Version May 2024
| Examination finding | Potential diagnosis |
| Vital signs | |
| Tachycardia, hypotension, orthostasis | Life-threatening pregnancy complication (eg, ectopic pregnancy); bleeding disorder; severe anovulatory uterine bleeding; eating disorder |
| Fever | Infection (PID, endometritis) |
| Growth parameters | |
| Short stature | Turner syndrome, hypothalamic-pituitary disease |
| Obesity (BMI >30 kg/m2) | PCOS |
| Underweight (BMI <18.5) | Hypothalamic amenorrhea secondary to eating disorder, exercise, or weight loss from systemic disease |
| Arm span > height plus 5 cm | Delayed epiphyseal closure secondary to hypogonadism |
| Eyes | |
| Visual field defects | Pituitary tumor |
| Lymph nodes | |
| Lymphadenopathy | Malignancy |
| Skin and hair | |
| Acanthosis nigricans | PCOS, insulin resistance |
| Abnormal bleeding (bruises, petechiae) | Bleeding diathesis |
| Striae | Cushing syndrome |
| Hyperpigmentation, vitiligo | Adrenal insufficiency |
| Dry skin, excessive sweating, thin hair | Thyroid dysfunction |
| Low hair line | Turner syndrome |
| Hirsutism, acne, male-pattern balding | Hyperandrogenism (PCOS, CAH, androgen-secreting tumor, presence of Y chromosome) |
| Neck | |
| Thyroid enlargement | Hypothyroidism, hyperthyroidism |
| Webbed neck | Turner syndrome |
| Thorax/breasts | |
| Shield chest, widely spaced nipples | Turner syndrome |
| Galactorrhea | Hyperprolactinemia |
| Abdomen | |
| Abdominal/pelvic mass | Ovarian tumor, hematocolpos |
| Tanner staging | |
| Low for both breast and pubic hair | Delayed sexual development (ie, constitutional delay of puberty) |
| High for both breast and pubic hair | Normal progression of puberty |
| Divergent | Asynchrony between estrogen- and androgen-dependent aspects of puberty (eg, androgen excess) |
| External genitalia | |
| Imperforate hymen | May be the cause of primary amenorrhea |
| Clitoromegaly | Hyperandrogenism (PCOS, CAH, androgen-secreting tumor, presence of Y chromosome) |
| Perineal trauma | Sexual abuse/assault |
| Vaginal discharge, genital ulcer, condyloma lata | Sexually transmitted infection |
| Pelvic examination | |
| Depth of vagina, presence of cervix, uterus, ovaries | Congenital vaginal or uterine anomalies |
| Uterine enlargement | Pregnancy or mass (eg, leiomyoma) |
| Ovarian enlargement | Ovarian cyst, possibly related to PCOS; ovarian mass |
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