A 16-year-old female has not had a menstrual period yet and is concerned. She denies sexual activity. An exam reveals an adult sexual maturity rating. Which laboratory test will the primary care pediatric nurse practitioner order initially?

A 16-year-old female has not had a menstrual period yet and is concerned. She denies sexual activity. An exam reveals an adult sexual maturity rating. Which laboratory test will the primary care pediatric nurse practitioner order initially?

• A. Genetic test for Turner syndrome
• B. Pituitary hormone tests
• C. Pregnancy test
• D. Thyroid function tests

Answer: (C)

When evaluating primary amenorrhea in a teen, the first step is to rule out pregnancy. Pregnancy is a common, reversible cause of absent menses and must be checked even if the patient denies sexual activity, because adolescents may underreport or misinterpret activity. With a fully developed pubertal stage, missing menses is less likely due to delayed puberty and more likely to be due to pregnancy or another nonpubertal issue, so a pregnancy test guides the next steps. A simple hCG test (urine or serum) is quick and decisive. If negative, you’d then pursue other potential causes such as anatomical barriers or various endocrine or genetic conditions with a targeted workup.

When evaluating primary amenorrhea in a teen, the first step is to rule out pregnancy. Pregnancy is a common, reversible cause of absent menses and must be checked even if the patient denies sexual activity, because adolescents may underreport or misinterpret activity. With a fully developed pubertal stage, missing menses is less likely due to delayed puberty and more likely to be due to pregnancy or another nonpubertal issue, so a pregnancy test guides the next steps. A simple hCG test (urine or serum) is quick and decisive. If negative, you’d then pursue other potential causes such as anatomical barriers or various endocrine or genetic conditions with a targeted workup.