Case 3: Fatigue, Weight Loss, Pallor, and Polydipsia in 12-year-old Girl.

1. Ranita Patel, MD* 2. Kartik Pillutla, MD* 3. Lynn Thoreson, MD* 1. *Dell Children’s Medical Center, Austin, TX. A 12-year-old girl with a history of developmental delay presents for evaluation of 3 months of progressive fatigue and a 5-lb weight loss. For the past 7 days, her mother has noticed that her daughter has decreased activity and increased pallor. She has had no fevers, recent illnesses, or new exposures. The mother adds that her daughter has had polydipsia for the past 3 months. Physical examination reveals a tired-appearing, thin adolescent girl in no acute distress. Her temperature is 36.6°C (97.8°F), heart rate is 72 beats/min, blood pressure is 117/74 mm Hg, and weight is 27.3 kg (< 1st percentile). She has pale conjunctivae and a grade II/VI flow systolic ejection murmur. Abdominal examination reveals nodular hepatomegaly and splenomegaly extending 4 cm and 10 cm, respectively. No edema is appreciated. Laboratory results include: