Patient presents to pediatric endocrinology after concerns of delayed puberty and short stature.
Patient demographics: 14.75 years, male, white, 5'0, 155 lbs
After reviewing his chart, I, the endocrinologist, want to test his growth hormone.
For a 14.75 year old male for GH Stimulation Test is required, which is a test where a substance is injected intravenously to stimulate pituitary gland to release GH and measured over different time intervals. Normal limits 0-10 ng/mL (10 being no deficiency detected.)
0 min: below 0.1n g/mL
30 min: 0.1 ng/mL
60 min: 0.8 ng/mL
90 min: 2.7 ng/mL
120 min: 3.4 ng/mL
150 min: 1.4 ng/mL
180 min: 0/5ng/mL
Patient is diagnosed with GH deficiency and the patient is given anastrozole to prevent growth plate closure. Anastrozole prevents the conversion of testosterone into estrogen.
Mother of parent also tells us patient was born with failure to thrive, jaundice, and torti-collis, so to rule out pituitary tumors, MRI imaging is required.
Findings: 2mm thickening of the pituitary stem of an unknown origin, too risky to biopsy. Does not show to be interfering with GH deficiency.
Insurance companies are refusing to pay for GH injections for this patient, and request LH and FSH be tested.
LH: 3.5 (0.6-6.8)
FSH: 6.7 (0.7- 7.0)
Patient's LH and FSH present normal.
Insurance still refuses covering of GH, even though it is in desperate need. Doctor letter's of referral for drug have been sent, patient's mother is trying to go to non-profits. Out of pocket this drug is $1,500 a month. Our healthcare system has failed another child once again.
https://www.vantageurology.com/posts/low-testosterone-low-t/anastrozole-arimidex-for-men-on-testosterone-therapy/
https://www.mountsinai.org/health-library/tests/growth-hormone-stimulation-test
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