Diagnostic Dilemma - Pediatric Oncall
Short stature
Author: Naji Ahmed
A 14 years old girl presented with short stature. Weight is 44kg {25th centile}, length is 144cm {below 3rd centile}. Past medical history reveals affection with alopecia and vitiligo for which she received lengthy courses of steroid. Now she is off steroids. She has dysmenorrhea. Thyroid function tests are normal. There is no anemia and renal function tests are normal. LH is 1ml U, ml, FSH is 2.4ml U, ml, Prolactin is 9ng, ml, Progesterone is 4nmol, l, and estradiol is 128pmol, l. No clinical evidence of Turners syndrome. Ultrasound shows follicular cyst in left ovary. Uterus and right ovary is normal. Bone age is depicted in figure 1.
Answer Discussion :
Dr prakash nagar
check for GH. bone age is not clear so difficult to comment. May be effect of sterod, GH def , or Autoimmune Polyglandular syndrome. First investigate on this line.
5 years ago
Hany EGYcas
more investigation needed like
chromosomal study
possible diagnosis autoimmune polyglandular endocrineopathy
may treated with antiestrogen treatment

5 years ago
Uma Visserc
- Karyotype and plot on Turners Growth chart
- Bone age_? - can`t see XR clearly enough to interpret
- Tanner staging_?
- Proportional or disproportional short stature {UL:LL ratio etc. - any clinical hint of skeletal dysplasia_?}
- any cutaneous stigmata
- Clinically any signs of steroid excess - _?midnight, _?urine free cortisol
- any clinical signs of GH deficiency eg. midface hypoplasia, midline defects, episodic hypoglycemia when unwell etc., possibility of checking IGF1 and IGFBP3 as screen if not too expensive
- are TSH and T4 both normal_? any visual , gait changes in child
- any polyuria, polydipsia

5 years ago
khuteja fatima
assess zinc serum levels

also r, o pcod

5 years ago
nael dahleh
5 years ago
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