Ann Pediatr Endocrinol Metab.  2017 Mar;22(1):55-59. 10.6065/apem.2017.22.1.55.

Growth without growth hormone in combined pituitary hormone deficiency caused by pituitary stalk interruption syndrome

Affiliations
  • 1Department of Pediatrics, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea.
  • 2Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. soon926@catholic.ac.kr
  • 3Department of Pediatrics, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea.
  • 4Department of Pediatrics, St. Vincent Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea.
  • 5Department of Pediatrics, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Abstract

Growth hormone (GH) is an essential element for normal growth. However, reports of normal growth without GH have been made in patients who have undergone brain surgery for craniopharyngioma. Normal growth without GH can be explained by hyperinsulinemia, hyperprolactinemia, elevated leptin levels, and GH variants; however, its exact mechanism has not been elucidated yet. We diagnosed a female patient aged 13 with combined pituitary hormone deficiency (CPHD) caused by pituitary stalk interruption syndrome (PSIS). The patient has experienced recurrent hypoglycemic seizures since birth, but reached the height of 160 cm at the age of 13, showing normal growth. She grew another 8 cm for 3 years after the diagnosis, and she reached her final adult height of 168 cm which was greater than the midparental height, at the age of 16. The patient's blood GH and insulin-like growth factor-I levels were consistently subnormal, although her insulin levels were normal. Her physical examination conducted at the age of 15 showed truncal obesity, dyslipidemia, and osteoporosis, which are metabolic features of GH deficiency (GHD). Herein, we report a case in which a PSIS-induced CPHD patient attained her final height above mid parental height despite a severe GHD.

Keyword

Growth without growth hormone; Combined pituitary hormone deficiency; Pituitary stalk interruption syndrome
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