A Case of Apparent Hypopituitarism Complicating Chronic Inflammatory Bowel Disease in Childhood and Adolescence

Abstract

There is conflicting evidence regarding the adequacy of hypothalamic-pituitary function in children and adolescents with chronic inflammatory bowel disease complicated by growth retardation and delayed sexual maturation. A child with Crohn's disease, who has never received corticosteroid therapy, had delay of both growth and sexual maturation and has been investigated over the course of his disease. In addition to a skull X-ray (normal) and thyroid function tests (normal), a standard insulin tolerance test (insulin 0.15 u/kg) and a standard gonadotropin-releasing hormone (Gn-RH) test (100 microgram Gn-RH i/v) were performed when the bowel disease was in relapse and again during a remission of the bowel disease, achieved by surgery. When the bowel disease was in relapse (coincident with growth arrest) results showed an inadequate release of gonadotrophins and of growth hormone (even after pre-treatment with stilboestrol) but normal release of cortisol and prolactin. During a remission of the bowel disease coinciding with a period of rapid "catch-up" growth, release of growth hormone was normal and that of gonadotrophins supranormal. The demonstration of a reversible apparent partial hypopituitarism in this boy not only re-questions the adequacy of hypothalamic-pituitary function in inflammatory bowel disease but also indicates a potential diagnostic pitfall in the routine investigation of growth retardation if gastrointestinal symptoms are not prominent at presentation.

Sex differences in statural growth impairment in Crohnʼs disease: Role of IGF-1

“…In a rat model of colitis, investigators reported that the profile of plasma LH and FSH concentrations was similar to levels observed in control female rats38, suggesting that hypopituitarism may not be the cause of growth impairment in CD36,45. In contrast, others have reported diminished plasma LH and FSH levels in CD46,47 and cystic fibrosis, to a lesser extent in females than males48. Thus, the existing evidence is mixed and deserves further study to advance our understanding of the impact of CD on hypothalamic-pituitary function and statural growth.…”

Crohn's Disease Associated with Growth Hormone Secretory Dysfunction.

“…Some reports contradict the theory that endocrine function related to GHsecretion is impaired in the presence of Crohn's disease; normal GHsecretion has been reported in Crohn's disease patients (13,14). One study reported that rhGH therapy had no marked effects on GHsecretion in Crohn's disease patients (15), which contrasted with the findings of Green et al (16) that the secretion of GHand gonadotropin was somewhatabnormal during relapses of Crohn's disease but was normalized during remission, as in the present case. Someinvestigators attributed the short stature of Crohn's disease patients to a malnutritioninduced decrease in somatomedin production by the liver (6, 1 1, 17).…”

Neurological complications of gastrointestinal disorders. A review of the literature.

“…Less common symptoms of patients with IBD are migraine, tension headache, cerebellar syndrome, dystonia, urinary incontinence, Parkinson-like syndrome, organic brain syndrome, chronic fatigue syndrome, chronic back pain, vertigo, nausea [2][3][4][5]7]. Also, a rare complication of growth retardation and delayed sexual maturation due to inadequacy of hypothalamic-pituitary function in a child with Crohn's disease has been described [8].…”