A Girl with Delayed Puberty and Bumpy Lips

A 14-year-old girl presented to the endocrine department for evaluation of primary amenorrhea. Her medical history was remarkable for recurrent abdominal pain and diarrhea since infancy, with growth in the third percentile for weight and height. Physical examination revealed "bumpy lips" (Figure 1; available at www.jpeds.com), diastema of her anterior teeth, and several lesions on the tip of the tongue and on the oral mucosa (Figure 2 and Figure 3), suggesting the presence of multiple mucosal/submucosal neuromas.

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