ESPE Abstracts (2021) 94 P2-306

ESPE2021 ePoster Category 2 Growth and syndromes (to include Turner syndrome) (56 abstracts)

Growth hormone deficiency (GHD) with high circulating insulin-like growth factor-1 (IGF-1) in an adolescent with celiac disease: Is it IGF-1 insensitivity?

Nada Alaaraj , Ashraf Soliman & Noor Hamed

Hamad General Hospital, Doha, Qatar

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.

Volume 94

59th Annual ESPE (ESPE 2021 Online)

22 Sep 2021 - 26 Sep 2021

European Society for Paediatric Endocrinology 

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