not seen a physician in 4 years because her family has no health insurance. Beth looks like a healthy young adolescent. She would like to be a “little taller,” but she is very worried about why she has not had any breast development. “All my friends are developed, and I get teased in gym class when I undress. My mom said she got her period when she was 12.”
Beth’s past medical history is remarkable for recurrent otitis media as a child. She was the product of a full-term gestation after an uncomplicated pregnancy; her birthweight was over 7 pounds and her length was 21 inches. She met normal developmental milestones, and her only surgery was placement of tympanoplasty tubes at age 2 years for the recurrent otitis media. She was admitted only once at age 1 year for observation after a febrile seizure. She is taking no medications or vitamins. On a growth chart, she is in the 5-10 percentile for weight and below the 5 percentile for height. Her mother’s height is 62.” and the father’s height 69.”; therefore, the patient’s mid-parental height is 63.”
On physical exam, she is young-appearing and healthy.
VS: BP 100/64, Pulse 76.
Weight is 35 kg (77 pounds).
Height 132.4 cm (52 inches)
Skin: pigmented nevi on back, anterior neck, and right axilla.
Neck: no goiter or lymphadenopathy
Breast: Tanner I
Heart: S1 S2, RRR. No murmur, gallop or rub.
Abdominal: soft, no hepatosplenomegaly
Genitourinary: Tanner I pubic hair. Normal external genitalia.
Neurologic: nonfocal, normal reflexes, without delayed relaxation.
4 Differential Diagnosis?
Two nursing Diagnosis?