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In the name of GOD

In the name of GOD. Patient Identification:. Patient is a 21 years old man Studies:student of mechanic engineering Habitatoin:Tehran Marriage:single. Present illness:.

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In the name of GOD

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  1. In the name of GOD

  2. Patient Identification: • Patient is a 21 years old man • Studies:student of mechanic engineering • Habitatoin:Tehran • Marriage:single

  3. Present illness: • Patient is a 21 years old man who came with polyuria and polydipsia since 3 years ago that was exacerbated during 5 months.He has 2-3 kg weighting loss during 1 year.He has no complaint of muscle weakness or malaise.He has nocturia and that developed since 5 months ago and progressed gradually to 3 times a night .He has not hearing loss and visual loss and growth disorder or Renal stone or blood pressure or any history of headache or recurrent seizures. He had a short stature between his classmates in high school age that had a reference to a doctor and he got reassurance that this problem is not a disorder because of comparing of parents statures . episodes of change in blood pressure not seen.

  4. Patient had some work up for this problem in years 93, 94, 95 as below: • 1393:K=2.07Ca=9.9ph=3.6Bun=56cr=1.29 ~GFR=56.6

  5. 1395:ESR=20CRP=0.2Bun=13cr=1.26~GFR=53TSH=1.6T3=1.51T4=8.42UA=SG=1010 / pH=8 / osm=405 & other parameters was NL HbA1c=6.2 / 2hpp=106 / FBS=101

  6. Patient admitted in endocrinology ward for more evaluation from 8.8.95 to 12.8.95: patient reciped oral kcl (6-8 tab daily) then reciped 15 cc kcl 15% in 4 doses in 24 hour for normalization of serum potassium and remitting samples for serum Aldosterone and PRA and urine 24 he test. Then after 4 days discharged with tab Aldactone 100mg daily and tab kcl 6 tab daily.

  7. Other Lab data during admission : • Biochemistry :bun=15cr=1.2~GFR=55VBG:Ph=7.47 / pco2=46.3 /Hco3=31.5Mg=2.1Ca=9.9ph=3.6TFT:TSH=2.5 / T3=1.9 / T4=5.9UA: ph=7 / SG=1010 / other parameters of UA was NL Blood pressures during all days of admission werepressures 100/70orthostatic hypotension was not seen. other lab data was NL.

  8. Past medical history: • _He had a history of febrile seizure in 1y/o(2 times in 24 hour) and reciped tab phenobarbital for one year .seizure was not remittant. _he was premature and had low birth weight =2000gr and was delivered in 29th weeks of pregnancy .reason of that was premature rupture of membrane. sonography of pregnancy was NL and polyhydramonios was negative._he has a history of head trauma3_4years ago that not terminating to decreasing in level of consciousness.

  9. Family history : • No history of hereditary or congenital disease in family and close relatives.patient has one younger brother that has not same history of prematurity or this problems.

  10. Drug history :negative Past surgical history :negative Allergy history :negative

  11. Review of systems : • Patient has not any complaints or problems in systematic review of all organs.

  12. General appearance : • Patient is a awake and aware man; oriented to the time and place and person, that face hair development and real age has not good adaptation and proportion. Poor face hair growing was not in other male sexes of his reatives. ortostaticchange =negative BP=100/70PR=88RR=15 Tempreture:36.5 height =163 cm / weight =51 kg /BMI=19.2 kg/m2 father height =170 /mother height =157cm /brother height =168 cm mean parental height =160_180 cm

  13. Physical examination : • Skin: skin was normal . Eye:sclera isn't ichteric, conjunctiva isn't pale, examination of retina is normal. mouth:aphthous, wound or other pathology were not seen. head and neck :thyromegally and nodularity of thyroid were not detected. He has not moon face,supra clavicular fat pad wasn't seen. Lymphadenopathy was Negative. chest:chest has a normal and symmetrical expansion without any deformities, clear in auscultation, gynaecomastia was not found. heart :s1, s2, were detected,no any Stanger sounds were heared. Abdomen :soft,was not distended, organomegally was not found, steria was not seen.Extremities :cyanosis, clubbing were not seen. Pulses are symmetric and regular. Neurological exam of Extremities are normal.

  14. Genital exam:appearance of genitalia is as a man,genitalia is G5,P5,testis size is 4 cm. • Axillary hair and chest hair is normal. Neurology exam:mental status is normal.pt is aware and awake, motor:force of limbs are normal,tone of muscles are normal.babanski test was down.cerebellar exam:finger to nose test,heel to shin test and tandem gate is normal.sensory :sense of touch,vibration, position ,proprioception and heat were normal.

  15. Results of urine 24 he test and serum aldosterone and PRA : • Ca=464 (50_300)Mg=128 (73_122)Na=128 (40_220)~ serum Na=139cl=128 (110_150)K=69 (25_125) ~ serum K=3pr=0.1 (0_0.15)cr=1gr (nl)volume=5800 ccAldosterone =410 (17.6_233)PRA= >35 (0.2_1.6)

  16. 1393: 1394:Iron:66 LH:2.6TIBC:373 FSH:2.6ferritin :54.5 PRL:20.2Ast:20 testosterone :10.8Alt:12Alkph:12Via D:34 1395:uric acid:6.1 cortisol 8 AM:293.8chol:193 ACTH:3.4TG:124HDL:49LDL:137

  17. Thanks for your tolerance!

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