January 24, 2002
Other Illnesses
Question from Archbald, Pennsylvania, USA:
When he was five, my eight year old son began wetting the bed four to six times a week, complaining of headaches, had severe fatigue to the point of not being able to walk, constant hunger, and personality changes like irritability. His pediatrician did a routine blood glucose test which was 19 mg/dl [1.1 mmol/L], and sent my son to a medical center for testing over a couple of days. There, they gave us a monitor and strips to test at home for three days.
I know we did the tests right, and his levels were anywhere from 22 to 187 mg/dl [1.2 to 10.4 mmol/L]. Sometimes, they’d jump from 25 mg/dl [1.4 mmol/L] in the morning to 160 mg/dl [8.9 mmol/L] before bed, but after everything, they said he didn’t have diabetes and to wait and see what happens.
Now, two years later, he still wets the bed, is super thin, extremely tiny for an eight year old, has trouble waking (sleeps 11 hours a night) eats constantly, and gets easily fatigued and cranky, especially at school. His new pediatrician did another blood sugar which was okay, but his growth hormone level is really low. (It was low at when he was five too). He’s never made it past the fifth percentile for anything, and the difference between his size and other eight year olds is staggering, not only in his height, but in his overall size. His wrists are as big around as a half dollar. Also, his legs seem to be turning inward toward each other, his feet almost overlap, and he trips a lot. The doctor said his hips are straight and doesn’t know why his legs turn like this below the knees.
My son is going back to the hospital soon for a bone age test. I don’t know what that is. Can you tell me whether blood sugar and growth hormone are ever related? Is there anything I should ask the doctors or anything I should specifically remember to tell them, like a family history? I am scared my son is going to be abnormally short and picked on if he doesn’t grow soon. Are children with diabetes usually short?
Answer:
I have to say that I do not think that there is any evidence now or three years ago that your son’s problems are due to the most common form of diabetes in childhood. It seems much more likely that he has “short stature.” The occasional abnormally low blood sugars and the low growth hormone levels are all linked and due to one of the many forms of growth hormone deficiency, which is idiopathic in nature most of the time. In other words, the basic cause is not yet understood, but in about one third of the cases, a specific reason can be found and these cases are often accompanied by other hormonal insufficiencies.
Investigations usual include estimations of growth hormone after stimulation with a variety of agents like arginine and glucagon. as well as special X-rays of the base of the skull, and other blood tests to see if other hormones are involved. The bone age test, put very simply, is an estimate on an X ray of whether the fusion of the ends of the long bones is maturing at a pace consistent with a child’s age. In hypopituitarism, you would expect a delay.
I am not clear why no further steps at investigation and treatment were initiated when your son was five so perhaps there has been a communication problem. This time you must get the doctor to explain to you exactly what the diagnosis is, what further tests may be needed, and what treatment is proposed. In particular, you should enquire about treatment with recombinant human growth hormone. If the plan is still not clear, ask to see the medical social worker at the hospital, and I am sure he/she will help. In addition, you should ask your son’s pediatrician to make quite sure himself that there is a plan for your son and that you understand it.
I am sorry to have to offer so little help, but without seeing your son and having access to his medical record, this is hard to do in an E-mail.
DOB
[Editor’s comment: Also, in kids with short stature, at least one test should be done to check for hypothyroidism.
WWQ]
