Author: Rathna Nuti, MD
Co Author #1: Brigham Au, MD
Senior Editor: Carolyn Landsberg, MD
Editor: Jacob Miller, MD
A 13-year-old active female athlete presented for metabolic workup after having frequent fractures of the left fifth metatarsal.
The first fracture was sustained while playing volleyball. She recovered well and started playing basketball and soccer. Six months later, she felt similar foot pain and was diagnosed with another fifth metatarsal fracture. She was training ten hours per week for basketball and three hours per week for soccer. The athlete reported a ten-pound weight loss in the past month. She also reported polydipsia, mood changes, and fatigue. Menarche began one month prior to evaluation. There was no history of eating disorders. She typically skipped breakfast, ate lunch and dinner, and had snacks. Two years ago, she was evaluated by an endocrinologist for a questionable history of hypothyroidism and elevated cholesterol. No further medical management was necessary except lifestyle modifications.
Vitals: BMI 23.41 kg/m2
General: Not in acute distress. Normal in appearance.
Cardiovascular: Regular, rate, and rhythm.
Pulmonary: Clear to auscultation in all lung fields.
Gastrointestinal: Soft, nontender, active bowel sounds, no guarding or rebound tenderness.
Psych: Alert, oriented x 3.
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