You are performing an annual physical examination on a 14-year-old girl. In the last couple years, she started having constipation ""every other day or so,"" followed by loose stools; she still feels depressed because of her parents' recent divorce. She has no problems at school; her grades are good; and she participates in sport activities. Her mother is worried because she is so slim (despite excellent appetite), has not grown enough, and still has not gotten her period (her mother had her first period when she was 13-year-old). The rest of personal and family history is not contributing. Your patient's height is 5 ft, weight 79 lbs (BMI 15,46; percentile 3%); she is in Tanner stage 2 (the same as the last year according to her records); and her bone age is 12.5 years. The rest of physical examination is normal. Laboratory shows Hct of 31% and MCV of 73, low insulin-like growth factor (IGF), low FSH, positive anti-tissue transglutaminase antibodies, and the rest of laboratory results are within normal limits, including TSH and prolactin.
What will restore normal puberty, growth, and weight in your patient?
A) A gluten-free diet
B) Ferrous sulfate
C) Fluoxetine
D) Estrogen
E) Growth hormone
