A 5-year old boy was referred to the general Pediatric clinic because of ‘failur

Question

A 5-year old boy was referred to the general Pediatric clinic because of ‘failure to thrive’. He had been born weighing 2.7 kg

after a normal pregnancy and delivery. Developmental milestones (such as the age of speaking and walking) were delayed.

In addition, he was found to be in the higher percentile of weight (bordering obese) despites efforts from his parents to

maintain and active and healthy lifestyle for the boy. After a physical test and blood tests, you obtain the following

results:

Physical test Results:

• BP 82/50 (normal: 100/70)

• HR=55 (normal: 60 bpm)

• Body Temperature: 94°F (normal = 98°F)

Blood Test Results:

• Glucose Levels: 50 mg/dL (normal 60-110 mg/dL)

• Fatty Acid Levels: low

a. What do you think the diagnosis is? Explain the reasons for ALL his symptoms (make sure to include those in the paragraph

as well)

b. Normally, the hypothalamus releases the hormone ____________. This then travels to its target cell known as a

______________________. What signaling pathway occurs in this cell type and results in hormone secretion and synthesis?

c. When the hormone in part B finally reaches its target cell, what is the normal full cellular response for the synthesis of the

next hormone in this pathway?

d. When the hormone made in “C” is released into the blood stream, describe the mode of transport and the normal cellular

response of this hormone “C” in its target cell.

Explanation / Answer

a. it is a cas of Juvenile myxoedema.

1. onset after few years of birth. but before puberty.

2.BMI decreased. so temperature would be low

3.hypothuroidism causes impaired growth , thus milestones delay

4.myocardial contractility and heart rate decrease , so BP would be low.( thyroid hormone increase s HR) as per MArey's law BP is inversely proportional to HR.

it increases blood glucose so decrease of this causes low blood glucose.

myxoedema pt are usually obese , slight ly .

b. Thyroid Releasing Hormone from hypothalamus. target cells are thyrotroph cells of pituitary.

c. thyrotroph hormone releases the thyroid stimulating hormone.

d. it transport to the follicular cella of thyroid gland, iodine uptake from blood stream occur. then in presence of thyroglobulin tyrosine converts into tri iodothyronin and tetra iodo thyronin.

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