title: Acceleration of puberty during growth hormone therapy in a child with septo-optic dysplasia.
abstract: Septo-optic dysplasia (SOD) is a heterogeneous disorder of the central nervous system characterized by various endocrinological and neurological findings. It is a complex disease caused by a combination of genetic and environmental factors. Herein, we report the case of a 5.5-year-old girl who presented with short stature and strabismus. Ophthalmological examination revealed bilateral optic nerve hypoplasia. Ectopic posterior pituitary and bilateral optic hypoplasia were detected on brain magnetic resonance imaging. The presence of bilateral optic nerve hypoplasia and hypopituitarism led to the diagnosis of SOD. An abated growth hormone (GH) response was found in the GH stimulation test and GH replacement therapy was initiated. At the end of the first year of clinical follow-up, secondary hypothyroidism was detected and L-thyroxine was added to the treatment. At the age of 8.25 years, thelarche was noted and 6 months later, the patient presented with menarche. At this time, the bone age was 12 years and the basal luteinizing hormone level was 7 mIU/mL. These findings indicated acceleration in the process of pubertal development. We report this case (i) to emphasize the need to investigate hypopituitarism in cases with bilateral optic nerve hypoplasia and (ii) to draw attention to the fact that during the follow-up of SOD cases receiving GH therapy, inappropriate acceleration of growth velocity and rapid improvement in bone age may be predictive of central precocious puberty development.
authors.affiliation: Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey. E-mail: ayhanabaci@gmail.com.
authors.forename: Gönül
authors.initials: G
authors.lastname: Catlı
authors.forename: Ayça
authors.initials: A
authors.lastname: Altıncık
authors.forename: Ahmet
authors.initials: A
authors.lastname: Anık
authors.forename: Korcan
authors.initials: K
authors.lastname: Demir
authors.forename: Handan
authors.initials: H
authors.lastname: Güleryüz
authors.forename: Ayhan
authors.initials: A
authors.lastname: Abacı
authors.forename: Ece
authors.initials: E
authors.lastname: Böber
mesh_terms: D002648:Child; D005260:Female; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced*; D011629:Puberty, Precocious / Q000139:chemically induced*; D011994:Recombinant Proteins / Q000627:therapeutic use; D025962:Septo-Optic Dysplasia / Q000150:complications / Q000188:drug therapy*; D012741:Sexual Maturation; D013974:Thyroxine
chemical_list: D011994:Recombinant Proteins; D019382:Human Growth Hormone; D013974:Thyroxine