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{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |,|-| A01 |-| A02 |-| A03 | |A01= Stage 1|A02= Prepubertal [[external genitalia]]<br>Prepubertal pubic hair<br>[[Growth]] 5-6 cm/year|A03=[[image:Untitled12365.jpg|by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642]]}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | }}
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01= Stage 2|B02= Enlargement of [[scrotum]] and [[testes]]; [[scrotum]] skin become hyperpigmented and harder<br>Sparse [[growth]] of long, slightly pigmented hair, straight or curled, at base of [[penis]]<br>[[Growth]] 5-6 cm/year}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | }}
{{familytree | | | | | C01 |-|-|+|-| C02 |-| C03 | | | |C01= '''''Boys'''''|C02= Stage 3|C03= Enlargement of [[penis]] (length at first); further [[testes]] growth <br>Darker, coarser, and more curled hair, spreading over pubes<br>[[Growth]] 7-8 cm/year }}
{{familytree | | | | | |!| | | |!| | | | | | | | | | | | }}
{{familytree | | | | | |!| | | |)|-| D01 |-| D02 | | | |D01= Stage 4|D02= Increased [[penis]] size with [[growth]] and development of glans; [[testes]] and [[scrotum]] larger, [[scrotum]] skin darker<br>Adult type hair, but smaller area; no spread to medial surface of [[thighs]]<br>[[Growth]] 10 cm/year}}
{{familytree | | | | | |!| | | |!| | | | | | | | | | | | }}
{{familytree | | | | | |!| | | |`|-| E01 |-| E02 | | | |E01= Stage 5|E02= Adult [[external genitalia]]<br>Adult type hair with same horizontal distribution ("feminine")<br>No further height increase after 17 years}}
{{familytree | | C01 |-|(| | | | | | | | | | | | | | | | |C01='''Tanner staging'''}}
{{familytree | | | | | |!| | | |,|-| A01 |-| A02 | | | |A01= Stage 1|A02= Prepubertal [[external genitalia]]<br>Prepubertal pubic hair<br>[[Growth]] 5-6 cm/year}}
{{familytree | | | | | |!| | | |!| | | | | | | | | | | | }}
{{familytree | | | | | |!| | | |)|-| B01 |-| B02 | | | |B01= Stage 2|B02= Breast bud with elevation of [[breast]] and [[papilla]]; enlargement of [[areola]]<br>Sparse growth of long, slightly pigmented hair, straight or curled, along [[labia]]<br>[[Growth]] 7-8 cm/year}}
{{familytree | | | | | |!| | | |!| | | | | | | | | | | | }}
{{familytree | | | | | C01 |-|-|+|-| C02 |-| C03 | | | |C01= '''''Girls'''''|C02= Stage 3|C03= Further enlargement of [[breast]] and [[areola]]; no separation of their contour<br>Darker, coarser and more curled hair, spreading sparsely over junction of pubes<br>[[Growth]] 8 cm/year}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | }}
{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01= Stage 4|D02= [[Areola]] and [[papilla]] form a secondary mound above level of [[breast]]<br>Adult type hair, but smaller area than in adult; no spread to medial surface of [[thighs]]<br>[[Growth]] 7 cm/year}}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | }}
{{familytree | | | | | | | | | |`|-| E01 |-| E02 | | | |E01= Stage 5|E02= Mature [[breast]]: projection of [[papilla]] only, related to recession of [[areola]]<br>Adult type hair with horizontal distribution ("feminine")<br>No further [[growth]] after 16 years}}
{{familytree/end}}


{{family tree/start}}
{{family tree/start}}

Revision as of 20:30, 14 September 2017


The following signs may be seen:

  1. Sunsetting signs
    1. Associated with tumor
    2. Associated with disease
    3. Associated with tumor
  2. ABC
  3. DEF


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 1
 
Prepubertal external genitalia
Prepubertal pubic hair
Growth 5-6 cm/year
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 2
 
Enlargement of scrotum and testes; scrotum skin become hyperpigmented and harder
Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis
Growth 5-6 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Boys
 
 
 
 
 
Stage 3
 
Enlargement of penis (length at first); further testes growth
Darker, coarser, and more curled hair, spreading over pubes
Growth 7-8 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 4
 
Increased penis size with growth and development of glans; testes and scrotum larger, scrotum skin darker
Adult type hair, but smaller area; no spread to medial surface of thighs
Growth 10 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 5
 
Adult external genitalia
Adult type hair with same horizontal distribution ("feminine")
No further height increase after 17 years
 
 
 
 
 
 
 
Tanner staging
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 1
 
Prepubertal external genitalia
Prepubertal pubic hair
Growth 5-6 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 2
 
Breast bud with elevation of breast and papilla; enlargement of areola
Sparse growth of long, slightly pigmented hair, straight or curled, along labia
Growth 7-8 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Girls
 
 
 
 
 
Stage 3
 
Further enlargement of breast and areola; no separation of their contour
Darker, coarser and more curled hair, spreading sparsely over junction of pubes
Growth 8 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 4
 
Areola and papilla form a secondary mound above level of breast
Adult type hair, but smaller area than in adult; no spread to medial surface of thighs
Growth 7 cm/year
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 5
 
Mature breast: projection of papilla only, related to recession of areola
Adult type hair with horizontal distribution ("feminine")
No further growth after 16 years
 
 
 
 
 
 


 
 
 
 
Exercise
 
Calcium Supplementation
 
Vitamin D supplementation
 
Smoking cessation
 
Reduced alcohol consumption
 
Hip protectors
 
Fall protection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Balance, strength and functional training exercises
 
Women
• 9-18 yrs: 1,300 mg
• 19-50 yrs: 1,000 mg
• 51-70 yrs: 1,200 mg
• 71 and more yrs: 1,200 mg
Men
• 50-70 yrs: 1,000 mg
• 71 and more yrs: 1,200 mg
 
Women
• 9-18 yrs: 600 IU
• 19-50 yrs: 600 IU
• 51-70 yrs: 600 IU
• 71 and more yrs: 800 IU
Men
• More than 50 yrs: 800-1,000 IU

Serum vitamin D level of 20 ng per mL (50 nmol per L) is recommended for good bone health
 
• Stop-smoking program and nicotine patch
 
Limit to:
• One drink/day for women
• Two drinks/day for men

Moderate alcohol may associated with slightly higher BMD and lower fracture risk in postmenopausal women
 
• Hard and soft hip protectors, upon preference
 
Multifactorial interventions:
• Individual risk assessment
• Tai Chi and other exercise programs
• Home safety assessment and modification by an occupational therapist
• Gradual withdrawal of psychotropic medication
• Visual impairment correction
• Improve mobility
 


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lifestyle modifications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Exercise
 
Calcium Supplementation
 
Vitamin D supplementation
 
Smoking cessation
 
Reduced alcohol consumption
 
Hip protectors
 
 
 
 
 
 
Fall protection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Balance, strength and functional training exercises
 
Women
• 9-18 yrs: 1,300 mg
• 19-50 yrs: 1,000 mg
• 51-70 yrs: 1,200 mg
• 71 and more yrs: 1,200 mg
Men
• 50-70 yrs: 1,000 mg
• 71 and more yrs: 1,200 mg
 
Women
• 9-18 yrs: 600 IU
• 19-50 yrs: 600 IU
• 51-70 yrs: 600 IU
• 71 and more yrs: 800 IU
Men
• More than 50 yrs: 800-1,000 IU

Serum vitamin D level of 20 ng per mL (50 nmol per L) is recommended for good bone health
 
• Stop-smoking program • Nicotine patch
 
Limit to:
• One drink/day for women
• Two drinks/day for men
• Moderate alcohol may associated with slightly higher BMD and lower fracture risk in postmenopausal women
 
Hard and soft hip protectors, upon preference
 
 
 
 
 
 
 
 
 
Multifactorial interventions:
• Individual risk assessment
• Tai Chi and other exercise programs
• Home safety assessment and modification by an occupational therapist

• Gradual withdrawal of psychotropic medication
• Visual impairment correction
• Improve mobility
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chronic corticosteroid use
 
 
 
Children and adolescent
 
 
 
 
 
 
 
 
 
 
 
Adults
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Men
 
 
 
 
 
 
 
 
 
Women
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Young hypogonadal
• More than 70 yrs
• Less than 70 yrs with:
••Low body weight
••Prior fracture
••High risk medication use
••Disease or condition associated with bone loss
 
 
 
 
 
 
 
 
 
• More than 65 yrs
• Postmenopausal women younger than 65 yrs with:
••History of fragility fracture
•• Weigh less than 127 lb (58 kg)
••Medications or diseases that cause bone loss
•• Parental history of hip fracture
•• smoking
•• Alcoholism
•• Rheumatoid arthritis.