Endocrine Abstracts

A17 years old male student was following pediatric clinic for short stature for about 5 years, investigated thoroughly for cortisol Growth hormone deficiency Gluten enteropathy but serum testosterone level was never done, growth hormone replacement was given for 18 months and then stopped, during history and complaint in his current visit his concerns was not short stature only but reduced libido and no hair growth in face and axilla.

On examination he looks pale and has no hair growth in face or axilla tanner stage 2 to 3. CVS normal s1s2, chest normal, abdomen examination not remarkable.

Investigations Anemia Hb 9.6 TSH 1.6 IU/ml Total T4 6.1 ug/dl normal thyroid function, Prolactin 9.61ng/ml normal LH 1.19 mIU/ml below normal, FSH 1.87mIU/ml, testosterone Total 0.06 ng/ml remarkably reduced.

Ultrasound Testes small in size Right 27*17*11mm 2.8 cc left 26*18*10 mm 2.5 cc, MRI pituitary normal unremarkable, waiting for karyotype semen analysis as patient unwilling to do but he agreed to do next visit.

Diagnosis 1-Hypogonadotrophic Hypogonadism with Growth hormone deficiency

Treatment: Testosterone propionate Sustanone injection, every two weeks for two months, changed medications to Testosterone undecanoate Nebido 1000 mg Deep IM . Feed back after testosterone replacement patient was dramatically improved from course of two months treatment he has more hair growth change in voice and size of his testes and other sexual organs, he has more power less fatigue and not pale any more

Questions 1-Can be testosterone deficiency presented as short stature or affect constitutional growth. 2-Transition from pediatric to adult clinic can be done earlier than 17 years. 3-Do we need combined team to asses patients in age 13 to 14 to decide which one to be shifted to adult clinic earlier and what is plan of management. 4-Is there any chance to start Growth hormone if needed.