ESPE Abstracts

Impaired growth in children with Celiac Disease (CD) results mainly from nutritional deficits. Withdrawal of gluten from the diet is frequently associated with a marked improvement of linear growth. Some CD patients still have impaired growth despite good gluten elimination. GH secretion should be evaluated in CD patients showing no catch-up growth. We describe a case with CD and severe linear growth retardation due to possible IGF-1 resistance.

Case Presentation: A 16 years old girl, a known case of celiac disease, diagnosed at age of 10 years. She has been compliant with a Gluten-free diet. She was born at term with a weight of 2.5kg, followed by insignificant neonatal history. She was growing well until the age of 7 years. There was no family history of short stature or growth abnormalities. She did not reach menarche yet and her mother and sister had menarche at age of 14-15years. By examination: she had no apparent dysmorphic features, no goiter or webbed neck, and normal hands. She was at Tanner stage 4 breast developments. Her growth parameters were: Height SDS: -3.76, BMI SDS: -0.85, Mid-Parental Height SDS: -1.2, and weight gain was normal. Investigation revealed normal hemogram, renal, liver, and thyroid profile. She had negative celiac antibodies (TGA). Her IGF-1 level was 436 ug/l= +1.2 SDS). The bone age was 14 years. Two growth hormone provocation tests done and showed a low peak as (1.15 and 4.6 mcg/l, respectively). Her gonadal hormonal profile was (LH: 16.9 IU/L, FSH=6.3IU/L, Estradiol, 238pmol/l, Progesterone: 1310 nmol/l) and prolactin level: 418 mIU/L. Pituitary MRI showed normal pituitary size with no focal lesion. A trial of growth hormone therapy (0.05mg/kg/day) was given. However, after 2 months she complained of significant headache, not associated with vomiting or visual changes. Repeat IGF-1 level was (713 ug/l= +3 SDS), which necessitated stopping GH therapy.

Discussion and conclusion: The finding in this adolescent girl with CD, severe linear growth retardation, and high IGF-1highly suggested IGF-1 insensitivity of the growth plate and pituitary level) causing her defect in linear growth. To our best of knowledge, this was not described before.