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Late Puberty, Constitutional Growth Delay, Low HGB, HCT, MPV, High MCHC, Failed Ferriten Test. Treatment ?

Posted on Tue, 2 Oct 2012

Question: Our son is 14- late puberty- failed 3 hr growth stem test his baseline was .008ng/ml after clonadine it went to-- .499ng/ml, .595 ng/ml then dropped to .110ng/ml for glucogone .113ng/ml, 1.5ng/ml, 2.7ng/ml then dropped again to .768 ng/ml. Endocrinologist says no big deal but anything less than 10ng/ml is a failed test. blood test showed low HGB, low HCT,, high MCHC, low MPV. Has also failed ferriten test. Endocrinolgist says he has constitutional growth delay. We are looking for answers- no real growth in last 5 years has gone from 90thpercentile in height and is now in down 50th percentile. Any suggestions?

Answered by Dr. V. Kumaravel (8 hours later)

Hello,

Thanks for your query.

I do understand your son was breech presentation during delivery and your concern seems to be related to delay in growth.

Drop in Height from 90th centile to 50th centile is a major concern and is usually abnormal. Given the value of clonidine and glucagon stimulated growth hormone, i feel your son might have growth hormone deficeincy.

He would require complete physical examination, further blood tests of IGF-1(insulin growth factor), IGFBP-3 (insulin-like growth factor binding protein-3 ), other pituitary hormone tests, Bone age, Imaging of the pituitary gland. These examination and tests would help to arrive at the correct diagnosis.

If it is growth hormone deficeincy, he will require growth hormone therapy and will grow with treatment.

Hope this answers your query.I will be available for follow up.

regards

Above answer was peer-reviewed by : Dr. Radhika

Follow up: Dr. V. Kumaravel (5 hours later)

thank you for your response. Is there any connection to his blood work tests that I put in the original question and (anemia) and his lack of growing. Bone age is consistent with his age, MRI of pituitary was normal, IGF-1 was low normal. thank your for your help.
take care
XXXXXXX

Answered by Dr. V. Kumaravel (8 hours later)

Hello

Thanks for your feedback.

If your MRI, Bone age and IGF-1 are normal then it is very unlikely to be growth hormone deficeincy.

Chronic Anemia can affect growth. In such cases, correction of anemia usually leads to growth. So the child should grow after correction of anemia.

Decrease in growth centile from 90th to 50th centile is definitly a concern and hence your child needs to kept under close follow-up.

Hope this helps.

Wish you and your son good health.

Regards

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Above answer was peer-reviewed by : Dr. Prasad