A 19 yr old female with lack of growth

 

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A 19yr old female patient came to OPD with chief complaints of 

                   •lack of gain of weight and height since childhood 

                     • weakness and tiredness 

                    • burning micturition since 1 month 

HISTORY OF PRESENTING ILLNESS

The informant of the patient is mother . She noticed that the patient was not growing adequately since childhood . She was taken to multiple hospitals for treatment 3-4 years back and used the medication prescribed by them. She is working as a labourer

H/o burning micturition and polyuria since 1 month 

 No H/O pica

No H/O irritability
No H/O loss of weight, loss of appetite
No H/O diarrhoea, steatorrhoea
No H/O PND, ORTHOPNEA
No H/O recurrent infection
No H/O chough, dyspnoea 
No H/O cold intolerance to cold, constipation, hoarseness of voice, decreased activity

BIRTH HISTORY 

Full term normal vaginal delivery
Birth weight 1kg
H/O fever in neonatal period, diagnosed with ? pneumonia

PAST HISTORY 

Not a known case of DM, HTN, THYROID DISORDER, EPILEPSY, TB

DEVELOPMENTAL

Gross motor - started to walk without support at 2 years of age.
Fine motor - started feeding by herself by 2 years of age
Social - smiles and identified mother at 3 months of age
Language - used bi-sylable words like "amama nanna" at 2 years of age

MENSTRUAL HISTORY

Menarche 12yrs
3/30 irregular
LMP: 24/2/2022 

FAMILY HISTORY 

Mother's height 150 cms

Father's height 180 cm

Mid-parental height 167.5

ON EXAMINATION -

PATIENT IS CONCIOUS , COHERENT COOPERATIVE

No Pallor, NO ICTRUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA

BLOOD PRESSURE - 110/70 MM OF HG 

RESPIRATORY RATE - 16

SPO2 - 99 % AT ROOM AIR

Height 146 cm - less than 3rd percentile

Weight 35 kg 

BMI -16.41 _3rd percentile 

VITALS - 

TEMPERATURE - 99.1

PULSE RATE - 94 BPM

BLOOD PRESSURE - 110/70 MM OF HG 

RESPIRATORY RATE - 16

SPO2 - 99 % AT ROOM AIR

SYSTEMIC EXAMINATION - 

PER ABDOMEN : NON DISTENDED, SOFT NON-TENDER, NO GAURDING/RIGIDITY

CARDIOVASCULAR SYSTEM : 

Apex beat - 5th intercostal space mid clavicular line right side

S1 AND S2 HEARD (prominent on right side), NO MURMURS

RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS

CENTRAL NERVOUS SYSTEM : NAD

SEXUAL MATURITY RATINGS

Public hair -Stage 2 - Sparse, slightly pigmented, straight, at medial border of labia
Breasts - Stage 4 - Projection of areola and papilla to form secondary mound above the level of the breast

ECG

HEMOGRAM

HB 14.7
TC 9,400
PLT 3.99 lac
MCV 85.5
PCV 42.5
MCH 29.6
MCHC 34.6
SMEAR - NORMOCYTIC NORMOCHROMIC

RFT
Urea- 14
Creatinine- 0.7
Sodium- 140
Potassium- 4.1
Chloride- 99

LFT
TB- 0.74
DB- 0.20
AST- 25
ALT- 11
ALP- 189
TP- 7.3
ALB- 4.34

RBS
93
BGT 
O POSITIVE

CHEST X-RAY 

PELVIS X-RAY 

Ultrasound abdomen

Liver on right side normal echotexture

Spleen on left side normal echotexture

2D echocardiogram

LA - 3 CM

LV

ESD 2.4

EDD 3.96

EF 62%

FS 32%

DPW 1

AORTA 2.6

RSVP 30MMHG

No RWMA

No Diastolic dysfunction

No PAH

THYROID FUNCTION TESTS

T3 1.29

TR 12.33

TSH 3.67

MMSE

23/30 - mild cognitive impairment

Diagnosis

Developmental delay with dextrocardia