Introduction: Growth hormone deficiency is a rare cause of stunting; its diagnosis is often delayed by severe growth retardation; confirmed by non-response to GH stimulation tests (insulin and glucagon-propranolol test). The absence of early diagnosis and treatment can lead to severe growth retardation. We propose to determine the prevalence of different etiologies of growth hormone deficiency in patients followed for a saturo-weight delay at the Arrazi Hospital, Medical University Hospital VI of Marrakech.
Materials and methods: A prospective study was conducted over a period of 4 years [January 2013-January 2017]. 65 files were identified. The clinical symptomatology was varied, ranging from signs of hypopituitarism, polymalformative syndrome to intracranial hypertension. Biological exploration was oriented by clinical symptomatology, based on stimulation tests and reinforced by radiological exploration (hypothalamic-pituitary MRI).
Results: The average age of these patients is 15.6 years with a H-F sex ratio of 3.7. Severe growth retardation was observed in 89.3% of cases. Of the 65 cases with a GHG deficiency, 38 cases of congenital deficiency were found. 58.4% of cases (26.2% of which were due to malformation of the hypothalamic-pituitary area), 13 cases of acquired deficit -tumors- (20%) and 14 cases integrating into polymalformative syndromes (21.6% of cases). Ante-pituitary deficits were associated: 33.9% of cases of gonadotropic deficiency, 23.8% of thyrotropic cases and 8.4% of adrenocorticotropic cases.
Discussion: The plasma IGF-1 assay allows in the majority of cases to detect the severe deficits in growth hormone. Confirmed by the couple, dynamic stimulation tests and hypothalamic-pituitary MRI. Some are currently based on IGF-1 and IGFBP3 assays in combination with imaging of the pituitary region, given the very poor reliability and reproducibility of the tests.
Conclusion: The staggered delay can be the gateway to a large number of serious diseases of the child and that the diagnostic priority is not to ignore a tumor: cranipharyngioma, glioma.
18 - 21 May 2019
European Society of Endocrinology