Endocrine Abstracts

Context: GH deficiencies could be associated with other pituitary insufficiencies. Our main objective is to assess othe pituitary secretion in short stature patients.

Patients and methods: Twenty three patients (17 boys, 6 girls) were included in the study for exploration of short stature, after oral and informed consent of their parents, from January 2016 to June 2017 in the Department of Endocrinology of the University Hospital of Farhat Hached Sousse. The mean age of the patients was 11.30±2.83 years. Patients were excluded if they had a known chromosomal abnormality, untreated primary hypothyroidism, metabolic disease or disease associated with disordered glucose metabolism, MRI abnormalities, a known endocrine abnormality that could interfere with HPA axis function, were treated by any kind of steroid preparation, or had an anatomic abnormality or tumor of the central nervous system, a history of central nervous system irradiation, or documented central or primary hypothyroidism. The Inslin Tolerance Test (ITT) was performed by administering an IV bolus injection of 0.10 U/kg regular human insulin (Actrapid*). The Glucagon Stimulation Test (GST) was performed by intramuscular injection of 1 mg glucagon. We assessed the other pituitary axis by hormonal assays: TSH and T4 for the thyroid deficiency, ACTH and cortisol for adrenal insufficiency and Gonadotrophins for gonadic axis.

Results: From 23 children with short stature, 15 had GH deficiency (GHD) confirmed by both of Insulin tolerance test and Glucagon stimulation test. The mean age of the patients was 10.67±3.24 yo. The mean height was 164.33±4.22 cm, with a standard derivation (SD) of −2 DS for 53.3% and −3 DS for 46.7%. Hypophysary MRI performed in 6 children was normal. The bone age was of 10.13±2.85 yo. They were 12 boys and 3 girls. The mean peak of GH under ITT and GST was respectively of 1.95±1.04 ng/ml and 2.92±1.7 ng/ml significantly lower than normal children (P<10⁻³). Of the children with GHD, 5 of them had secondary adrenal insufficiency confirmed by both of ITT and GST, 3 of them had hypogonadotropic hypogonadism and 1 of them had central hypothyroidism. None of them had hyperprolactinemia.

Conclusion: GH deficiency could be associated with other pituitary insufficiencies that may be asymptomatic in children with short stature. Assessing the entire pituitary secretion may discover these deficiencies and permit earlier treatment.