26457578 Visualization

The patient, a 9 Age year Age - old Age Caucasian Personal_background female Sex , was first diagnosed with medulloblastoma Disease_disorder at age Date 3 Date years Date .
Treatment Therapeutic_procedure included surgical Therapeutic_procedure resection Therapeutic_procedure of the tumor Sign_symptom followed by systemic chemotherapy Medication ( Vincristine Medication , Lomustine Medication , Cisplatin Medication , Carboplatin Medication , Cyclophosphamide Medication , Etoposide Medication ), and craniospinal Biological_structure radiation Therapeutic_procedure ( 2,340 Dosage cGy Dosage ) with boost Therapeutic_procedure to the posterior Biological_structure fossa Biological_structure ( total Dosage dose Dosage 5,900 Dosage cGy Dosage ).
Cis Medication - RA Medication was subsequently administered for eleven, Dosage 14 Dosage - day Dosage cycles Dosage ( 180mg/m2 Dosage per Dosage day Dosage ), over a 13 Duration - month Duration period Duration for a cumulative dose of 17,360 Dosage mg Dosage ( 24,640 Dosage mg/m2 Dosage ).
She completed Lab_value medulloblastoma Therapeutic_procedure therapy Therapeutic_procedure at age Date 5.6 Date years Date .
At age Date 6 Date years Date , she was diagnosed with radiation Detailed_description - induced Detailed_description central Detailed_description hypothyroidism Disease_disorder and growth Disease_disorder hormone Disease_disorder deficiency Disease_disorder ( GHD Disease_disorder ).
She was treated with levothyroxine Medication with subsequent biochemical Detailed_description euthyroidism Sign_symptom .
Given tumor Sign_symptom remission Sign_symptom status and an abnormal Qualitative_concept height Diagnostic_procedure velocity Diagnostic_procedure of 0.94 Lab_value cm/year Lab_value , growth Medication hormone Medication ( GH Medication ) therapy was initiated at age Date 7 Date years Date ( 0.3 Dosage mg/kg/week Dosage ) with subsequent increased Qualitative_concept height Diagnostic_procedure velocity Diagnostic_procedure of 3.6 Lab_value cm Lab_value growth/seven Lab_value months Lab_value ; however, seven Date months Date after Date initiation of GH Medication , increased Qualitative_concept bony Sign_symptom prominence Sign_symptom was noted at wrists Biological_structure and knees Biological_structure , concomitant with declining Qualitative_concept height Diagnostic_procedure velocity Diagnostic_procedure ( 1.6 Lab_value cm Lab_value growth/five Lab_value months Lab_value ).
Physical Diagnostic_procedure examination Diagnostic_procedure and radiographs Diagnostic_procedure were significant for leg Diagnostic_procedure length Diagnostic_procedure discrepancy Lab_value : the right Biological_structure lower Biological_structure extremity Biological_structure measured Diagnostic_procedure 1.75 Lab_value cm Lab_value shorter Lab_value than Lab_value the Lab_value left Lab_value ( right Lab_value femur Lab_value 24.9 Lab_value cm Lab_value , right Lab_value tibia Lab_value 19.6 Lab_value cm Lab_value , right Lab_value lower Lab_value extremity Lab_value 44.5 Lab_value cm Lab_value , left Lab_value femur Lab_value 25.25 Lab_value cm Lab_value , left Lab_value tibia Lab_value 21 Lab_value cm Lab_value , and left Lab_value lower Lab_value extremity Lab_value 46.25 Lab_value cm Lab_value ).
Prior to initiation of GH Medication , height Diagnostic_procedure ( 102 Lab_value cm Lab_value ) (Figure 1) and armspan Diagnostic_procedure ( 102 Lab_value cm Lab_value ) were similar, with upper Diagnostic_procedure segment/lower Diagnostic_procedure segment Diagnostic_procedure ratio Diagnostic_procedure of one Lab_value ; seven Date months Date after Date GH Medication , height Diagnostic_procedure increased Lab_value minimally Lab_value ( 105.6 Lab_value cm Lab_value ) compared to the more Lab_value significant Lab_value increase Lab_value in armspan Diagnostic_procedure ( 109.2 Lab_value cm Lab_value ), with upper Diagnostic_procedure segment/lower Diagnostic_procedure segment Diagnostic_procedure ratio Diagnostic_procedure remaining at one Lab_value .
Radiographs Diagnostic_procedure revealed poorly Lab_value visualized Lab_value growth Diagnostic_procedure plates Diagnostic_procedure in both distal Biological_structure and Biological_structure proximal Biological_structure femurs Biological_structure and Biological_structure tibias Biological_structure (Figure 2A-B), raising concern for premature Disease_disorder closure Disease_disorder of Disease_disorder the Disease_disorder physes Disease_disorder .
This lower limb growth plate closure would normally be observed at the time of late-stage puberty.
By contrast, all bone Diagnostic_procedure ages Diagnostic_procedure using left Biological_structure hand Biological_structure and wrist Biological_structure radiographs Diagnostic_procedure over the preceding Duration two Duration years Duration displayed open Lab_value growth Diagnostic_procedure plates Diagnostic_procedure (Figure 2C-D).