Patient Demographics
Patient A is a 15 ½-year-old Caucasian male. Patient B is a 17-year-old Caucasian male.
Clinical Presentation
Patient A has been followed in an endocrine clinic since the age of 18 months with growth hormone (GH) and thyroid deficiencies. GH was discontinued 4 months prior because of growth completion (bone age 16y 6 m @ 15y 1 m). He had an appendectomy 1 month ago and reported diminished energy level and a 15-lb weight loss despite adequate oral intake and absence of gastrointestinal symptoms. No acute illness was noted. Patient B has been followed in endocrine clinic since age 7 years with growth hormone deficiency (GHD). GH was discontinued 6 months prior because of poor compliance (bone age 14y @ 15y 5 m). He reported a 20-lb weight loss and diminished energy levels. No changes had occurred in his medical regimen, and no other acute illness was present.
Past History
Patient A was diagnosed with GHD and hypothyroidism at age 18 months. Patient B was diagnosed with GHD at age 7 1/2 years; other medical conditions include fetal alcohol syndrome with failure to thrive, global developmental delay, attention-deficit/hyperactivity disorder, and gastroesophageal reflux with fundoplication.
Evaluation
Patient A had laboratory assessments as follows: IGF-1 70 (201–609 ng/mL), thyroid function studies normal, fasting glucose 80 (56–145 mg/dL), and fasting cortisol 21 (6.0–23.0 μg/dL). Insulin tolerance test with GH maximum 0.9 ng/mL. Repeat MRI showed empty sella. Patient B had laboratory assessments as follows: IGF-1 129 (209–602 ng/mL), thyroid function studies normal, and fasting cortisol 21.5 (4.2–38.4 μg/dL). Insulin tolerance test with GH maximum 1.5 ng/mL. Repeat MRI was normal.
Interventions
Patient A was restarted on GH therapy at a transition dose of 0.03 mg/kg per day. He achieved an 18-lb weight gain with 2 months of therapy and improvement in energy level. Patient B will restart on GH therapy at a dose of 0.01 mg/kg per day.
Discussion/Recommendations
The etiology of weight loss in these adolescent males is not understood. Metabolic changes in adipose tissue result in weight gain with increased adiposity and reduced muscle mass in GH-deficient young adults. This phenomenon is opposite of the usual presentation.
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© 2012 Published by Elsevier Inc.
