The case of Crohn's disease in a child with congenital growth hormone deficiency.

Abstract

A female patient with congenital hypopituitarism is followed up at the Children’s Endocrinology Centre (St. Petersburg, Russia). Growth hormone deficiency was confirmed by the diagnostic stimulation test; the maximum peak value of growth hormone was 8.3 ng/ml. At the moment of diagnosis, the growth deficit was –3.9 SDS. MRI showed the «empty Turkish saddle», the heterogeneous structure of the pituitary gland. No dysfunction of the other endocrine glands was identified. Bone age lagged behind the chronological age and was 9 years. The somatogenic causes of growth delay and chromosomal abnormalities were ruled out. Molecular genetic testing of the genes associated with hypopituitarism revealed no mutations. Growth hormone therapy was started in a daily dose of 0.033 mg/kg body weight. Two months after the growth hormone therapy had been started, the patient was admitted to the Surgical Department with the symptoms of «acute abdomen». The growth hormone therapy was suspended. The patient was diagnosed with Crohn’s disease upon further examination. After surgical treatment and prescription of specific therapy with Remicade, treatment with growth hormone was resumed after the 6-month break. Now the patient is receiving replacement therapy with growth hormone and permanent therapy of the concomitant Crohn’s disease.