Fig. 4

Diagnostic (a) and follow-up (b) flowcharts for patients with suspected PHP. a In the initial diagnostic phase we suggest to assess the presence or absence of each AHO sign and hormone resistance possibly involved in PHP through targeted clinical examinations (physical and neuropsychiatric), laboratory tests (on blood and urine) and medical imaging investigations. This wide diagnostic approach, despite laborious, represents an exhaustive base-line assessment for later comparative examinations. b During the follow-up management we propose for each clinical feature involved in PHP a practical checklist of clinical, biochemical and/or imaging investigations to perform periodically or in case of symptoms in the follow-up of PHP patients. In particular, we believe that patients who are very young at diagnosis would benefit of systematic reevaluations, in order to correctly manage late complications of the disease and to detect late-onset signs during the growth for a prompt treatment