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Paeds Casesendocrinology-diabetes-and-growth

Paeds Cases · endocrinology-diabetes-and-growth

Counsel parents given a new finding of atypical genitalia — OSCE

OSCE communication and shared-planning station: breaking the news of a disorder of sex development to the parents of a two-day-old infant with atypical genitalia, explaining that no gender or surgical decision will be made that day, naming the work-up, addressing the fear and the shame honestly, and building a shared plan with the multidisciplinary team.

osce communication and shared decision-making2 min readVerification in progress

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
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Study tools

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
The parents of a two-day-old infant, noted at birth to have clitoromegaly and posterior labial fusion, are frightened and tearful. They have heard a nurse say the word 'intersex' and have read online that their child may never have a normal life. They do not understand why the team will not tell them whether their baby is a boy or a girl, and they are asking for the genitalia to be surgically corrected immediately. The 17-hydroxyprogesterone is pending and the karyotype is not yet back. Counsel them.

Candidate brief

You have eight minutes to counsel the parents of a two-day-old infant noted at birth to have atypical genitalia. The work-up is pending and no gender or surgical decision will be made today. Use a structured, honest, empathic approach that addresses the fear and the shame, names the work-up, and builds a shared plan with the multidisciplinary team. [1] [5]

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References4ShowHide
  1. [1]Hughes IA, Houk C, Ahmed SF, Lee PA, et al. Consensus statement on management of intersex disorders. Arch Dis Child, 2006.PMID 16624884
  2. [3]Lee PA, Nordenström A, Houk CP, et al. Global Disorders of Sex Development Update since 2006: Perceptions, Approach and Care. Horm Res Paediatr, 2016.PMID 26820577
  3. [5]Ahmed SF, Achermann JC, Arlt W, et al. Society for Endocrinology UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development (Revised 2015). Clin Endocrinol (Oxf), 2016.PMID 26270788
  4. [11]Speiser PW, Arlt W, Auchus RJ, et al. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2018.PMID 30272171
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