From Atlanta, Georgia, USA:
Our son is now 3.5 years old and was diagnosed with Type 1 diabetes when he was 11 months old. Our questions are regarding growth hormone deficiency in conjunction with Type I diabetes. Before we list the questions we want to give some background:
- Child below 0 percentile for height and 20% percentile for weight. He has always been at or below 5% since birth (6 lbs 1 oz)
- Blood sugar readings about 80% in target range (100 - 200 including post meal) and if high or low other 20% not there for very long
- Bone age at age 3 showed 2 years 7 months
- IGF-BP-3 showed .04 mg/dl (with normal range being 0.9 - 4.1)
- Somatomedin-C showed < 1.0 and 2.2 respectively Somatomedin-C lower on followup testing
- All A1C's after diagnosis have been good. Last three have been 7.3, 7.1, 7.8 respectively
- Meal plan caloric goal is between 1250 and 1400. We do not always reach that range but he eats overall "good food"
- Last thyroid test was done 9 months ago, and were T4 of 6.1 and TSH of 3.4.
These are our questions. We are hoping for some additional insight from one of the pediatric endocrinologists on the staff:
- Can a child not have a growth hormone deficiency even if blood tests listed above show a deficiency? If so why are the levels low and will they ever get in a normal range?
- Is there a relation between growth hormone deficiency and diabetes?
- Could the growth "problem" be due to not eating recommend caloric intake or due to some malabsorption problem? I know so many young kids that really do not have good eating habits but their growth per their parents is a bit below normal range to well above
- Should another thyroid test be done?
Any insight would be greatly appreciated!
It sounds like this can't be diagnosed through cyberspace, but a few thoughts:
There is no absolutely reliable test for growth hormone deficiency. As far as I know, there is no association with growth hormone deficiency and diabetes. Growth hormone levels can be abnormally high in children with diabetes even though they are not growing well if they are in poor control.
IGF-1 levels are low normally in children under 5, so it is difficult to distinguish low from normal.
IGF-BP3 levels are supposed to be more helpful in young children, but they are also low normally in young children.
Depending on the lab, the T4 of 6.1 may be low normal and TSH of 3.4 may be in the upper range of normal, suggesting that possibly your child is starting to develop an underactive thyroid which is very common in children with diabetes. I would suggest measuring antithyroid antibodies. If anti-thyroid antibodies are abnormal, or the child's thyroid is enlarged, you might want to consider a trial of a small dose of Synthroid if the child's growth rate is abnormal. (Many normal children may be below the 5th percentile on the growth curve, but if their growth rate is normal, they probably do not have a hormonal problem.)
Celiac disease is more common in children with diabetes. Testing for antigliadin, endomysial, and antireticulin antibodies would be a good idea, especially if there are any gastrointestinal symptoms such as abdominal pain or diarrhea.
Original posting 27 Sep 97
Last Updated: Tuesday April 06, 2010 15:08:53
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