Growth retardation is a multifactorial process involving genetic, nutritional and hormonal factors. It has a significant psychological impact. The etiologies are multiple. This case illustrates a growth retardation related to more than one etiology.
A 22 year-old patient consulted in orthopedics for a right lameness. Diagnosis of primary hip osteochondritis had been suspected on standard X-ray and confirmed by magnetic resonnance imaging. He consulted in endocrinology for a small height relative to target height. Clinical examination showed a height at 1 m 56 (-3.3 standard deviations), a body mass index at 31.27 kg/m2 and a Tanner stage G5P5A5. The bone age was less than chronological age with a difference of 6 years. Biology assessment showed a TSH at 100, low ft4 at 0.1 ng/ml, GH at 2.05 ng/ml and peak GH at 0.31 ng/ml (<5 ng/ml) in L-dopa test. The diagnosis of peripheral and complete growth hormone deficiency were confirmed. The rest of the pituitary assessment showed a cortisol at 358 nmol/l, hyperprolactinemia at 37 ng/ml secondary to hypothyroidism, testosteroemia at 7.95 nmol/l LH at 2.6 mUI/l concluding to a functional gonadotropic insufficiency related to hyperprolactinemia. The patient had a thyroid ultrasound showing a thyroiditis and an pituitary MRI showing a pituitary gland of normal size and morphology, a pituitary stalk and a posterior lobe in place with a normal signal. The patient has been treated with substitution by L thyroxin. He could not benefit from recombinant growth hormon since he had already a lean growth cartilage on the x-ray. The evolution was marked by the normalization of the thyroid serum level. He was referred to orthopedics for the management of his joint pathology.
Growth retardation is a frequent reason for consultation. Its psycological repercussions are significant. It may be secondary to one or more causes, especially when it is a severe delay. Hence the interest of looking for an associated growth hormone deficiency early to guarantee the child a gain in height via treatment with recombinant growth hormone.
22 May 2021 - 26 May 2021