2026 New Edition Pediatrics ITE Sample Question
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Try This Peds ITE Sample Question from the 2026 New Edition
You are in the office evaluating a 6-year-old male for early development of hair on his axilla and genitals. Per the parents, they only noticed this hair recently but he has been having a musty body odor for the past few months. You examine him and note that his pubic hair is almost sexual maturity rating stage 2. His testicular volume is less than 3 mL. The father, who is a nurse, is extremely worried since no one in the family reached puberty earlier than 10 years of age.
Which of the following tests will best help you to determine if the patient’s condition is due to an adrenal tumor?
A. Bone age
B. Dehydroepiandrosterone sulfate
C. 17-hydroxyprogesterone
D. Luteinizing hormone and follicle-stimulating hormone
E. Testosterone levels
Show The Answer Key
Did you get it right? The correct answer is B.
Answer Explanation
For a child whose hepatic function is normal, the serum dehydroepiandrosterone sulfate (DHEAS) concentration provides an estimate of adrenocortical sex steroid production. Values elevated beyond that expected for pubertal stage suggest adrenal pathology (e.g., congenital adrenal hyperplasia [CAH], adrenal tumor). DHEAS is exclusively secreted by the adrenal glands and will be markedly elevated in patients with adrenal neoplasm. Precocious puberty can be categorized as central, or gonadotropin dependent, and peripheral, or gonadotropin independent. The gonadotropin-independent form can be gonadal steroid dependent or adrenal steroid dependent. Children with incomplete precocious puberty are those who have isolated premature adrenarche or thelarche. Investigative workup includes looking for elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) for central sources of precocious puberty, 17-hydroxyprogesterone (17-OHP) to evaluate for CAH, DHEAS to evaluate for the possibility of adrenal tumors, and testosterone for gonadal sources.
Incorrect Answer Explanations
Answer A: Bone age is part of the workup in patients with precocious puberty. However, it is not specific and will not be able to give information if the patient has gonadotropin-independent or gonadotropin-dependent precocious puberty.
Answer C: Biosynthetic defects of adrenocortical steroids are identified best by high concentrations of the substrate for the enzyme that is deficient. For example, 21-hydroxylase deficiency is diagnosed by determining the serum 17-hydroxyprogesterone concentration (17-OHP). Although 17-OHP can evaluate for excess androgen production by the adrenal glands, DHEAS is more specific. 17-OHP is also affected by stress level, whereas DHEAS is not. DHEAS is more diagnostic for the possibility of adrenal tumors.
Answer D: Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are usually elevated in patients with central or true precocious puberty. This patient has a prepubertal testicular volume, making central precocious puberty unlikely.
Answer E: Random measures of testosterone or estradiol are helpful for detecting gonadal steroid production. This may be part of the workup in patients with precocious puberty, but they do not help in determining the sources of excess androgens.
Bottom Line
DHEAS is a good initial test to determine if the patient has excess androgen production due to an adrenal neoplasm.
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