Exp Clin Endocrinol Diabetes 2010; 118(3): 180-183
DOI: 10.1055/s-0030-1248309
Case Report

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Growth Impairment in a Boy with Late-Onset Congenital Adrenal Hyperplasia and Anorexia Nervosa[1]

Growth disorder in CAH with anorexia nervosa.M. Niedziela1 , W. Sippell2
  • 12nd Chair of Pediatrics, Department of Pediatric Endocrinology and Diabetes, Poznan University of Medical Sciences, Poznan, Poland
  • 2Department of Paediatrics, Division of Paediatric Endocrinology & Diabetology, University Children's Hospital, Kiel, Germany
Further Information

Publication History

received 24.01.2007 first decision 03.07.2007

accepted 11.07.2007

Publication Date:
02 March 2010 (online)

Abstract

Treatment of congenital adrenal hyperplasia (CAH) in its salt-wasting form with appropriate doses of glucocorticoids and mineralocorticoids should promote growth, puberty and final height in a similar to normal pattern. However, the individual requirements for these drugs to normalize the hormonal profile and to achieve a physiologic growth pattern may differ. Moreover, the time of onset of puberty is also unpredictable since the course of the disease may predispose for precocity. The aim of this study was to explain the unexpected arrest of growth during puberty in a boy with late-onset CAH, who had been treated with glucocorticoid from early childhood. A short course of GnRH agonist treatment was also introduced in later years. The growth chart reflects two periods of impaired growth velocity preceded by weight loss. The reason for the first decline is difficult to prove retrospectively, but during the second episode the boy became both clinically and hormonally hypogonadal. At that time the anorexia nervosa (AN) was diagnosed according to APA DSM-IV criteria. We conclude that there were several reasons for the discontinued growth spurt and reduced final height in this boy with CAH: (a) early variant of puberty and subsequent late treatment with GnRH agonist, (b) AN possibly occurring during mid-childhood and clearly during puberty and (c) the repeated use of high doses of glucocorticoids. AN, a relatively rare disorder in boys, appears to have had a significant negative effect on this patient's growth and should be considered in the differential diagnosis in CAH children with impaired growth.

1 Presented in part at the 37th International Symposium: GH and Growth Factors in Endocrinology and Metabolism, Athens, Greece, 4 – 5 March 2005.

References

  • 1 American Psychiatric Association .Diagnostic and Statistical Manual of mental disorders.. 4th ed (DSM-IV) Washington, DC: American Psychiatric Association; 1994
  • 2 Andersen AE, Holman JE. Males with eating disorders: challenges for treatment and research.  Psychopharmacol Bull. 1997;  33 391-397
  • 3 Argente J, Caballo N, Barrios V. et al . Multiple endocrine abnormalities of the growth hormone and insulin-like growth factor axis in patients with anorexia nervosa: effect of short- and long-term weight recuperation.  J Clin Endocrinol Metab. 1997;  82 2084-2092
  • 4 Barrios V, Argente J, Munoz MT. et al . Diagnostic interest of acid-labile subunit measurement in relationship to other components of the IGF system in pediatric patients with growth or eating disorders.  Eur J Endocrinol. 2001;  144 245-250
  • 5 Barry A, Lippmann SB. Anorexia nervosa in males.  Postgrad Med. 1990;  87 161-165
  • 6 Bayley N, Pinneau SR. Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards.  J Pediatr. 1952;  40 423-441
  • 7 Boys IGF-I normal range . IGF-I normogram developed by Diagnostic Systems Laboratories, Inc., Texas, USA http://www.dslabs.com/ 2005; 
  • 8 Brand M, Schoof E, Partsch C-J. et al . Anorexia nervosa in congenital adrenal hyperplasia: long-term follow-up of 4 cases.  Exp Clin Endocrinol Diabetes. 2000;  108 430-435
  • 9 Caldefie-Chezet F, Moinard C, Minet-Quinard R. et al . Dexamethasone treatment induces long-lasting hyperleptinemia and anorexia in old rats.  Metabolism. 2001;  50 1054-1058
  • 10 Fosson A, Knibbs J, Bryant-Waugh R. et al . Early onset anorexia nervosa.  Arch Dis Child. 1987;  62 114-118
  • 11 Krawczynski M, Krzyzaniak A, Walkowiak J. Normy rozwojowe wysokosci i masy ciala dzieci i mlodziezy miasta Poznania w wieku od 3 do 18 lat (Normative developmental data of height and weight in children and adolescents aged from 3 to 18 years in Poznan city).  Ped. Prakt. (Pediatrics in Practice). 2000;  8 341-353 (in Polish).
  • 12 Nussbaum M, Baird D, Sonnenblick M. et al . Short stature in anorexia nervosa patients.  J Adolesc Health Care. 1985;  6 453-455
  • 13 Partsch CJ, Sippell WG. Pathogenesis and epidemiology of precocious puberty. Effects of exogenous oestrogens.  Hum Reprod Update.. 2001;  7 292-302
  • 14 Robb AS, Dadson MJ. Eating disorders in males.  Child Adolesc Psychiatr Clin N Am. 2002;  11 399-418
  • 15 Romeo F. Adolescent boys and anorexia nervosa.  Adolescence. 1994;  29 643-647
  • 16 Scacchi M, Ida Pincelli A, Cavagnini F. Nutritional status in the neuroendocrine control of growth hormone secretion: the model of anorexia nervosa.  Front Neuroendocrinol. 2003;  24 200-224
  • 17 Soliman AT, AlLamki M, AlSalmi I. et al . Congenital adrenal hyperplasia complicated by central precocious puberty: linear growth during infancy and treatment with gonadotropin-releasing hormone analog.  Metabolism. 1997;  46 513-517
  • 18 Sreenivasan U. Anorexia nervosa in boys.  Can Psychiatr Assoc J. 1978;  23 159-162
  • 19 Tronche F, Opherk C, Moriggl R. et al . Glucocorticoid receptor function in hepatocytes is essential to promote postnatal body growth.  Genes Dev. 2004;  18 492-497

1 Presented in part at the 37th International Symposium: GH and Growth Factors in Endocrinology and Metabolism, Athens, Greece, 4 – 5 March 2005.

Correspondence

M. NiedzielaMD, PhD 

Department of Pediatric Endocrinology and Diabetes

Poznan University of Medical Sciences

Szpitalna Street 27/33

60-572 Poznan

Poland

Phone: +48/61/848 0291, 849 1481

Fax: +48/61/848 0291

Email: mniedzie@am.poznan.pl

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