Endocrine Abstracts

We describe the case of an Asian male who is currently 20 years of age. He originally presented aged 18 months with short stature (height below 3rd centile). Isolated growth hormone (GH) deficiency was confirmed by an insulin tolerance test (normal thyroid function/cortisol/GH antibodies). He commenced GH injections (1 unit/day), to which he responded well, reaching the 50th centile for height within one year. Due to his parents’ wishes, GH therapy was discontinued at 3 years of age, causing his growth to tail off. Aged 6, he was noted to have a hypoplastic scrotum. An ultrasound scan confirmed undescended testes in the inguinal canal and he underwent bilateral orchidopexy. Following a 4 years loss to follow up, he resurfaced aged 10 (height below 3rd centile) and was then restarted on GH therapy (3 units/day). Aged 13, he remained pre-pubertal, so a prolonged HCG test and LHRH test were performed. This showed a good response of testosterone, LH and FSH. A MRI of his pituitary showed a hypoplastic anterior pituitary gland with an undescended posterior pituitary. Following concerns about his delayed onset of puberty he was also started on testosterone therapy at age 14. This was stopped after 4 years. His most recent gonadotrophin levels, testosterone, thyroid function, renal function and cortisol were normal in 2006. His IGF-1 level was 7.6 nmol/l. Now under the adult endocrinology service, he continues on GH therapy 0.5 units daily. Currently 176 cm in height and 85 kg in mass, his external genitalia are at stage 5 (Tanner criteria) with a testicular volume of 8 ml bilaterally. He has no postural hypotension. His isolated GH deficiency has the potential to evolve to include other hormone deficiencies, especially in view of the pituitary MRI findings. Therefore, he warrants regular pituitary follow up.