V aliavskaya Aleksandra Vitalievna

14.03.2M3 year of birth (i2 years old)

Date of receipt in hospital - 04,02.20"t2
Home address: Hertzevsky district, Ostritsa village
The Clinical diagnosis:
The basic: Hypopituitarism. Isolated deficiency of growth hormone.
Hypophyseal subnanizm.
Complications:
Accompanying diseases :

growth at birth - 54 cm
weight at birth - 3300 g
In 4 years she was ill with a measles.
mother's growth - 165 cm
father's growth - 181 cm

History of the present illness: Lack of growth is noted from three years of age.
Klofelin test: GH > 5.8 ng/ml (conducted in 5 years)
Insulin test: GH > 6.5 nglml (conducted in 5 years)

Complaints of the patient at date of examination: growth retardation.

Growth - 139 cm (grew by 3 cm in 6 months) (- 1 sigma)

Body weight 31 kg (normal is 45 kg) (- 1 sigma)
Physical development of the child is harmonious, low. Subnanism

Respiratory rate - 18 per minute

Heart rate is 77 per minute
Liver is normal.

Thyroid gland is normal"

Thebloodtest: Hb 120g|L,er.4,5x10121, leukocytes4.3x10e/1,p.- 5o/o,e.-0oz,s.- 660 ,1.-27yo,

m.-ZYo, ESR 5 mm/hour.

Fasting giucose in blood - 4.1 mmol/l

Blood glucose after meals (2 hours) - 5.0 mmol/l

The Urine test:

color - light yellow
density - 1020
transparency - is complete
the reaction is6.0 .
protein not detected
glucose - oZ
leucocytes - 1-2 field of view
Flat epithelium - 2-4 field of view

The level of hormones in the blood:

TSH - 2.5 mUll (normal)
tT3 - 3.0 ng / ml (normal)
tT4 - 17.5 pg / dl (normal)
IGF-1-195nノ ml

cholesterol 4,5 1rmo1/1

triglycerides 1,31:r遺 ■o1/1

Assessment of bone age - Bone age is 10 years. Growth zones is saved.

Karyotyping in females - 46XX.

X-ray of the skull in two projections - the sella turcika is not changed

Treatment:
1.dict(｀ Vritle)
2.Growth horinone O。 l IU/kg(0.035 mg/kg)subc■ aneously tt night 7 timcs a week

Write analyzes that are not inthe history (ECG, Ultrasound of the abdominal cavity).
You write two diaries
Differential diagnosis with two diseases (Familian stunting and Tumer syndrome)

Treatment of present illness (plan and indications for treatment)

Substantiation of the plan of treatment of the patient (drugs, doses, prescription - insulin)
Example:

Rp: Sol. Norditropini SimpleX (10 mg/1.5 ml)

D.t.d. N1
S. _ (0.035 mg / kg) subcutaneously at night 7 times a week

cpicris± ol■ historv

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