Clinical Cases - Endocrinology

Q1:

A 13-year-old girl presented at clinic having been diagnosed as having hypothyroidism by her family

doctor who had confirmed the diagnosis with TFT’s. She also had a 2-year history of a limp in her left leg. On examination, she was short and obese with a goitre and other signs of hypothyroidism. She had

limitation of movement of her left hip and a limp.

Questions

1 What is the most likely diagnosis?

2 What investigations should be done?

3 What is the treatment?

Answers :

1 Slipped upper femoral epiphysis and Hashimoto’s disease.

2 Frontal and lateral hip X-rays (a frontal X-ray alone may not demonstrate the slipped epiphysis)
and thyroid autoantibodies.

3 In spite of the long history, urgent referral to an orthopaedic surgeon and urgent surgery are
necessary. An acute or chronic slip of the epiphysis may cause avascular necrosis of the femoral head.
Prophylactic pinning of the other femoral head is advocated by some surgeons. T4 treatment should
also be started.

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Case 2

A 13-year-old boy was referred to the regional endocrine clinic for consideration of growth hormone (GH) treatment. He also had delayed puberty and intermittent headaches. On examination, his height was > –4.0 SD with evidence of growth failure for at least 4 years. His weight was –1.0 SD and he was entirely prepubertal. A recent GH stimulation test at the referring hospital showed a maximum response to a diethylstilbestrol primed clonidine test of 5 mU/L. He was said to have had normal TFT’s 2 years previously with a FT4 = 9.2 pmol/L (9–24) and a TSH of 1.2 mU/L (0.4–4.0).

Questions

1 Are these TFT’s normal?
2 What is the likely overall diagnosis?
3 Is there a problem in interpreting his clonidine test?