Severe Growth Failure in a Prepubertal Boy: What is Behind the Scene?

Case Report

Austin J Endocrinol Diabetes. 2016; 3(3): 1046.

Severe Growth Failure in a Prepubertal Boy: What is Behind the Scene?

Ljiljana Saranac¹*, Zlatko Djuric¹, Zorica Stojsic², Ana Milenovic¹ and Dragoljub Lazarevic¹

¹Pediatric Clinic, University of Nis, Serbia

²Institute of Pathology, University of Belgrade, Serbia

*Corresponding author: Ljiljana Saranac, Pediatric Clinic, Faculty of Medicine Nis, University of Nis, Nis, Serbia

Received: July 14, 2016; Accepted: August 08, 2016; Published: August 10, 2016

Abstract

Background: When examining a short child, the pediatrician-endocrinologist must be aware of the vast number of causative issues and the complex origin of growth disorders.

Case Report: A prepubertal boy aged 12.75 years was referred for an endocrinological assessment because of severe growth retardation. His height of 119.5 cm was -4.8 SD for his Chronological Age (CA), his Height Age (HA) corresponded to 6.5 years, and his Body Mass (BM) of 21.4 kg was 0.6 kg below his ideal weight-for-height. The boy also presented very poor verbal skills and learning and hearing problems. He did not have any abdominal complaints, pain, nausea or abnormal stools; however, his appetite was poor.

Results: Upper endoscopy revealed diffuse macro nodular changes in the distal duodenum. Because of this very unusual endoscopic picture, various polyposis syndromes and enteropathies were considered. However, the pathohistology of the small bowel biopsies revealed the real nature of the disease: the presence of Giardia lamblia trophozoites in the mucosa. Multihormonal acquired pituitary dysfunction was suspected and confirmed.

Conclusion: We reported an unusual case of severe growth failure accompanied by poor cognitive, verbal and hearing skills caused by longterm giardiasis that probably began during a critical period for growth and development.

Keywords: Giardia; Polyposis; Growth

Introduction

Height is the most prominent human phenotypic characteristic, and short stature produces significant anxiety in children and their families. When examining a short child, the pediatricianendocrinologist must be aware of the vast number of causative issues and the complex origin of growth disorders. In this era of wide genetic use in diagnosis of short stature, we should not forget a clinical picture of old phenotypes, that could mimic different pathological conditions.

Case Report

A prepubertal boy aged 12.75 years was referred for an endocrinological assessment because of severe growth retardation. His height of 119.5 cm was -4.8 SD for his Chronological Age (CA), his Height Age (HA) corresponded to 6.5 years, and his Body Mass (BM) of 21.4 kg was 0.6 kg below his ideal weight-for-height. His BMI was 14.98 kg/m2 (-1.88 SD). The boy’s stature was proportionally short, without any dysmorphic features. In addition to growth failure, the main reason for the referral was an extremely low serum iron level (Table 1). There were no signs of puberty, and the boy’s Bone Age (BA) was estimated at 8.5 years. The boy also presented very poor verbal skills and learning and hearing problems. He did not have any abdominal complaints, pain, nausea or abnormal stools; however, his appetite was poor. His family history was positive for short stature; the boy had an extremely short grandmother and short parents, and his two-year-younger sister was also pathologically short (-4 SD for CA).