Case: MMW was born at 39 weeks by elective caesarian section because of placenta praevia with a birth weight of 2.32kg.She was known to dietetics and medical services because of failure to thrive and short stature (BMI SDS -3.32, Height SDS -2.21). Due to chronic upper airways obstruction, she had a tonsillectomy at aged 2.5 yrs. Following this, appetite and weight improved (BMI SDS -1.3) but abdominal pains prompted blood investigations which revealed positive coeliac serology (tTg and endomyseal antibodies). Diagnosis was made by HLA typing at 6.3 years by a Paediatric gastroenterologist. She was discharged to general follow up when growth improved on a gluten free diet at 7.3 years. Catch up growth was presumed to be due to her medical management. However she presented in B2 puberty 3 months later at 7.5 years. Bone age advancement was noted and LHRH stimulation test confirmed a central cause for her precocious puberty (LH peak 14.72 IU/L, oestradiol 121 pmol/L). GNRH analogue was started a few weeks later (7.6 years).
Imaging: Bone age 3 yrs (CA 5.7 yrs). Bone age 5 yrs 9 months (CA 7.5 yrs). Bone age 10 years (CA 9.1 yrs). Pituitary MRI was normal.
Conclusion: Typical bone age delay is seen in a child with chronic feeding difficulties and obstructive airways. This bone age delay is noted to advance when she presents with precocious puberty at 7.5 years. One can assume the trigger for earlier puberty here may be due to improved nutrition and BMI following improved appetite following tonsillectomy and being gluten-free after coeliac diagnosis. However the natural progression of catch-up growth in a SGA child may also be influencing growth patterns and bone age advancement here.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology