Endocrine Abstracts

A 28-year-man originally from Africa presented with short stature. His height at first clinic visit was 128 cm and there was no family history of short stature. He had pale complexion, lack of facial/body hair and under-developed secondary sexual characteristics consistent with morphology of hypopituitaric dwarfism. Insulin stress test with adequate hypoglycaemia<2.2 mmol/l confirmed flat growth hormone (GH) response (peak <0.5 mU/l) and inadequate cortisol response (peak 441 nmol/l). Baseline testosterone, leutenizing hormone and follicle-stimulating hormone were low at <0.7 nmol/l, <0.7 u/l and 0.9 u/l respectively. Thyroid function tests (TSH<0.05 mU/l and total T4-42 nmol/l) indicated secondary hypothyroidism confirmed by TRH test (peak TSH-0.05 mU/l). MRI pituitary showed empty sella with a thin rim of pituitary tissue. He was started on hydrocortisone, thyroxine and testosterone followed by GH replacement a year later at the age of 30. During the following 3 years, his height increased by 17.6 cm. X-ray revealed reduced bone age with unclosed epiphyses at distal ulnar and radius.

Growth failure in children can be treated with GH replacement to achieve the adult height till epiphyseal plate closure after which gaining height is impossible. Hypogonadism can delay epiphyseal closure permitting further vertical growth. We describe an adult patient with anterior hypopituitarism including hypogonadism and GH deficiency, achieving further height due to delayed epiphyseal closure. Patient achieved target IGF1 level within one month and maximal growth occurred when testosterone level was in the lower third of normal range. However, there is no clear explanation for continued growth after achieving normal testosterone level.