1. Turner's syndrome

2. Patau syndrome

3. Morris's syndrome

4. Klinefelter's syndrome

5. Down's syndrome

Case 115. A 24 years old man is refferred because incidentally discovered pituitary adenoma. He relates that he was involved in an automobile accident three weeks earlier. Magnetic resonance imaging performed to evaluate the consequences of head trauma revealed a 7 mm area in the right side of the pituitary that did not emit as bright a signal following gadolinium as did the rest of the pituitary. On questioning, he said he had been felling generally well. Specifically, he had experienced headaches for a week after the accident but not before or since. He had not noted a change in libido, potency, or appearance. Objective status: height -160 cm; weight -75,5 kg, blood pressure was 118/82 mmHg; pulse - 72 beats/min and regular. He didn’t appear acromegalic or to have Cushing’s syndrome. He had no lid lag or lid retraction. His thyroid gland was not palpably enlarged. Serum rolactin concentration was 12 ng/mL (normal<15 ng/mL). Which one of the following tests should you order next?

1. Thyroid Stimulating Hormone (TSH)

2. Visual fields

3. Luteinizing Hormone (LH)

4. Follicle Stimulating Hormone (fsh)

5. Insulin-like growth factor-1 (IGF – 1)

Case 116. Patient F., 57 years old, complains of general weakness, headache, weight gain, menstrual irregularity, hirsutism, frequent urination and thirst. Objective status: height - 157 cm, weight - 92 kg. Localization of fat tissue is disproportional, being found mostly on the face, neck and trunk with relatively thin extremities. Face is ruddy, “moon face”. There are dark red striae under her arms, on the inner surfaces of the hips and on the belly. Skin is normal, moist, pulse - 70 beats/min, blood pressure – 180/100 mmHg. Over her upper lip and chin large amount of hair growth (patient shaves). Laboratory tests: 17-OHCS is elevated, oral glucose tolerance test (OGTT) – 6.2-10.8-9.4 mmol/l, glucose in urine – 0.5%. What is the most likely diagnosis?

1. Diabetes mellitus

2. Arterial hypertension

3. Itsenko-Cushing syndrome, steroid diabetes

4. Obesity

5. Steroid diabetes

Case 117. A 45 year old man was referred by his dentist for prognathism and malocclusion. Shoe size had increased from 6 to 8 in the last six years and the patient complained of excessive sweating, headache, but denied change in sexual activity. Objective status: the patient had a prominent jaw, spacing of the teeth, thick skin and the thyroid was enlarged 2 times normal size, and felt firm and finely nodular. The rest of the examination was normal except for large, spade-like hands and feet. Laboratory evaluation revealed: fasting growth hormone increase 1,5 times normal, fasting glucose was 6,5 mmol/L. The most likely diagnosis is:

1. Gigantism

2. Obesity

3. Acromegaly

4. Physiologic Growth Hormone variation

5. Hypothyrosis

Case 118. Patient S., 33 years old, complains of a tiresome thirst (drinks 8-12 l/day), mouth dryness, frequent urination, weight loss and headache. In the anamnesis - tree months ago patient suffered a craniocerebral injury. Objective status: height – 174 cm, weight – 53 kg, skin is dry, turgor decreased. Blood pressure – 110/60 mmHg, pulse –70 beats/min. Result of laboratory tests: specific gravity 1002-1004, oral glucose tolerance test – 4.7-7.1-5.5 mmol/l. X-ray of the cranium – normal, eye fields – normal. What diagnosis would you suggest?