Discussion - Endocrine Case Study
Jane is a 10-year old girl who presents to the pediatric primary care office due to concern
regarding her height. Upon evaluation, the provider notes that her height is 48 inches, (fifth
percentile); with a weight of 68 lbs., < fifth percentile. The provider discusses Janes' mother's
concerns. Upon further discussion with Jane's mother she states that Jane has had occasional
visits to the urologist because of a horseshoe kidney, and that she has a heart murmur that was
described as innocent. She states that Jane does well in school although she has some social
issues including difficulty interacting with other children her age. Jane prefers to play with
younger children. When you ask Jane about her height, she becomes somewhat tearful and tells
you that she is the shortest girl in her class. Jane's mother notes no recent illness in the family.
Jane was 38 week gestation, NSVD, 7 lbs. 4 oz. healthy infant at birth. Immunizations are up to
date. PMH: Innocent heart murmur, h/o horseshoe kidney, last well visit over a year age.
Otherwise she is healthy. FH: noncontributory. SH: Jane lives with her parents and infant sister.
She attends school and is the 5th grade. Meds: None. Allergies: NKA. ROS: negative except for
complaints noted in the HPI. On Exam: well, developed, well nourished female child. Tanner I.
Wt. 21 kg. Ht. 45", BP 104/70, P 92, RR 22, T 101.7F. Skin: pink, moist, no rashes. HEENT:
PERRLA; TM normal, posteriorly rotated ears, small chin.. Neck/Lymph Nodes: supple, no
palpable nodes. Lungs/Thorax: CTA bilaterally, (-) shortness of breath, (-) cough. CV: RRR,
grade I/VI heart murmur heard LLSB. ABD: soft, nontender, nondistended, (+) BS. Neuro: CN
I-XII intact. Assessment: 10- year old female presents to pediatric primary care office due to
concern of short stature. Based on the case study:
Provide 3 differential diagnoses along with rationale and ICD codes.
What further information would you want to ask Jane's mother at this point?
How would the practitioner determine if growth is normal or not?
Discuss potential genetic disorders that can cause short stature?
What are the treatment options for short stature?
What are clinical indications for referral for short stature?
Discuss anticipated immunizations that may be needed for this patient. In addition, would
you immunize now yes, or no and why?
Jane is a 10-year old girl who presents to the pediatric primary care office due to concern
regarding her height. Upon evaluation, the provider notes that her height is 48 inches, (fifth
percentile); with a weight of 68 lbs., < fifth percentile. The provider discusses Janes' mother's
concerns. Upon further discussion with Jane's mother she states that Jane has had occasional
visits to the urologist because of a horseshoe kidney, and that she has a heart murmur that was
described as innocent. She states that Jane does well in school although she has some social
issues including difficulty interacting with other children her age. Jane prefers to play with
younger children. When you ask Jane about her height, she becomes somewhat tearful and tells
you that she is the shortest girl in her class. Jane's mother notes no recent illness in the family.
Jane was 38 week gestation, NSVD, 7 lbs. 4 oz. healthy infant at birth. Immunizations are up to
date. PMH: Innocent heart murmur, h/o horseshoe kidney, last well visit over a year age.
Otherwise she is healthy. FH: noncontributory. SH: Jane lives with her parents and infant sister.
She attends school and is the 5th grade. Meds: None. Allergies: NKA. ROS: negative except for
complaints noted in the HPI. On Exam: well, developed, well nourished female child. Tanner I.
Wt. 21 kg. Ht. 45", BP 104/70, P 92, RR 22, T 101.7F. Skin: pink, moist, no rashes. HEENT:
PERRLA; TM normal, posteriorly rotated ears, small chin.. Neck/Lymph Nodes: supple, no
palpable nodes. Lungs/Thorax: CTA bilaterally, (-) shortness of breath, (-) cough. CV: RRR,
grade I/VI heart murmur heard LLSB. ABD: soft, nontender, nondistended, (+) BS. Neuro: CN
I-XII intact. Assessment: 10- year old female presents to pediatric primary care office due to
concern of short stature. Based on the case study:
Provide 3 differential diagnoses along with rationale and ICD codes.
What further information would you want to ask Jane's mother at this point?
How would the practitioner determine if growth is normal or not?
Discuss potential genetic disorders that can cause short stature?
What are the treatment options for short stature?
What are clinical indications for referral for short stature?
Discuss anticipated immunizations that may be needed for this patient. In addition, would
you immunize now yes, or no and why?
