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X-rays of the skull and a CT scan will help identify a pituitary eosinophilic adenoma, but serum growth hormone will also be elevated early, and FSH and LH may be depressed later. An MRI will be necessary to pick up microadenomas. Serum FSH and LH will be elevated in Klinefelter's syndrome. A chromosome study should be done to identify Klinefelter's syndrome, supermale, and superfemale. A serum testosterone, dihydrotestosterone, and dehydroepiandrosterone sulfate will be helpful in diagnosing sexual precocity and virilism caused by tumors and hyperplasia of the adrenal gland. Echocardiography and urinary hydroxyproline will help identify Marfan's syndrome, whereas a urine for homocystine will help diagnose homocystinuria. A thyroid profile should be done to rule out thyrotoxicosis.
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
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