733.2 Stepwise Analysis
The index patient presented with growth failure and poor development of second-
ary sexual characteristics. With these presenting complaints, the possibilities in a
girl child include Turner syndrome, chronic systemic illness, panhypopituitarism,
Cushing’s syndrome, and juvenile hypothyroidism. As her height was more com-
promised than weight (height age < weight age < chronological age; 6 <10.5
<14 years), chronic systemic illness is unlikely. Severely retarded bone age (BA <
CA) and absence of Turner stigma decline the possibility of Turner syndrome. In
the index patient as height and weight are both severely compromised, the proba-
bility of Cushing’s syndrome is unlikely, where the children are usually short but
obese. The overt features of myxoedematous hypothyroidism and severe
a bcFig. 3.2 ( a ) X-ray showing bone age of 6 years. ( b ) CEMRI sella showing diffuse pituitary
enlargement (thyro-lactotrope hyperplasia, red arrow ). ( c ) Ultrasonography of the pelvis depicting
bilateral enlarged multicystic ovaries ( red arrows )
3 Thyroid Disorders in Children