RT Book, Section
A1 Long, Roger K.
A1 Cakmak, Hakan
A2 Katzung, Bertram G.
SR Print(0)
ID 1148438684
T1 Hypothalamic & Pituitary Hormones
T2 Basic & Clinical Pharmacology, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259641152
LK accesspharmacy.mhmedical.com/content.aspx?aid=1148438684
RD 2024/04/19
AB CASE  STUDYA  4-year-old  boy  (height  90  cm,  –3  standard  deviations  [SD];  weight  14.5  kg,  approximately  15th  percentile)  presents  with  short  stature.  Review  of  the  past  history  and  growth  chart  demonstrates  normal  birth  weight  and  birth  length,  but  a  progressive  decrease  in  height  percentiles  relative  to  age-matched  normal  ranges  starting  at  6  months  of  age,  and  orthostasis  with  febrile  illnesses.  Physical  examination  demonstrates  short  stature  and  mild  generalized  obesity.  Genital  examination  reveals  descended  but  small  testes  and  a  phallic  length  of  –2  SD.  Laboratory  evaluations  demonstrate  growth  hormone  (GH)  deficiency  and  a  delayed  bone  age  of  18  months.  The  patient  is  started  on  replacement  with  recombinant  human  GH  at  a  dose  of  40  mcg/kg  per  day  subcutaneously.  After  1  year  of  treatment,  his  height  velocity  has  increased  from  5  cm/y  to  11  cm/y.  How  does  GH  stimulate  growth  in  children?  What  other  hormone  deficiencies  are  suggested  by  the  patient’s  history  and  physical  examination?  What  other  hormone  replacements  is  this  patient  likely  to  require?