A 17-year 3-month-old male presents with concern for short stature. Patient is short, appears well-nourished, has no dysmorphic features, is normotensive, and noted to be prepubertal. Past medical history: Patient has been well and has not had any chronic illnesses nor has he been on any chronic medications. Parents report that he has always been among the shorter children at school. Birth history: Patient was born at full term by normal vaginal delivery. His birth weight was 2.5 kg and his birth length is not available. Developmental history: Parents report normal developmental milestones. No history of delayed dentition. Diet history: Patient consumes about 1800 kcal/day. Family history: Patient lives with his parents and younger brother. No reported medical or hormonal disorders in the immediate or extended family. Social history: Patient is studying in twelfth grade and reported good grades. Physical examination: Patient is noted to be 147 cm tall (–3.5 SD below mean) and 40 kg (–1.88 SD below mean). No evidence of goiter. Patient is noted to be tanner 1 for pubic hair with tanner 1 prepubertal testicles. Other systemic exam is within normal limits. Labs • Normal CBC, electrolytes, S. calcium and phosphorus, renal function, liver function and urinalysis • AM cortisol noted to be 4.6 mg/dL, stimulated cortisol level 15 mg/dL • FSH 0.51 mIU/mL, LH 0.10 mIU/mL, Testosterone <2.5 ng/dL • Prolactin 11.44 ng/mL • TSH 0.019 mcIU/L (0.6–5.5), fT4 0.6 ng/dL (0.8–1.7) • Testosterone primed GH stimulation testing with clonidine noting peak GH level below 3 ng/mL.
What forms of estrogen and progesterone are available?
Medicine
Transdermal estrogens (TDE), oral estradiol or ethinyl estradiol or conjugated equine estrogens (CEE) are available for therapy. The equivalence of daily doses are 100 μg TDE or 2 mg oral estradiol or 20 μg ethinyl estradiol or 1.25 mg CEE or injectable estradiol cypionate, 2.5 mg/month. Micronized oral progestogens or medroxyprogesterone are commonly used progesterones. Other progesterones part of combined oral contraceptives are levonorgestrel, desogestrel, etc. Follow-up of clinical case: Patient undergoes MRI brain noting hypoplasia of anterior pituitary gland and ectopic posterior pituitary bright spot. Patient is diagnosed with panhypopituitarism and initiated on thyroid and growth hormone replacement with plan to induce puberty once he achieves a height close to 3%. Patient is also instructed on stress dose hydrocortisone coverage in case of illness.
need an explanation for this answer? contact us directly to get an explanation for this answer