Description
The patient was a middle-aged man who was very tall. He had
a very wide arm span and the lower segment of his body appeared longer than the
upper segment. He was obese but not grossly so.
His head looked of normal dimensions in particular the
head did not look elongated. His nose was of normal size and he did not have a
change in his sense of smell. His jaw was of normal dimensions, there was no
malocclusion of his teeth and his palate was not high arched.
His hands were large but seemed in keeping with his height.
There was no arachnodactyly. There were no deformities.
There was no abnormality of his neck.
On examination of the chest it was noted that his shoulders
were relatively narrow. He had gynaecomastia and there was paucity of body hair.
No abnormality was seen on inspection of his abdomen but
his hips appeared to be wide
Analysis
©
This patient is very tall and this raises several possibilities
(Page 65) .The fact that his proportions are eunuchoid rules out
normal variation and pituitary gigantism
ª
The fact that he has eunuchoid proportions reduces the
possibilities to hypogonadism or inherited disorders such as Marfan’s syndrome,
Homocystinuria or Marfanoid features in MEN type 2 B
(Page 66)
¨
On examination of his head one does not encounter features of
Marfan’s syndrome, (Page 177)
Homocystinuria (Page 178), Kallman’s
syndrome (Page 350)or acromegaly(Page
73,74,83,84).
§
He does not have an abnormal facies and this makes Sotos syndrome
(Page 99) unlikely.
♥
This leaves the other cause of hypogonadism- Klinefelter’s
syndrome (Page 178)
ª
His hands do not reveal features of inherited disorders
¨
Examination of his chest adds further weight to the diagnosis of
hypogonadism (gynaecomastia, sparse body hair) and the narrow shoulders and wide
hips are also suggestive.
Confirmation would be by examining the testes although this
is usually not allowed in an exam situation such as MRCP PACES, OSCES and short
cases
Diagnosis
§
Klinefelter’s’ syndrome
