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Abstract
Here we describe a male patient who attained normal height despite combined hypopituitarism with an abnormal growth hormone-insulin-like growth factor (IGF)-I axis. When he was an 18-year-old, he presented with a short stature and underdeveloped external genitalia. The patient had not undergone normal pubertal development and he displayed a height below the fifth percentile. Hormonal and radiological studies revealed the findings of severe anterior pituitary hormone deficiency and an atrophic pituitary gland. There had been no recent follow-ups with the patient or medical treatment since that time. In the current presentation, the patient, now 22 years of age, had attained normal height, yet he remained prepubertal and showed manifestations of delayed bone age and combined hypopituitarism. In addition, the patient's IGF-II levels were increased for his age.
References
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Fig. 1.
A photograph of the patient. Height was 176 cm and body weight was 72 kg (body mass index: 23.2 kg/m2). Waist/hip and upper/lower body ratios were 0.92 and 0.60, respectively. The patient presented with a micropenis, small scrotum, and no pubic hairs.
Fig. 2.
Patient growth curve. Until 16 years of age, the subject's height-for-age and weight-for-age remained below the 10th percentile. At age 18, the subject's height-for-age remained below the third percentile; however, the weight-for-age increased to the 25th percentile. At age 22, the patient gained mid-parental height and his weight-for-age increased to the 75th percentile. Closed squares represent height and closed circles represent weights, which were measured at 14, 15, 16, 17, 18 and 22 years of age.
Fig. 3.
Sellar MRI findings. Sagittal view shows an interrupted or thin hypoplastic stalk (thick arrow) and an aplastic or hypoplastic hypophyseal gland (thin arrow).
Table 1.
Combined pituitary stimulation tests performed during the first and second visits
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