A 13-Year-Old Boy Is Brought to the Office Due to Poor

A 13-year-old boy is brought to the office due to poor weight gain.  His mother also notes that he is the shortest student in his class.  The patient has occasional abdominal discomfort and a bloating sensation but has a good appetite and eats a balanced diet.  He has had no nausea, vomiting, diarrhea, hematochezia, or melena.  The patient has a 3-year history of type 1 diabetes, and his insulin was recently decreased due to recurrent episodes of hypoglycemia.  Family history is significant for hypothyroidism in the mother.  Vital signs are within normal limits.  Weight is at the 5th percentile for age and height is at the 10th.  Physical examination shows anicteric sclera, moist mucous membranes, no enlarged lymph nodes, and normal heart and lung sounds.  The abdomen is nondistended, soft, and nontender with no organomegaly.  Laboratory results are as follows: Which of the following is the best next step in evaluation of this patient?

A) Antitissue transglutaminase antibody assay
B) Contrast-enhanced abdominal CT scan
C) Quantitative fecal fat testing
D) Serum insulin-like growth factor 1 level
E) Sweat chloride measurement

Correct Answer:

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