What is the next step in the management of this patient?

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Introducción
Evaluation of growth may prove to be complicated especially during pre- and early puberty, mainly because growth velocity decreases to its nadir at this period. The case below is a good example of such a patient in whom the decisions for management of short stature may be controversial. A 13 year-old boy admitted for short stature which became more pronounced in the last two years. On physical examination his height was 139 cm (<3rd percentile corresponding to a height age of 10 years), weight 32 kg, BMI: 16.5 kg/m2 (10-25 percentile), body proportions were normal. Puberty staging revealed a testicular size of 5 and 6 ml left and right sides, respectively, with Tanner stage 2 pubic hair and genitalia. There was no sign or history of chronic systemic disorder. The history of stature in the family is insignificant, and midparental height was 168.5 cm. Contact with the family practitioner revealed a growth velocity of 4 cm/year in the last year. On laboratory examination bone age was 10.5 years, thyroid functions were within normal limits, FSH: 2.15 mIU/L, LH: 1.8 mIU/L, Testosterone 67 ng/dl; IGF-I: 205 ng/ml (1 SD below the mean for sex and age) IGFBP-3: 3897 ng/ml (at mean for sex and age). Peak GH levels in L-Dopa and Clonidine stimulation tests were 3.6 and 6.8 ng/ml respectively.

GH treatment should be started
Clinical follow up for growth until pubertal spurt
GH stimulation should be repeated after priming
Sex steroid treatment should be started

La respuesta correcta se infiere al leer atentamente el trabajo:

Programa SIIC de Eduación Médica Contínua (PEMC-SIIC)

ua40317

Acerca de SIIC

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