Introduction: Very late step growth is quite rare, and probably very rare, if there is, 10 years after the end of treatment with GH. Therefore, we would like to present our patient, even though we cannot yet give a full pathomechanism of his disorders.
Case report: A man 28 years, was admitted to us to assess hormonal status before elective hip surgery. He had congenital brain toxoplasmosis. From 8 to 16 years he was treated with GH without a good effect. However, in the last 2 years, so between 26 and twenty eight years, he has grown more than 20 cm. Laboratory results indicated hypopituitarism with undetectable GH and low IGF1, adrenal insufficiency (cortisol 18 μg/l, ACTH 21 ng/l), and hypothyroidism (FT4 7.2 pmol/l and TSH 5.8 mIU/l) and hypogonadism with undetectable testosterone levels and LH <0.20 mIU/l, FSH 0.4 mIU/l and estradiol 29 pg/ml. In inguinal canal and scrotum, we found small fragments of glandular tissue. The response to gonadothropin was week. In MRI normal pituitary 5×6×9 mm, and at the bottom of third ventricle 5 mm size, expansive tissue. No signs of puberty, height 174 cm, weight 54 kg BMI 17.8. The epiphyses are not fused together and the patient is still growing despite the very low IGF.
Adrenal replacement therapy was started followed by thyroid replacement therapy. We consider the operations to remove the glandular tissue of the inguinal canal and scrotum and substitutions with testosterone.
Discussion: We take into account the possibility of ectopic secretion of IGF other than growth factors and/or factor causing sensitivity to IGF. However, this remains speculation. Therefore, we would like to present him hoping for help from the European Endocrinologists.