Tall stature evaluationDownloads

A 15-year-old girl comes to the physician with her father for evaluation of her tall stature. She is concerned because she is taller than all of her friends. Her birth weight and height were within normal limits. Her father is 174 cm (5 ft 7 in) tall; her mother is 162 cm (5 ft 3 in) tall. She is at the 98th percentile for height and 90th percentile for BMI. She has not had her menstrual period yet. Her mother has Graves disease. Vital signs are within normal limits. Examination shows a tall stature with broad hands and feet. There is frontal bossing and protrusion of the mandible. Finger perimetry is normal. The remainder of the examinations shows no abnormalities. Serum studies show a fasting serum glucose of 144 mg/dL. An x-ray of the left hand and wrist shows a bone age of 15 years. Which of the following is the most appropriate definitive treatment for this patient's condition?

A 3-year-old male presents with his parents to a pediatrician for a new patient visit. The child was recently adopted and little is known about his prior medical or family history. The parents report that the child seems to be doing well, but they are concerned because the patient is much larger than any of the other 3-year-olds in his preschool class. They report that he eats a varied diet at home, and that they limit juice and snack foods. On physical exam, the patient is in the 73rd percentile for weight, 99th percentile for height, and 86th percentile for head circumference. He appears mildly developmentally delayed. He has a fair complexion and tall stature with a prominent sternum. The patient also has joint hypermobility and hyperelastic skin. He appears to have poor visual acuity and is referred to an ophthalmologist, who diagnoses upward lens subluxation of the right eye. This child is most likely to develop which of the following complications?