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Contributor Details
Name
*
Institute/Hospital
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Email
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Email OTP
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Mobile
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Patient Details
Name
Age
*
Gender
--Select--
Male
Female
Others
Aadhar number
Education
Occupation
Address
Presenting Complaints
Primary Amenorrhea
*
--Select--
Yes
No
Short Stature
*
--Select--
Yes
No
Webbing of Neck
*
--Select--
Yes
No
Ear Problems
*
--Select--
Yes
No
Cardiac Symptoms
*
--Select--
Yes
No
Birth History
Maternal Age at Birth
Paternal Age at Birth
Edema of hands and feet
--Select--
Yes
No
Neck Edema
--Select--
Yes
No
Height at presentation
Weight in kg
Height SDS
Weight SDS
Target SDS
Clinical Examination: Head & Neck
Eyes
Epicanthal fold
--Select--
Yes
No
Pseudo Ptosis
--Select--
Yes
No
strabismus
--Select--
Yes
No
Ear
Deformity of ear
--Select--
Yes
No
Ear infections
--Select--
Yes
No
Hearing defects
--Select--
Yes
No
Oral Cavity
Multiple Nevi
--Select--
Yes
No
High arched palate
--Select--
Yes
No
Micrognathia
--Select--
Yes
No
Teeth abnormality
--Select--
Yes
No
Neck
Goitre
--Select--
Yes
No
Webbing of neck
--Select--
Yes
No
Low posterior hairline
--Select--
Yes
No
Chest
Inverted nipple
--Select--
Yes
No
Shield chest
--Select--
Yes
No
Skeletal
Cubitus Valgus (carrying angle)
--Select--
Yes
No
Madelung Deformity
--Select--
Yes
No
Short IV Metacarpals
--Select--
Yes
No
Scoliosis
--Select--
Yes
No
Pectus Excavatum
--Select--
Yes
No
Genu Valgum
--Select--
Yes
No
Pubertal Staging
Breast
*
--Select--
B1
B2
B3
B4
B5
Pubic hair
*
--Select--
P1
P2
P3
P4
P5
Axillary hair
*
--Select--
A1
A2
A3
A4
Cardiovascular system
Loud A2 Heart Sound
--Select--
Yes
No
Ejection Systolic Murmur
--Select--
Yes
No
Coarctation of Aorta
--Select--
Yes
No
Bicuspid Aortic Valve
--Select--
Yes
No
Aortic Dilatation & Aneurysm
--Select--
Yes
No
Biochemical Investigations
FBS in mg/dl
PPBS in mg/dl
RBS in mg/dl
HbA1c in %
LH in mIU/ml
*
FSH in mIU/ml
*
Prolactin in ng/ml
Total Testosterone in ng/dl
Estradiol in pg/ml
Beta HCG in mIU/ml
TSH in mIU/mL
T4 in μg/dL
Free T4 in ng /dL
Anti TPO antibody
--Select--
Positive
Negative
Anti TPO antibody value in/ml
Anti TPO Level (IU/ml)
IgAtTGAb
Baseline Growth hormone
IGF-1 (ng/ml)
Growth Hormone stimulation test done or not
--Select--
Yes
No
If yes, whether priming done with Estrogen before GH stimulation test
--Select--
Yes
No
LFT
Insulin tolerance test
0 hour GH level (ng/ml)
1 hour GH level (ng/ml)
2 hour GH level (ng/ml)
Karyotype
Karyotype
*
Attach Image(Jpeg/PDF)
*
Bone Age
Chronological age
Bone age
Height age
Ultrasound Pelvis
Right Ovary Visualised
--Select--
Yes
No
Right Ovary Streak
--Select--
Yes
No
Right Ovary Volume
--Select--
Volume ≤ 1.6 cm
3
Volume 1.7 to 2.7 cm
3
Volume ≥ 2.8 cm
3
Left Ovary Visualised
--Select--
Yes
No
Left Ovary Streak
--Select--
Yes
No
Left Ovary Volume
--Select--
Volume ≤ 1.6 cm
3
Volume 1.7 to 2.7 cm
3
Volume ≥ 2.8 cm
3
Uterine length
--Select--
< 3.5 cm
3.5 to 5 cm
> 5 cm
Kidney
--Select--
Normal
Pelvic kidney
Horse shoe kidney
ECG & ECHO
QTc Interval
Echocardiogram
Cardiac MRI
Celiac Disease
--Select--
Yes
No
MRI Pituitary
Audiogram
Right ear
Left ear
Miscellaneous
Miscellaneous
Intelligent Quotient (IQ)
Bone / Dexa
Cancer
Growth Hormone Therapy (Dose, Duration, Response)
Puberty Induction (Dose and type, Duration, Response)
HRpQCT
Others
IBD
--Select--
Yes
No
