Instructions
You are a medical student on placement in the paediatric endocrine clinic. Your next patient is Ishani Raghavan, 14, back with her mother, Kavitha, for the results of tests arranged because she is short and has not started to develop. They have not been told the results yet.
Take a focused history from Ishani and her mother
Explain your diagnosis and management plan to the patient
- You do not need to examine Ishani
- You do not need to summarise your findings to the examiner
Growth record (last visit)
Height 141.8 cm, below the 3rd centile. Mid-parental target height about 161 cm.
Results from the last visit
FSH 68 IU/L (high; 1 to 8). LH 21 IU/L (high; 1 to 10). Oestradiol under 40 pmol/L (low; 70 to 500). Karyotype 45,X in all 30 cells counted (46,XX expected). Bone age 12 years 6 months. TSH 2.1 and free T4 14 (normal). Coeliac serology negative.
Results from the last visit
| Item | Value | Reference range |
|---|---|---|
| FSH | 68 IU/L | 1-8 IU/L |
| LH | 21 IU/L | 1-10 IU/L |
| Oestradiol | <40 pmol/L | 70-500 pmol/L |
| TSH | 2.1 mIU/L | 0.5-4.5 mIU/L |
| Free T4 | 14 pmol/L | 10-20 pmol/L |
| Coeliac serology (tTG-IgA, with normal total IgA) | Negative | - |
| Bone age (left hand X-ray) | 12 years 6 months (age 14) | - |
| Karyotype (peripheral blood, 30 cells) | 45,X in all cells counted | 46,XX |