Question

A young boy has retarded physical and mental development. X-rays reveal fragmentation of the epiphyses and the presence of wormian bones. What is the diagnosis?

• A. Hypopituitarism
• B. Hypothyroidism
• C. Hypogonadism
• D. Scurvy

Hint:

Combined growth and mental delay with fragmented epiphyses and wormian bones on x-ray points to hypothyroidism.

Answer 1

The Correct Option is B

This question links a growth and mental delay together with specific bone x-ray changes to reach a diagnosis.

1. Hypopituitarism: growth hormone lack slows physical growth and bone age, but the brain usually still develops close to normally, so it does not explain the mental retardation or the fragmented epiphyses and wormian bones seen here.
2. Hypothyroidism: thyroid hormone is needed for both bone growth and brain maturation, so a lack of it in infancy stunts height and slows mental development together. On x-ray, the epiphyses ossify unevenly, giving a stippled, fragmented look, and delayed skull ossification produces extra wormian bones within the sutures.
3. Hypogonadism: mainly affects puberty and the growth spurt, it does not cause mental retardation or these particular bone changes in a young boy.
4. Scurvy: is caused by a lack of vitamin C and shows up as bone pain, bleeding gums, and a white line with a ground glass look at the metaphysis on x-ray, along with bleeding under the periosteum, a very different picture from fragmented epiphyses and wormian bones, and it does not cause mental delay.

Only hypothyroidism ties together slowed physical growth, slowed mental development, fragmented epiphyses, and wormian bones in one diagnosis.

Let's summarize:

• Thyroid hormone is essential for both bone growth and brain development, so its lack delays both together.
• Fragmented, stippled epiphyses and wormian bones on x-ray are classic hypothyroidism findings.

So the diagnosis is hypothyroidism.