Adolescent Medicine

Gynecomastia is a benign proliferation of male breast glandular ductal tissue, usually bilateral, caused by increased estrogen activity, decreased testosterone activity, or medications. The condition is common and physiological in neonates, adolescent boys, and elderly men. Some cases are pathological or secondary to chronic liver disease, kidney disease, or hyperthyroidism. The majority of cases are asymptomatic and do not need treatment.

Eating disorders like anorexia nervosa, bulimia nervosa, and the binge eating disorder are common diseases. Exact knowledge of the pathogenesis and symptoms of these diseases, which mostly affect young women, is crucial for a correct diagnosis and treatment. This article will help you to correctly diagnose the different eating disorders in both the second state exam and in professional life later on.

Substance abuse is the use of drugs for unintended purposes that harmful to the consumer and/or others. Up to third of adolescents are at risk of substance abuse with a higher risk seen in neglected children, those exposed to drugs by bad influence, poor socio-economic status, and family history of drug addicts. Identification of these children is done by the CRAFFT screening tool or the CAGE questionnaire. Clinical presentation of substance abuse patients can vary based on the type of drug taken. Hyperalertness, restlessness, seizures, dilated pupils, hypertension, arrhythmias, aggressive behavior, paranoia, and tachycardia are commonly seen.

In this article, etiology, pathophysiology, clinical features, diagnosis, differential diagnosis, and treatment of painful testicles in children are described. Acute scrotum is subject to a sudden onset of pain in the scrotum or its contents, accompanied by local signs such as swelling and redness. Many conditions can present with this clinical picture, which explains why this is a diagnostic dilemma. Testicular torsion, in particular, is of major concern because it is a surgical emergency. 

Contraception refers to the process/methods that allow one to have children by choice other than by chance. These methods can be based on certain behaviors, physical barriers, chemical compounds, or hormonal therapies.

Abnormal menstrual bleeding is a common problem faced by adolescentgirls after menarche. It is marked by irregular bleeding in amount, duration and frequency. It may represent menorrhagia (heavy bleeding at regular intervals), metrorrhagia  ( excessive bleeding in irregular intervals) or combination of both or intermittent bleeding or reduced bleeding (oligomenorrhea). About 95 % of abnormal bleeding is characterized by dysfunctional uterine bleeding. The cause of AUB can be physiological or pathological or both. After complete medical evolution, hormonal therapeutic intervention is considered more useful than surgery.

The acute scrotum is an emergency condition that is characterized by scrotal pain, swelling, and redness which are of acute onset. The most important diagnosis to exclude is testicular torsion, as the testicular tissues cannot withstand ischemia for more than few hours.

The absence of menses in a woman is the definition of amenorrhea. Primary amenorrhea is defined as the absence of menses in a 16-year-old girl with secondary sexual characteristics or a 14-year-old girl without secondary sexual characteristics. Secondary amenorrhea is defined as the absence of menses for six consecutive months in a female with a previous irregular pattern of menstruation. If the menstrual cycle is regular, then secondary amenorrhea can be diagnosed in a female who does not have her menses for only three consecutive months.

Breast masses are uncommon in adolescents but can cause significant distress to the affected individual. They are usually benign fibroadenomas, intraductal papilloma, or phyllodes tumors. Malignant phyllodes tumors and primary breast cancer are very rare in adolescents but have been diagnosed before. Treatment of benign lesions is usually local excision, whereas malignant lesions usually need complete surgical resection. Chemotherapy and radiotherapy are not recommended in adolescents with breast cancer.

Learn more about the use of immunofluorescence to differentiate between Bullous Pemphigoid and Memphis Vulgaris.

Human papillomavirus infection is common in adolescents and can present with genital warts, precancerous lesions or cervical cancer many decades after acquiring the infection. Genital warts are the most common presentation in adolescents and are usually diagnosed clinically. Screening programs with pap smears and liquid-based cytology are the main tools for the early detection of HPV-associated precancerous lesions. DNA testing is available for HPV typing. Treatment of genital warts can include observation alone or destructive therapy. Treatment of HPV-related precancerous lesions, such as low-grade squamous intraepithelial lesions, should be close monitoring and follow-up. Treatment of cervical cancer is usually inefficient; therefore we should focus on the prevention of the condition by the administration of human papillomavirus vaccines before the initiation of sexual activity.

Pelvic inflammatory disease is a common disorder among young women, especially adolescents. The most important risk factor for pelvic inflammatory disease is previous history of a sexually transmitted infection. Sexually transmitted infections are more commonly identified in adolescents due to physiologic, anatomic and behavioral differences from adult females. Antibiotic therapy that covers chlamydia and gonorrhea is the mainstay of treatment for pelvic inflammatory disease in adolescents.

Dysmenorrhea refers to pain experienced during menstruation. It is a very common problem among adolescent females. It can either be primary or secondary dysmenorrhea. Primary dysmenorrhea is a condition that is characterized by cyclic lower abdominal pain/ pelvic pains, nausea and vomiting experienced during menstruation. Secondary dysmenorrhea refers to pain during menstruation that occurs due to an underlying medical problem such as endometriosis, fibroids and adenomyosis. It presents with both cyclic and acyclic lower abdominal pain. The management of primary dysmenorrhea mainly revolves around the use of nonsteroidal anti-inflammatory drugs or oral contraceptive pills. Patients who fail to respond to this conservative approach should undergo a diagnostic and therapeutic laparoscopy to exclude endometriosis.

Vulvovaginitis is a common condition in adolescents—especially sexually active girls. The diagnosis is usually confirmed by the presence of vulvitis in addition to a vaginal discharge. The physical characteristics of the vaginal discharge can point towards the most likely etiology. Gram stain, wet preparations and culture and sensitivity tests are indicated to define an exact etiology of vaginitis in the adolescent girl as the treatment is dependent on the etiology. Treatment of bacterial vaginosis is mainly metronidazole. Candida vaginitis responds well to clotrimazole. Chlamydial and gonorrheal vaginitis should be treated with azithromycin plus ceftriaxone. Trichomonas vaginitis should be treated with metronidazole.

Dysuria due to urethritis is a widespread problem in adolescent girls which can be caused by either a urinary tract infection or a sexually transmitted disease. The incidence of urethritis due to sexually transmitted infections is highest in sexually active adolescent girls. Cases of urethritis might be complicated by cervicitis and an ascending pelvic inflammatory disease. Therefore, girls with chronic lower abdominal pain and dysuria should undergo a pelvic exam, if possible, to exclude the possibility of pelvic inflammatory disease. Treatment with antibiotics should be started as soon as possible to avoid complications.

Syphilis is becoming more commonl in adolescents nowadays, especially in men. Syphilis is caused by Treponema pallidum. The main risk factors for acquiring syphilis are multiple sexual partners, having previous history of syphilis and having a partner with syphilis. Apart from Nontreponemal reactive tests, treponemal specific reactive tests is highly recommendable to confirm the diagnosis. Once the diagnosis is confirmed, penicillin G should be administered. Response to penicillin G is excellent but doxycycline, ceftriaxone or azithromycin might be indicated in selected cases where affected individuals are allergic to penicillin G.

Patients with drug overdose or substance abuse present as unconscious, hyperstimulated, or with psychotic features. Acute management includes basic life support protocol, sedation, as well as symptomatic and supportive treatment. Antidotes should be given if available. Oral drug overdose requires GI decontamination using activated charcoal and gastric lavage. Incidents of drug abuse can be decreased through parental monitoring and supportive family relationships.

Adolescence is a developmental age where the youth undergoes a number of challenges in society and academics. There is a need for intimacy and increased responsibilities towards society an academics. One in every six adolescents experiences depression at least once in a lifetime and nearly one third reflect the symptoms of their behavior. Females are more susceptible to major depressive disorders as compared to males.

Genital herpes is caused by either herpes simplex virus type 2 (70% of the cases) or herpes simplex virus type 1 (30% of the cases). The patient can present with primary disease characterized by severe genital vesicles that are fluid-filled, or recurrent milder disease of dermatomal vesicular and ulcerative disease. Affected individuals can also be asymptomatic. Treatment of primary and recurrent genital herpes consists of acyclovir or valacyclovir for one week. Suppressive antiviral therapy is indicated in patients with frequent recurrent genital herpes.