30 Jan 2008
Dr. Daniel Keene
RE: LAVERGNE, NOAH, R 21 Aout 2007
Thank you very much for this very interesting referal.
Noah is 5 month-old boy referred for evaluation of
pituitary function given the finding on MRI of
septooptic dysplasia as well as schizencepahly and
cortical dysplasia.
Noah was born at 38 weeks gestational age by vaginal
delivery. His birthweight was 9 lbs. He did
have difficulty breast-feeding in the newborn period and
mom switched to formula feeding. He did gain
weight well in the newborn period. He is currently
feeding 8 oz. every four hours during the day and sleeps
for about ten hours overnight. He does wake to
demand feeds. He does have a vigorous cry
according to mom and dad. He does spit up on
occasion with feeding. He has about eight to nine
wet diapers per day and one stool per day. Mom and
dad have not noticed any increased urination over the
last while. They feel his energy level is good and
that he is vigorous when he is awake. He seems to
get over illness easily. They have not noticed any
dry skin, dry hair or constipation.
Noah lives at home with both parents. Mom is 18
years of age and healthy and is 4 ft., 6 in. tall.
She works at a Drug Store. Dad is 23 years of age,
healthy, 5 ft., 6 in. tall and is a Plumber.
Paternal grandmother helps to take care of Noah when mom
is at work. She is 48 years of age and healthy.
Paternal grandfather is 46 years of age and healthy.
Maternal grandmother is 37 years of age and healthy.
Not much is known about maternal grandfather.
On examination today, Noah looks well. He does
have some roving nystagmus. His palate looks
normal. His thyroid gland is not enlarged.
His abdomen is soft with no organomegaly. He has
normal male genitalia. Both testes are descended.
He does have some dysmorphic features on examination.
His head circumference is about 41 cm.
Noah did have an MRI of his head done yesterday and
he does have features of septooptic dysplasia. He
was also assessed by both Neurology and Ophthalmology
yesterday. He is at high risk for pituitary
hypofunction. We have arranged for Noah to undergo
an ACTH stimulation test tomorrow morning to assess his
pituitary adrenal axis. we will also measure his
thyroid function including TSH and free T4 and IGFI 1
level. We will also look at his electroytes to
determine whether he has any evidence of diabetes
insipidus.
We will contact the family with the results of our
investigations. We will continue to follow Noah
closely either through regular visits here or through
Tele health visits every four months.
Addendum: ACTH stimulation test normal. Thyroid
function test normal. Lytes normal. No sign
of pituitary hypofunction at this time.
Thank you again for this very interesting referral.
Yours sincerely,
Stasia Hadjiyannakis, M.D., FRCPC
Dictated by Stasia Hadjiyannakis, M.D., FRCPC - 30
Jan 2008
Transcribed mm/job # 28553216 - 22693220 31 Jan 2008
02/14/2008 13:04:22
Cc: Stasia Hadjiyannakis, M.D., FRCPC
Dr. Joseph K Madden, 720 Mclaren street, North Bay,
Ont., P1B 3L8
Document authenticated by Stasia Hadjiyannakis, M.D.,
FRCPC, on 02/14/2008 13:04:22 ET
