Panhypopituitarism in one identical twin: the effect of hormone replacement
Del Canho, H.; van Alfen-van der Velden, J.ël.; del Canho, R.; Otten, B.
Nederlands Tijdschrift Voor Geneeskunde 155(42): A3084
2011
ISSN/ISBN: 1876-8784 PMID: 22027454 Document Number: 654823
Panhypopituitarism in childhood is rare. It is even rarer if the disorder appears in a boy with an identical but healthy twin brother. In such a patient it is useful to study the consequences of the hormone disorder and the effect of hormone replacement. A 6-year-old boy saw a paediatrician because of short stature. He was much shorter than his identical twin brother and he had more abdominal fat mass and a smaller penis. Laboratory tests identified hypothyroidism of central origin, in combination with hypocortisolism and growth hormone deficiency. Hormonal replacement resulted in an improvement in growth rate. At the age of 15 years, testosterone therapy was introduced because puberty had not occurred and his growth rate was low. Finally the patient grew a few centimetres taller than his twin brother. In the first year of life, panhypopituitarism has no negative consequences for growth. After this point, growth is clearly delayed. With sufficient replacement growth can completely catch up.