Ped Endo – precocious puberty

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Pediatric Endocrinology Clinic Note
Consultant: [textarea cols=40 rows=1 default="Dr."]
Date: [date]
Patient accompanied by: [select name="Q1" value="mother|father|mother,father"][text default="_"]
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Chief Complaint: [textarea cols=40 rows=1 default="early puberty"]
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In Summary:
This is a [textarea cols=10 rows=1 default="_"] [select value="y/o|m/o"] [select value="F|M"] , [textarea cols=60 rows=1 default=" previously healthy. with _"].
The patient [select value="was referred to our clinic for evaluation of|is presenting to endocrine clinic for follow-up for"] [textarea cols=60 rows=1 default=" precocious puberty. Last seen on _"].
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HPI:
[textarea cols=60 rows=1 default="-Initial pubertal changes were first noted _ ago, and progressed _. Progression rate was rapid/slow/gradual."]
[checklist value="Breast developement|Testicular enlargement|Axillary hair|Pubic hair|Body odor|Acne|Vaginal discharge|Vaginal bleeding"]
[checklist value="linear growth acceleration|headaches, changes in behavior or vision, or seizures|exposure to exogenous sex steroids (medicinal or cosmetic/herbal sources)|vaginal discharge or foul smell suggesting foreign body; any itchiness or scratching around the genitals, rashes, dysuria/ frequency|excessive weight gain, change in energy level or appetite"]
-PMHx:[textarea cols=60 rows=1 default="Born FT_, BW: _, "]
[text cols=60 rows=1 default="Otherwise unremarkable PHMx."]
[checklist name="98" value="cranial radiation, head trauma, or hx of CNS infections|developmental delay/learning disabilities|meeting all developmental milestones"]
-PSHx: [textarea cols=60 rows=1 default="none"]
-Medications: [textarea cols=60 rows=1 default="none. _"]
-FHx:[textarea cols=60 rows=2 default="Mother is _cm tall and menarche at _yrs, father is _cm tall, and growth spurt at _yrs."]
[checklist value="family hx of short stature/growth problem|family hx of precocious puberty"]
[textarea cols=60 rows=1 default="otherwise unremarkable FHx."]
-Social Hx: [textarea cols=60 rows=1 default="lives with parents. Grade _ in school"]
-ROS:
[checklist name="99" value="poor appetite/caloric intake|weight loss/poor weight gain|abdominal pain|nausea/vomiting|diarrhea|constipation|polyuria/polydipsia.|heat or cold intolerance|skin/hair changes|headache|vision changes|fatigue|fever|arthralgia|rashes|lymphadenopathy"]
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PHYSICAL EXAM [textarea cols=60 rows=1 default="( done in presence of _, with patient/guardian permission)"].
[textarea cols=60 rows=2 default="GEN: Awake, alert and oriented. No acute distress. vitals reviewed. Healthy appearing, hydrated and nourished."]
[textarea cols=60 rows=1 default="HEAD: atraumatic, normocephalic."]
[textarea cols=60 rows=2 default="ENT: Moist mucus membranes. Normal eyes, conjunctiva clear. No abnormal eye movement."]
[textarea cols=60 rows=2 default="NECK: Thyroid is _ in size, no goiter. no nodules or tenderness. no cervical lymphadenopathy."]
[textarea cols=60 rows=1 default="PULM/CVS: Regular rate, no tachypnea or no increase WOB."]
[textarea cols=60 rows=2 default="ABDOMEN: soft, non-tender, non-distended, no organomegaly or masses. _no striae."]
[textarea cols=60 rows=3 default="NEURO/MSK:Alert, no focal findings, PERRL, _ optic disc, deep tendon reflexes normal and symmetric, muscle tone and strength normal, gait normal, no tremors. No scoliosis."]
[textarea cols=60 rows=2 default="SKIN: warm, well perfused, no rashes or birth marks, _acanthosis."]
[textarea cols=60 rows=2 default="GU: normal female, no enlarged clitoris. _normal male, testes (Rt: _ml, Lt:_ml. SPL:_cm)."]
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Tanner stage:
-T[select value="1|2|3|4|5"] pubic hair
-T[select value="1|2|3|4|5"] [select value="breast|testes"]
[checklist value="facial dysmorphism|visual feild defects|café-au-lait spots"][comment memo="fill out"]
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Growth parameters:
-Pertinent info
[checklist value="SGA/IUGR"]
-Current height Z score: [textarea cols=5 rows=1 default="_"]
[textarea cols=60 rows=1 default="-Weight Zscore _, BMI Zscore _"]
[textarea cols=60 rows=1 default="-Arm span _cm"]
[textarea cols=60 rows=1 default="-Upper segment (sitting height = _), US/LS ratio"]
-Growth velocity:[textarea cols=60 rows=1 default=" _ cm/yr in the last _"]
[textarea cols=60 rows=1 default="-Growth curve description: no growth acceleration"]
[textarea cols=60 rows=1 default="-Mom: _ cm(measured in clinic)"]
[textarea cols=60 rows=1 default="-Dad: _ cm (per mother report)"]
[textarea cols=60 rows=1 default="-MPH:_ ±8.5cm"]
[textarea cols=60 rows=8 default="-Bone age (my reading): _.
CA is _Y _M.
BA is _Y _M
PAH is _cm (_within genetic potential. At _percentile).
Delayed or advanced bone age. 2SD above_below mean. BA-CA of approximately 12 months between 2 and 4 years, 18 months between 4 and 12 years, and 24 months after age 12."][comment memo="may skip"]
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Lab/imaging review and interpretation
[textarea name="variable_1" default="none
1.
2.
3. "]
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IMPRESSION:
This is _. Patient seen today for [text default="Precocious puberty"][textarea cols=60 rows=2 default="#Precocious puberty"]
PLAN:
[textarea default="1- Labs: TSH/FT4, LH/FSH/Estrogen, prolactin, 17OHP, DHEAS/androstendione, testosterone.
2- Imaging: Bone age XRY, pelvic US
3- Medication: none
4- Counseled about: growth and puberty
5- Referral: none
6- Follow up: in 3 months to assess GV and pubertal progression
Discussed with parents that assessment of growth and puberty over time is an integral part of the evaluation."]
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[textarea default="Counseled family at length about our impression, and explained diagnosis, lab results, and management plan. All questions were fully answered. Family verbalized understanding and agreement with the plan of care."]