1

Endocrinology

Pediatric Board Review

Calcium

An otherwise healthy 6-week infant presents with a

generalized seizure. She is exclusively breast fed. The

child is somewhat sleepy with a non focal examination.

Glucose 88; Na 141, Ca 5.1, Phos 9.1, Mag 2.1

The most likely diagnosis is:

1. Pseudohypoparathyroidism

2. Hypoparathyroidism

3. Vitamin D deficiency

4. Albright’s hereditary osteodystrophy

10

Pseudohypopar

athyro

idism

Hypoparath

yroid

ism

Vitam

in D

defic

iency

Albrig

ht’s h

eredita

ry o

s...

0% 0%0%0%

2

Actions of PTH

1.

2.

Ca PO4

NET EFFECT

25 OH Vit D

1,25 (OH)2 Vit D

1 hydroxylase

3.

Gut

This same 6-week infant with hypoparathyroidism

(Glucose 88; Na 141, Ca 5.1, Phos 9.1, Mag 2.1)

What is an important diagnostic consideration

(i.e. what is the underling disorder causing the

hypoparathyroidism)?

DiGeorge syndrome – thymic aplasia, congenital heart

disease, immune deficiency

Biochemical changes in rickets

Ca PO4 Bone Urine

NMinimal

changesStage 1

N Rickets

Aminoaciduria

Phosphaturia

Glycosuria

Bicarbonaturia

Stage 2

3

Initial

Ca:

PO4:

Alk Phos:

9.7

3.1

2514

2 ½ weeks

9.8

3.5

2185

4 months

10.5

6.5

518

Which is consistent with vitamin D deficiency

rickets?

A. Normal Normal Low

B. Low Low Low

C. Low High High

D. Low Normal Normal

E. Normal Low High

Calcium Phos Alk Phos 10

Normal

Normal

Low

Low

Low

L

ow

Low

Hig

h H

igh

Low

Norm

al N

ormal

Normal L

ow

Hig

h

0% 0% 0%0%0%

Choose correct answer

A. Vitamin D deficiency rickets

B. Renal osteodystrophy (renal rickets)

C. Both

D. Neither

1. Increased phosphate level

2. Increased PTH level

3. Increased creatinine level

4

THYROID

Baby A, born on 5/27/10. Newborn screening tests,

performed on 5/29/10 revealed: Normal range

TSH 37 µIU/ml < 20

T4 10.1 µg/dl 9-19

Which statement is most accurate:

A. Baby A has congenital

hypothyroidism warranting urgent

therapy

B. Baby A will develop mental

retardation if untreated

C. Baby A likely does not have any

thyroid abnormality

D. Baby A has an altered

hypothalamic set-point for T4

10

Baby A h

as congenita

l h...

Baby A w

ill d

evelo

p ment..

Baby A li

kely d

oes not h

a..

Baby A h

as an alte

red h

...

0% 0%0%0%

5

Venipuncture: (1/25/10)

Normal range

TSH 488 IU/ml (0.3-5.5)

T4 1.2 g/dl (4.5-12.5)

You are contacted by your state Neonatal Thyroid

Screening Program. Baby X was born on 1/4/10.

His newborn screening tests, performed on 1/6/10

revealed:

Initial filter paper

Normal range

TSH >200 IU/ml < 20

T4 2.1 g/dl 9-19

Congenital hypothyroidism

Thyroid dysgenesis/agenesis

Prevalence 1 in 4,000 [Whites 1 in 2,000; Blacks

1 in 32,000]

2:1 female to male ratio

Clinical features include:

hypotonia, enlarged posterior fontanelle,

umbilical hernia, indirect hyperbilirubinemia

Laboratory findings: Very high TSH and low T4

Therapy: Thyroxine – keep TSH in normal range

6

6 month female with

congenital hypothyroidism..following 4 months

therapy

A baby with gastroschisis has the following TFTs on day 5

of life:

T4 2.1 μg/dL (4.5-12.5)

TSH 2.3 μIU/mL (0.3-5.0)

The most likely diagnosis is:

A. Hypothyroidism due to thyroid dysgenesis

B. Central hypothyroidism

C. TBG deficiency

D. Hypothyroidism from excess iodine exposure

E. Normal thyroid function (as the TSH is normal)

10

Hypothyro

idism

due to

...

Central h

ypothyro

idism

TBG defic

iency

Hypothyro

idism

from

exc...

Normal t

hyroid

funct

ion ..

.

0% 0% 0%0%0%

Central hypothyroidism - rare

TBG deficiency

1:2800

vs.

7

Thyroxine (T4)

Major product secreted by the thyroid

Circulates bound to thyroid binding proteins

- thyroid binding globulin (TBG)

Only a tiny fraction (< 0.1%) is free and diffuses

into tissues

When we measure T4, we measure the T4 that is

bound to protein

The level of T4 is therefore largely dependent on

the amount of TBG

Changes in T4 may reflect TBG variation rather

than underlying pathology

TBG

deficiency

Central

hypothyroidism

Free T4 Low Normal

TBG level Normal Low

T3RU Low High

Thyroid function in a 17 year old: Normal range

TSH: 3.7 µIU/ml 0.3-5.5

T4: 13.4 µg/dl 4.5-12

Which of the following medication could explain the thyroid

function abnormality

A. INH

B. Retinoid acid

C. Ciprofloxacin

D. Ortho Tri-Cylen

E. Doxycycline

10

INH

Retinoid

acid

Cipro

floxa

cin

Ortho T

ri-Cyle

n

Doxycy

cline

0% 0% 0%0%0%

8

Conditions that cause alterations in TBG

Increased TBG Decreased TBG

Infancy Familial deficiency

Estrogen Androgenic steroid treatment

- OC Pill Glucocorticoids (large dose)

- pregnancy Nephrotic syndrome

Familial excess Acromegaly

Hepatitis

Tamoxifen treatment

A 12-yr female has diffuse enlargement of the thyroid. She

is asymptomatic. Her disorder is most likely associated with

which of the following pathological processes

A. Infectious

B. Inflammatory

C. Autoimmune

D. Toxic (drug)

E. Neoplastic

10

Infe

ctio

us

Infla

mm

atory

Autoim

mune

Toxic (d

rug)

Neoplast

ic

0% 0% 0%0%0%

Normal thyroid

Hashimoto thyroiditis

9

DC 16 year 7 month

Growth failure x 1 1/2 years

Labs:

TSH: 1008 µIU/ ml (0.3-5.0)

T4: <1.0 µg/dl (4-12)

Antithyro Ab. 232 U/ml (0-1)

A-perox Ab. 592 IU/ml (<0.3)

Prolactin: 29 ng/ml (2-18)

Cholesterol: 406 mg/dl (100-170)

DC

Start of thyroxine

Background:

Autoimmune destruction of the thyroid

Family history in 30-40%

Lymphocytic infiltration

Clinical:

Growth failure, constipation, goiter, dry skin, weight

gain, slow recoil of DTR

Laboratory:

High TSH

Anti-thyroglobulin and anti-peroxidase antibodies

Therapy:

Thyroxine

Hashimoto thyroiditis

10

15 year old female with a history of easy fatigability.

Found to have an elevated pulse rate at recent MD visit

Thyroid function: Normal range

TSH < 0.1 IU/ml 0.3-5.5

T4 14.8 g/dl 4.5-12

T3 580 ng/dl 90-190

Restlessness,

poor attention spanEye changes

Goiter

Tachycardia, wide pulse

pressure

Increased GFR

- polyuria

DiarrheaMenstrual

abnormalities

Myopathy

Antithyroid medication (Methimazole or Propylthiouracil [PTU])

Pros : 25% remission rate every 2 years

Cons: Drug induced side effects

- skin rashes, agranulocytosis, lupus-like reaction

Radioactive iodine (131I)

Pros : Easy. Essentially free of side effects

Cons: Long term hypothyroidism

Surgery

Blockers if markedly hyperthyroid

Therapy for Graves disease:

11

Sexual differentiation

Ambiguous genitalia is found in a newborn. The baby is

noted to be hyperpigmented. Ultrasound demonstrates the

presence of a uterus. The most useful test to aid in the

diagnosis of this medical condition is:

A. Testosterone

B. 17-hydroxyprogesterone

C. Serum sodium and potassium

D. DHEAS

E. DHEAS/androstenedione

ratio

10

Testost

erone

17-hyd

roxyp

rogest

erone

Serum

sodiu

m and p

otas..

.

DHEAS

DHEAS/andro

stenedio

ne ...

0% 0% 0%0%0%

Cholesterol

Pregnenolone

Progesterone

DOCA

Corticosterone

ALDOSTERONE

17 (OH) pregnenolone DHEA

17 (OH) progesterone Androstenedione

Compound S

CORTISOL

TESTOSTERONE

Desmolase

3--HSD 3--HSD 3--HSD

17-OH

17-OH

21-OH 21-OH

11-OH 11-OH

12

If she has salt wasting congenital adrenal

hyperplasia, which abnormalities are likely to

develop. True or False for each

a) Increased serum potassium

b) Decreased serum sodium

c) Decreased bicarbonate

d) Decreased plasma cortisol

e) Increased plasma renin activity

A 1-year male infant has non palpable testes.

Of the following, the most appropriate next step would be:

A. Re-examination in 18 months

B. Refer the patient for an

exploratory laparotomy

C. Begin therapy with LHRH

D. Measure the plasma

testosterone after stimulation

with HCG

E. Begin therapy with

testosterone enanthate, 50 mg

IM monthly for 3 months.

10

Re-exa

min

ation in

18 m

o...

Refer t

he patie

nt for a

n ...

Begin th

erapy w

ith LH

RH

Measu

re th

e plas

ma te

st...

Begin th

erapy w

ith te

sto...

0% 0% 0%0%0%

History

9 day old male infant

1 day history of decrease feeding, vomiting and lethargy.

Examination

Ill appearing infant with poor respiratory effort

Vital signs: T 99 F HR 100/min BP 61/40 RR 24/min

Resp: Subcostal retractions but clear to auscultation

Cardiac: Regular rate and rhythm. Normal S1 and S2

Abdomen: Soft, non distended. Non tender. No HSM

Neuro: Lethargic. No focal deficit

Genitalia: Normal male. Bilateral descended testes

13

Laboratory data:

WBC 16.7

Hb 16.4

Hct 49

Plt 537 K

Na 121

K 9.3

Cl 83

CO2 6.7

Glucose 163

BUN/Creat 33/0.2

CSF:

Chemistry: Protein 74 Glucose 82

Microscopy: WBC 6 RBC 100

Emergency therapy

Fluid resuscitation:20 ml/kg Normal saline

Glucocorticoid2 mg/kg Solucortef IV

Monitor EKG

Modes of presentation

Classical

Simple virilizing

Virilizing with salt loss

“Non classical” / Late onset

14

Therapy and evaluation of therapy

Glucocorticoid (Hydrocortisone)

Monitor growth, 17-OHP, urinary pregnanetriol

Fluorocortisol (Florinef 0.1 – 0.45 mg/day)

Blood pressure, plasma renin activity (PRA)

Supplemental salt

Until introduction of infant food

History

15 year female presents with primary amenorrhea

Breast development began at 10 years

Examination

Height: 5 ft 7 in Weight 130 lb

Tanner 5 breast development

Scant pubic hair

What is your diagnosis?

XY Genotype

Testosterone

Estradiol

Androgen

Receptor

Estrogen

Receptor

Complete androgen insensitivity

15

15 yr female presents with primary amenorrhea.

Breast development began at 10 y

Tanner 5 breasts, scant pubic hair

Which of the following clinical features is the most likely to

give you the correct diagnosis

A. Blood pressure in all 4

extremities

B. Careful fundoscopic examination

C. Rectal examination

D. Measurement of blood pressure

with postural change

E. Cubitus valgus and shield

shaped chest

10

Blood p

ress

ure in

all 4 e

x...

Carefu

l fundosc

opic exa.

..

Rectal e

xam

inat

ion

Measu

rem

ent of b

lood p

...

Cubitus v

algus a

nd shie

l...

0% 0% 0%0%0%

TESTIS

Leydig

cellsSertoli

cells

Gonadal Primordia

Testosterone

Wolfian ducts DHT

Normal male

ext. genitalia

Epidymus

Vas deferens

Seminal vesicles

Female

OVARY

No SRY

No AMH No testosterone

Mullerian

ducts

Wolfian duct

regression

Normal female

external genitalia

Fallopian tubes

Uterus

Upper vagina

No AMH

Mullerian duct

regression

nor DHT

Gonadal Primordia

Y

Chromosome TESTISSRY

Leydig

cellsSertoli

cells

TestosteroneAMH

Mullerian duct

regression Wolfian ducts DHT

Epidymus

Vas deferens

Seminal vesicles

Normal male

ext. genitalia

No AMH No testosterone

Mullerian

ducts

Wolfian duct

regression

Normal female

external genitalia

Fallopian tubes

Uterus

Upper vagina

nor DHT

16

Gonadal Primordia

Y

Chromosome TESTISSRY

Leydig

cellsSertoli

cells

TestosteroneAMH

Mullerian duct

regression Wolfian ducts DHT

Epidymus

Vas deferens

Seminal vesicles

Normal male

ext. genitalia

No AMH No testosterone

Mullerian

ducts

Wolfian duct

regression

Normal female

external genitalia

Fallopian tubes

Uterus

Upper vagina

nor DHT

Early Puberty

The earliest sign of puberty in a male is:

A. Enlargement of the penis

B. Enlargement of the testes

C. Growth acceleration

D. Pubic hair growth

E. Axillary hair growth

5

Enlarg

ement o

f the p

enis

Enlarg

ement o

f the te

stes

Growth

accele

ratio

n

Pubic hair

grow

th

Axilla

ry h

air gro

wth

0% 0% 0%0%0%

17

2 year old girl with breast development. No growth

acceleration. No bone age advancement

No detectable estradiol, LH or FSH

The most likely diagnosis is:

2 year old girl with breast development. No growth

acceleration. No bone age advancement

No detectable estradiol, LH or FSH

The most likely diagnosis is:

A. Ingestion of her

mother’s OCPs

B. Precocious puberty

C. Premature adrenarche

D. Premature thelarche

E. McCune Albright

Syndrome

10

Ingestion of h

er mother’..

.

Precocious puberty

Premature adrenarche

Premature thelarche

McCune Albright S

yndrome

0% 0% 0%0%0%

Benign Premature Thelarche

Isolated breast development

– 80% before age 2

– Rarely after age 4

Not associated with other signs of puberty (growth acceleration, advancement of bone age)

Children go on to normal timing of puberty and normal fertility

Benign process

Routine follow-up

18

5 year female with 6 months of pubic hair growth. Very fine

axillary hair as well as adult odor to sweat.

No breast development, no growth spurt

The most likely diagnosis is:

5 year female with 6 months of pubic hair growth. Very fine

axillary hair as well as adult odor to sweat.

No breast development, no growth spurt

The most likely diagnosis is:

A. Precocious puberty

B. Benign premature

adrenarche

C. Non-classical congenital

adrenal hyperplasia

D. Adrenal tumor

E. Pinealoma

10

Preco

cious p

uberty

Benign p

rem

ature

adre

n...

Non-class

ical c

ongenita

l ...

Adrenal

tum

or

Pinealo

ma

0% 0% 0%0%0%

Benign Premature Adrenarche

Production of adrenal androgens before true pubertal development begins

Presents as isolated pubic hair in mid childhood

– No growth acceleration

– No testicular enlargement in boys

If normal growth rate, routine follow-up

If accelerated growth and/or bone age advancement, screen for

– CAH

– Virilizing tumor (adrenal/gonadal)

19

Choose correct answer

A. Premature theralche

B. Premature adrenarche

C. Both

D. Neither

1. Growth acceleration

2. Normal adolescent sexual development

3. Onset of gonadal function usually in 3-4 years

You suspect a 16 year female has Turner syndrome. The

most definitive diagnostic test is

A. Buccal smear

B. Chromosome analysis

C. Measuring her FSH and

LH

D. Determining her bone

age

E. Determining her

testosterone level

5

Buccal s

mear

Chrom

osom

e analys

is

Measu

ring h

er FSH

and LH

Determ

inin

g her b

one age

Determ

inin

g her t

estos..

.

0% 0% 0%0%0%

5 year old girl with pubic hair and rapid growth.

She has no breast development

Possible sources of androgens:

1.Liver

2.Adrenal

3.Ovary

4.Pituitary

5.Pineal

20

5 year old girl with pubic hair and rapid growth.

She has no breast development

Which of the following should be considered

Answer T or F for each:

a) Central precocious puberty

b) Congenital adrenal hyperplasia

c) McCune Albright syndrome

d) Benign premature adrenarche

e) Adrenal tumor

When does puberty occur?

Classic teaching

– 8 -13 in girls (menarche ~ 2 years

after onset of puberty)

– 9 -14 in boys

Case:

Breast development: 6 years

Mother had menarche: 9.5 years

Why

Reactivation of

hypothalamic –

pituitary –gonadal

axis

21

Gonadatropin dependent

(central) precocious puberty

Clock turns on early

Idiopathic

> 95 % girls~ 50 % boys

– Hypothalamic hamartoma (Gelastic seizures)

– NF (optic glioma)

– Head trauma

– Neurosurgery

– Anoxic injury

– Hydrocephalus

Treatment

Why

– Psychosocial

– Height

What

– GnRH agonist

Gonadotropin independent

precocious puberty

22

7 year male presents with 6 month history of pubic

and axillary hair growth as well as adult body odor.

Mother thinks he is growing faster than his peers

No exposure to androgens

PM&SH – nil of note

Mother had menarche at 12 yr

Father had normal timing of his puberty

Medications – none

Height 50th percentile (last height at 25th)

Weight 40th percentile

No café au lait macules

No goiter

Heart and lungs: normal

Abdomen: Firm hepatomegaly with irregular border

Prepubertal Asymmetric Pubertal

Adrenal source Enlarged testicle Precocious puberty

Height 50th percentile (last height at 25th)

Weight 40th percentile

No café au lait macules

No goiter

Heart and lungs: normal

Abdomen: Firm hepatomegaly with irregular border

Genitalia:

Pubic hair - Tanner 2

Scrotal thinning

Testes 5 ml bilaterally (pubertal >3 ml)

Rest unremarkable

23

7 year male with signs of puberty

Pubertal

Central precocious

puberty

Gonadotropins

LH

GLeydig cell

LABS:

Testosterone 48 ng/dl (<10)

FSH <0.1 mIU/mL

LH <0.1 mIU/mL

TSH 1.0 μIU/mL

T4 8.9 μg/dL

Precocious puberty in the male

Gonadotropins

Prepubertal Pubertal

Gonadotropin independent Central precocious

precocious puberty puberty

HCG LH

*McCune Albright

syndrome

G G*

Familial male

Precocious puberty

(testotoxicosis)

1. Gonadotropin independent PP

2. Polyostotic Fibrous Dysplasia

3. Café au lait macules

Leydig cell

Final diagnosis: Gonadotropin independent precocious

puberty secondary to an βHCG secreting hepatoblastoma

24

5 year old with breast development

and growth acceleration

- Estradiol 62 pg/ml (<10)

- FSH <0.1 mIU/mL

- LH <0.1 mIU/mL

Gonadotropin independent

precocious puberty

McCune Albright syndrome:

1. Café au lait macules

2. Gonadotropin independent

precocious puberty

3. Polyostotic fibrous dysplasia

Growth disorders and

delayed puberty

25

Delayed puberty

Hypogonadism

Hypergonadotropic

Hypogonadism (↑FSH, LH)

Primary gonadal failure- Chromosomal

- iatrogenic (cancer therapy)

- autoimmune oophoritis

- galactosemia

- test. biosynthetic defect

Hypogonadotropic

Hypogonadism (FSH, LH)

Constitutional

delay

Central

Hypogonadism- Isolate gonad. def.

- MPHD

- Kallmann (anosmia)

- Functional

A 15 yr boy has short stature and delayed puberty. He is

now in early puberty (Tanner 2). His parents are of average

stature. His height and weight are just below 3rd percentile.

All of the following are likely EXCEPT:

A. A bone age of 12 ½ years

B. Growth hormone deficiency

C. Adult height in the normal range

D. Acceleration of growth and sexual maturation over the next 2 years.

E. History of normal length and weight at birth

10

A bone a

ge o

f 12 ½

years

Growth

horm

one defic

iency

Adult heigh

t in th

e norm

..

Accele

ratio

n of g

row

th a

..

History

of n

ormal le

ngth...

0% 0% 0%0%0%

A 15 yr male has delayed puberty. He also has headaches,

diplopia and increased urination. His height is < 3rd

percentile.

Which of the following is the most likely diagnosis?

A. Diabetes mellitus

B. Pinealoma

C. Cerebellar tumor

D. Craniopharyngioma

E. Pituitary adenoma

10

Diabete

s melli

tus

Pinealo

ma

Cerebella

r tum

or

Cranio

pharyngio

ma

Pituita

ry a

denoma

0% 0% 0%0%0%

26

A 14 yr male has tender gynecomastia (3 cm in diameter

bilaterally). He is in early to mid puberty. In most cases the

best management for this gynecomastia is:

A. Treatment with an anti-

estrogen (e.g.

Tamoxifen)

B. Treatment with an

aromatase inhibitor

C. Treatment with a

dopamine agonist

(bromocryptine)

D. Surgery

E. Reassurance

10

Treatm

ent with

an a

nti-e...

Treatm

ent with

an a

rom

...

Treatm

ent with

a dopam

i..

Surgery

Reassura

nce

0% 0% 0%0%0%

Diabetes

A 12 year female patient presents with a 4 week history of

polyuria, polydipsia, and marked weight loss.

She is noted to have deep, sighing respiration.

Glucose is 498 mg/dL, pH is 7.06. Her electrolytes show

Na 132, K 4.8, Cl 95 CO2 6 BUN 20 Creat 0.9.

The MOST important initial management is:

A. insulin drip 0.1 u/kg/hr

B. ½ NS with 40 meq K at

2x maintenance

C. Bicarb 1 meq/kg slowly

over 1 hour

D. 20 ml/kg normal saline

bolus IV

10

insu

lin d

rip 0

.1 u

/kg/h

r

½ NS w

ith 4

0 meq K

at 2

...

Bicarb

1 meq/k

g slow

ly o

v..

20 ml/k

g norm

al salin

e b...

0% 0%0%0%

27

GTT in a 16 year obese female:

Time Glucose (mg/dL)

-0- 109

-120- 188

Which of the following statements are correct?

This patient has:

A. Type 2 diabetes

B. Impaired glucose

tolerance but normal

fasting glucose

C. Normal glucose

tolerance

D. Both impaired fasting

glucose and impaired

glucose tolerance

10

Type 2 d

iabete

s

Impaire

d gluco

se to

lera

n..

Normal g

luco

se to

lera

nce

Both im

paired fa

sting gl..

.

0% 0%0%0%

Fasting 2 hr post load

< 100 < 140

Normal

≥ 100 ≥ 140

< 126 < 200

Pre-diabetes

≥ 126 ≥ 200Diabetes

Definition of diabetes

This obese patient with IFG and IGT is at risk for the

development of all the following EXCEPT

A. Type 2 diabetes

B. Dyslipidemia

C. Hypertension

D. Slipped capital femoral

epiphysis

E. Hashimoto thyroiditis

10

Metabolic syndrome

Type 2 d

iabete

s

Dyslipid

emia

Hypertensio

n

Slipped ca

pital f

emora

l ...

Hashim

oto th

yroid

itis

0% 0% 0%0%0%

28

A 13 year male has new onset type 1 diabetes mellitus.

Therapy for this child may include all of the following

EXCEPT:

A. Glargine (Lantus) and Lipro insulin (Humalog)

B. Detemir (Levemir) and Aspart insulin (Novolog)

C. Metformin

D. Analog insulin administered via an insulin pump

10

Glarg

ine (L

antus)

and Lip..

Detem

ir (L

evem

ir) a

nd A...

Metfo

rmin

Analog i

nsulin

admin

ister..

0% 0%0%0%

Miscellaneous

Side effects of corticosteroids include all of the following

except

A. hypertension

B. hypoglycemia

C. decrease bone

mineralization

D. myopathy

E. cataracts

10

hyperte

nsion

hypoglyc

emia

decrease

bone m

inera

liza...

myopath

y

cata

ract

s

0% 0% 0%0%0%

29

What is the most likely diagnosis in this newborn infant?

A. Mother has SLE

B. Anasarca from cardiac failure

C. Systemic allergic reaction

D. Congenital nephrotic syndrome

E. Turner syndrome

10

Moth

er has S

LE

Anasarc

a from

card

iac f

ai...

Syste

mic

allerg

ic re

actio

n

Congenita

l nephro

tic sy

...

Turner s

yndro

me

0% 0% 0%0%0%

5 year old male with short stature

A. Turner syndrome

B. VATER syndrome

C. Albright’s

hereditary

osteodystrophy

D. Noonan syndrome

E. Goldenhar

syndrome

10

Turner s

yndro

me

VATER syndro

me

Albrig

ht’s h

eredita

ry o

s...

Noonan syndro

me

Goldenhar

syndro

me

0% 0% 0%0%0%

A moderately obese adolescent female has irregular

periods, hirsutism and acne.

Of the following, which is the most likely diagnosis?

A. Cushing syndrome

B. Polycystic ovarian

syndrome

C. Virilizing adrenal

tumor

D. Non-classical CAH

E. Hyperprolactinemia

10

Cushin

g syndro

me

Polycy

stic

ovaria

n synd...

Viriliz

ing a

drenal t

umor

Non-class

ical C

AH

Hyperpro

lact

inem

ia

0% 0% 0%0%0%

30

Choose correct answer

A. Diabetes mellitus

B. Diabetes insipidus

C. Both

D. Neither

1. Osmolality of serum > 300 Osm/L

2. Osmolality of urine > 500 mOsm/L

3. Hypernatremia

2 Na + BUN/2.8 + Gluc/18