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Anthony121 · 10-06-2011, 07:37 PM

Hi,
My son turned 15 years old this summer prior to starting his sophomore year in high school, and is much smaller than all of his classmates. He is currently about 5' 1" and weighs 104 pounds. We charted his growth from the age of 3. He was in the 80th percentile through age 6, dropped to the 50th percentile through age 9, and then continued to drop steadily to the point where he has been below the 5th percentile since age 13. All of his classmates have experienced their growth spurt and voice change, etc., but he appears to be about 11 or 12 years old. I am 6' 1" and 220 pounds, and my wife is 5' 6" and 120 pounds, so I would assume he would normally end up between 5' 10" and 6' 0"?

My son has been seeing a pediatric endoctrinologist for the past 2 years. This doctor is apparently very conservative in prescribing GH's, according to our PCP, and has not yet prescribed GH's for my son. In the past 4 months, our Endo Dr. has referred our son to a Gastrointestinologist, to check for Celiac or Crohn's symptoms. The Gastro Dr. indicated that our son is exhibiting early (indicative) signs of Celiac's disease, so we started him on a Gluten-free diet 2 months ago.

My concern is that our Endo Dr's conservative nature will result in our son missing his opportunity for growth. In his last wrist x-ray 4 months ago, his plates had not yet fused, suggesting that his bone age was about 18 months behind his real age. My question is, should we seek out a different opinion from another Pediatric Endo Dr.? The Gastro Dr.'s diagnosis suggested that our son may have Celiacs in the future but is not yet exhibiting the full-blown signs of having it, so could this truly be the cause of our son's delayed growth (which our Endo Dr. is indicating)?

juner50 · 01-26-2012, 05:39 PM

I see this was posted a while ago but hopefully you'll check back.
Endos will not just prescribe HGH for patients without knowing if there is a deficiency. You haven't mentioned your son having a growth hormone stimulation test. The ITT (insulin tolerance test) is the gold standard but seldom used because it is hard on the patient. Most Drs now use the glucagon gh stimulation test. Without a test you have no way of knowing where your sons levels are. Also it's very expensive and insurance won't pay unless deficiency is proven.

I would ask the Ped. to test your son. If he won't, then I would move on to another Dr.

PS He should have all pituitary hormones checked.

Anthony121 · 01-27-2012, 04:20 PM

Quote:

Originally Posted by juner50

I see this was posted a while ago but hopefully you'll check back.
Endos will not just prescribe HGH for patients without knowing if there is a deficiency. You haven't mentioned your son having a growth hormone stimulation test. The ITT (insulin tolerance test) is the gold standard but seldom used because it is hard on the patient. Most Drs now use the glucagon gh stimulation test. Without a test you have no way of knowing where your sons levels are. Also it's very expensive and insurance won't pay unless deficiency is proven.

I would ask the Ped. to test your son. If he won't, then I would move on to another Dr.

PS He should have all pituitary hormones checked.

Hi. Thanks for posting. My son has had a number of tests taken over the past 2 years. I'll post the results below to see if you see anything significant:

July 2010:
Prealbumin 24 mg/dL
Rheumatology Sed. Rate 8 mm/hr
Tissue Transglutaminase Ab, IgA 20 H
Vitamin D 25-Hydroxy 48 ng/mL
Growth Hormone/Acromegaly 12.20 ng/mL

August 2010:
Follicle Stimulating Hormone 2.5 mIU/mL
Luteinizing Hormone (LH) ECL 1.4 mIU/mL
Rheumatology Sed. Rate 7 mm/hr

May 2011:
Follicle Stimulating Hormone 1.3 mIU/mL
Luteinizing Hormone (LH) ECL <1.0 mIU/mL
Prolactin 2.9 ng/mL
Thyroid Free T4 1.2 ng/dL
Urea Nitrogen 23 mg/dL
Alkaline Phosphatase 421 Int_Unit/L
Thyroid Thyrotropin (TSH) 1.98 ulU/mL
Testosterone 19 ng/dL
Insulin Like Growth Factor 215 ng/mL
Deamidated Gliadin Peptide Antibody, IgG (DGP IgG) 6.0 EU/ml
Deamidated Gliadin Peptide Antibody, IgA (DGP IgA) 2.4 EU/ml
Testosterone, Total, Serum, Mass Spectrometry 15 ng/dL

December 2011:
FSH 1.7 LH 1.0 TESTO 51 (L) SMC (IGF-1) 269 TSH 2.23 FREET4 1.1
VITD 36 WBC 6.9 RBC 5.06 HGB 13.4 HCT 40.8 MCV 81 MCH 26.4
MCHC 32.7 PLT 290 ESR 6

I'm not sure what most of these tests mean, but I've posted many of them, especially the ones that were beyond the standard range. If you can shed some light on them, I'd appreciate it! Thanks!

juner50 · 01-29-2012, 04:44 AM

Hi anthony,
could you give the normal ranges for tests. Every lab is different.

Anthony121 · 01-29-2012, 11:53 AM

I've added the "normal" ranges in brackets on the ones that I have:

July 2010:
Prealbumin 24 mg/dL [17-42]
Rheumatology Sed. Rate 8 mm/hr [0-15]
Tissue Transglutaminase Ab, IgA 20 H [0-19]
Vitamin D 25-Hydroxy 48 ng/mL [30-80]
Growth Hormone/Acromegaly 12.20 ng/mL [0.03-14.90]

August 2010:
Follicle Stimulating Hormone 2.5 mIU/mL [1.2-5.8]
Luteinizing Hormone (LH) ECL 1.4 mIU/mL [0.2-5.0]
Rheumatology Sed. Rate 7 mm/hr [0-15]

May 2011:
Follicle Stimulating Hormone 1.3 mIU/mL [1.2-5.8]
Luteinizing Hormone (LH) ECL <1.0 mIU/mL [0.2-5.0]
Prolactin 2.9 ng/mL [4.0-15.2]
Thyroid Free T4 1.2 ng/dL [0.9-1.7]
Urea Nitrogen 23 mg/dL [5-20]
Alkaline Phosphatase 421 Int_Unit/L [0-389]
Thyroid Thyrotropin (TSH) 1.98 ulU/mL [0.40-3.80]
Testosterone 19 ng/dL [33-585]
Insulin Like Growth Factor 215 ng/mL [108-558]
Deamidated Gliadin Peptide Antibody, IgG (DGP IgG) 6.0 EU/ml [<1.3EU/ml]
Deamidated Gliadin Peptide Antibody, IgA (DGP IgA) 2.4 EU/ml [<2.9EU/ml]
Testosterone, Total, Serum, Mass Spectrometry 15 ng/dL [100-320]

December 2011 (I don't have "normal" ranges for these):
FSH 1.7 LH 1.0 TESTO 51 (L) SMC (IGF-1) 269 TSH 2.23 FREET4 1.1
VITD 36 WBC 6.9 RBC 5.06 HGB 13.4 HCT 40.8 MCV 81 MCH 26.4
MCHC 32.7 PLT 290 ESR 6

juner50 · 01-29-2012, 08:06 PM

Hi Anthony,
It looks like there are some deficient numbers to me. I'm not a Dr but a pituitary patient and still learning.
Vit D looks a little low

I also noticed dropping FSH & LH levels (pituitary hormones)from August 2010 to May 2011. Then they rose a pinch in Dec 2011. FSH & LH are responsible for initiating pubertal changes. If your son's are low he's going to look young and may not mature properly.

His prolactin is low which is another pituitary hormone. I'm not sure what it means other than his pituitary not functioning properly.

His IGF1 isn't too bad but that isn't always an indicator of low growth hormone. Also I saw they took a randomized blood draw for GH and it was 12.20. I don't think those tests have a lot of meaning . GH is pulsatile and they could have caught him at a high peak. With the number of other blood tests being off I would. ask to have a GH stimulation test done. Finding a reliable testing center is also difficult. First see how far you can get with your current Dr.
good luck

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