Growth retardation in children with type 1 diabetes (T1D) is mostly associated with longterm poor metabolic control or combination with other autoimmune diseases. Although rare it could be due to growth hormone deficiency. We present eleven-year-old girl, diagnosed with T1D at age of 2y6mo., on multiple daily injections (MDI) with analogues. She is raised in poor social conditions – low parental education and income, rare follow-up due to difficult access to healthcare provider. Growth retardation was established at the age of 5y6mo. On this point she had a poor long-term metabolic control (HbA1C 13,22%) with unstable blood glucose levels. First insulin doses were adjusted, thyroid function was assessed and tissue transglutaminase antibodies (anti-tTG) were measured. She was negative for coeliac disease, but Hashimoto disease was diagnosed on re-evaluation at age of 7y (TSH 230 uIU/mL; fT4 4,0 pg/ml, TPO 4000 IU/L). Although thyroid hormone replacement treatment was started, short stature remained. On last evaluation auxology showed height 120,8 cm (<3P, -3,42 SDS), weight (<3P, -2,24 SDS), significant retarded bone age (equal to 9y). Physiological puberty was started – telarche 2nd st; pubarche 1-2nd st. She was retested for coeliac disease – negative anti-tTG Ab. Poor adherence to L-Thyroxin treatment (TSH 100 uIU/ml; fT4 12,19 pg/ml) and very low IGF-1: 77,8 ng/ml (136-315) were found. Imaging of head for anatomical abnormalities is negative. But does she need growth hormone treatment? Growth failure in T1D is often multifactorial. Among other factors affecting growth in children with T1D, downregulation of insulin like growth factor-1 (IGF-1) and insulin like growth factor binding protein-3 (IGFBP-3) with growth hormone resistance or even growth hormone deficiency could be considered. Afterwards growth hormone stimulation tests are appropriate only after better insulin treatment adherence and euthyroid state are achieved.
15 Sep 2022 - 17 Sep 2022