Clinical Case 3.3

A 19-year-old young man presented to the Emergency Room with pain in the left hip and knee. X-rays showed that he had a slipped femoral epiphysis A . At the age of 19.7 years, he was 1.544 m tall and weighed 57 kg. His mother, who had type 1 diabetes mellitus and hypothyroidism, reported him to be a ‘lazy sod … difficult to get out of bed in the morning’. His schoolwork had been poor and he had worn sweaters even during the summer. He looked much younger than his age C and, indeed, his bone age (an index of skeletal development) was markedly delayed at 13.4 years. His pubertal development was also delayed by several years (Tanner stage 3) and his serum testosterone concentration was low at 4 nmol/l (NR 9–25 nmol/l). A moderate size goiter was palpable.

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Image dclccA.jpg X-ray appearances of the hips at presentation. Comparison of the epiphyses of the right and left femurs shows that the left has ‘slipped’ sideways at the junction with the diaphysis (arrowed).

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Image dclccB.jpg X-ray appearances of the hips after surgical correction.

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Image dclccC.jpg Facial appearance at presentation (left) and after 7 months treatment of T4 (right).

From: Chapter 3, The thyroid gland

Cover of Endocrinology
Endocrinology: An Integrated Approach.
Nussey S, Whitehead S.
Copyright © 2001, BIOS Scientific Publishers Limited.

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