Grand round presentation on 17th November, 2013 in BSMMU by Dr. A B M Kamrul Hasan

1. A 14-YEAR-OLD BOY WITH SHORT
STATURE
PRESENTED BY:
DR. A.B.M. KAMRUL HASAN
MD FINAL PART (EM)
DEPARTMENT OF
ENDOCRINOLOGY
BSMMU

2. CASE SUMMARY

Md. SS, 14 years, Student, from B, got admitted
in the department of Endocrinology of BSMMU
on 19.10.2013 with the complaints of
 Stunted
growth since childhood and
 Failure
to develop secondary
characteristics.
sexual

3. CASE SUMMARY
CONTINUED




Was alright till 2 years of age with normal
developmental milestone
Failed to develop properly thereafter
Has not developed any secondary sexual
characteristics
No change of his clothing and shoe size for last
9 years

4. CASE SUMMARY
CONTINUED

No history of learning difficulty or mental
retardation; anosmia or hyposmia; features
suggestive of any chronic systemic illness

Suffered from diarrhea starting at his 1 month of
age which persisted for about 1.5 year

5. CASE SUMMARY
CONTINUED

Birth history was uneventful

His parents and elder sister had normal
pubertal onset. His 2 sisters are of good
health

No history of psychosocial disturbance

6. CASE SUMMARY
CONTINUED

On examination, his body built is below
average, height 106 cm (41.7 inches),
weight 15 kg, arm span 106 cm, upper
segment to lower segment ratio 0.96

Vital signs normal

No signs of malnutrition

7. CASE SUMMARY
CONTINUED

Tanner stage G1genitalia, testicular volume 2 ml
for both testes, small sized scrotum with no
change of scrotal skin, Stretched Penile Length
(SPL) 3.5 cm and Tanner stage P1 Pubic hair

His IQ appears to be normal

Other systems revealed no abnormality

8. OK135S067

9. Mid-parental height



Father’s height: 156 cm (61.5 inches )
Mother’s height: 146 cm (57.5 inches )
Mid-parental height: 62 inches

10. DIFFERENTIAL DIAGNOSIS
Short Stature with Delayed Puberty
Due to 1. Constitutional Delay of Growth & Puberty
(CDGP)
2. Panhypopituitarism

11. INVESTIGATIONS
Name of the
investigation
Date
Result
Normal values
CBC
11.11.2013
Hb: 11.7 g/dL
ESR: 28 mm in 1st
hr
TC of WBC: 5.5X109
/L
DC of WBC: N 46%,
L 43%, M 07%, E
04%, B 00%
Hb: 13-17 g/dL
ESR: 0-10 mm in 1st
hr
TC of WBC: 411X109 /L
DC of WBC: N 4070%, L 20-40%, M
2-8%, E 1-7%, B
0-2%
Urine RE
11.11.2013
Normal
Fasting plasma
glucose
23.10.2013
4.0 mmol/L
<6.1 mmol/L
Plasma glucose 2
hours after breakfast
23.10.2013
5.0 mmol/L
<7.8 mmol/L

12. INVESTIGATIONS
(CONTD...)
Name of the
investigation
Date
Result
Normal values
Serum Creatinine
23.10.2013
0.5 mg/dL
0.6 - 1.3 mg/dL
Serum SGPT
23.10.2013
42 U/L
30 – 65 U/L
Serum Calcium
23.10.2013
8.5 mg/dL
9.0 – 11.0 mg/dL
13.11.2013
9.1 mg/dL
9.0 – 11.0 mg/dL
Serum ALP
30.10.2013
209 U/L
50 – 136 U/L
Serum Albumin
30.10.2013
41 gm/L
35 – 50 gm/L
Serum Inorganic
Phosphate
30.10.2013
0.14 ng/ml
0.05 – 5.0 ng/ml

13. INVESTIGATIONS
(CONTD...)
Name of the
investigation
Date
Result
Normal values
Serum TSH
23.10.2013
4.83 mIU/L
0.47 – 5.01 mIU/L
Serum FT4
23.10.2013
13.43 pmol/L
9.14 – 23.81 pmol/L
Serum FSH
23.10.2013
2.38 IU/L
Boys 14-17 years:
0.4- 7.4 IU/L
0.91 ng/ml
Male:
Prepubertal (Late):
0.1 – 0.2
ng/ml
Adult: 3 – 10 ng/ml
Serum
23.10.2013
Testosterone (Total)

14. INVESTIGATIONS
(CONTD...)
Name of the
investigation
Date
Result
Normal values
Serum Growth
Hormone (Basal)
23.10.2013
0.14 ng/ml
0.06 – 5.0 ng/ml
Serum Growth
Hormone (Post
Exercise)
02.11.2013
0.14 ng/ml
Serum Cortisol
(Basal)
14.11.2013
268 nmol/L
138 – 690 nmol/L
Serum Prolactin
14.11.2013
6.26 ng/ml
Adult male: 2.5 – 17
ng/ml

15. INVESTIGATIONS
(CONTD...)
Name of the
investigation
Date
Result
X-ray Skull both view
23.10.2013
Normal Findings
X-ray Left Hand for Bony 23.10.2013
Age
Bony age consistent with 8 – 9
years
MRI of Pituitary and
Hypothalamus
Partial empty sella with
relatively smaller pituitary
gland
10.11.2013

16. MRI of Pituitary and Hypothalamus

17. FINAL DIAGNOSIS

Short Stature with Delayed Puberty due to
Partial Empty Sella Syndrome

18. PROBLEM LIST


Cause of Empty Sella
Further plan of management

19. ACKNOWLEDGEMENT

Prof. Md. Fariduddin
Chairman & Course Co-ordinator,
Department of Endocrinology, BSMMU

Dr. M.A. Hasanat
Associate Prof,
Department of Endocrinology, BSMMU

All the colleagues of my department