History: This 13-year-old white male was admitted to Sarah Morris Hospital on April 17, 1960, for re-evaluation of diabetes insipidus.
The patient was first seen at another hospital in June, 1957, because of small penis and shortness of stature. Laboratory studies revealed 17-ketosteroids, 2.9 mg/24 hr, and follicle-stimulating hormone in urine, 13.6 units/24 hr. The bone age was 8 3/12 years, and roentgenograms of the skull revealed normal findings. The specific gravity of urine was 1.002; otherwise, findings were negative.
In August, 1958, he was readmitted with complaints of growth failure, polyuria and polydypsia. His weight on the first admission was 71.5 lb (32.4 kg), and on the second, 82.0 lb (37.2 kg), but his height was the same. Water load and pitressin test were diagnostic for diabetes insipidus. An intravenous pyelogram was normal. He developed a short period of hypernatremia, which was corrected with intravenous fluids. The protein-bound iodine value was 6.8µg; fasting blood sugar, 115 mg/100 ml; and nonprotein nitrogen, 35 mg/100 ml. On October 15, 1958, the specific gravity of urine varied between 1.016 and 1.027 following administration of vasopressin (Pitressin) tannate. Vasopressin was administered in doses of 0.5 to 1.0 cc daily, and the patient responded well.
He did well until the summer of 1959 when he developed almost constant sleepiness. He had been a grade A student, but his work deteriorated. He also became a difficult person to get along with because of uncontrollable emotional outbursts and a definite personality change. His weight had increased considerably but his linear growth remained stationary.
Physical Findings: Physical examination revealed a small obese boy in no acute distress. His height was 130 cm (3rd percentile for 10 years of age) and his weight, 50.2 kg (75th percentile for 13 years of age).
- Copyright © 1961 by the American Academy of Pediatrics