Physical examination

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1. Breast development and pubic hair distribution should be assessed because they demonstrate exposure to estrogens and sexual maturity. Galactorrhea is a sign of hyperprolactinemia.

2. Thyroid gland should be palpated for enlargement and nodules. Abdominal striae in a nulliparous woman suggests hypercortisolism (Cushing's syndrome).

3. Hair distribution may reveal signs of androgen excess. The absence of both axillary and pubic hair in a phenotypically normal female suggests androgen insensitivity.

4. External genitalia and vagina should be inspected for atrophy from estrogen deficiency or clitoromegaly from androgen excess. An imperforate hymen or vaginal septum can block the outflow tract.

5. Palpation of the uterus and ovaries assures their presence and detects abnormalities.

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