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A case of functional growth hormone deficiency and early growth retardation in a child with IFT172 mutations
Angela K Lucas-Herald1, Esther Kinning, Aritoshi Iida
1Developmental Endocrinology Research Group (A.K.L.-H., S.F.A.), School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), Yorkhill, Glasgow, G3 8SJ United Kingdom; Department of Clinical Genetics (E.K.), Southern General Hospital, Glasgow, G51 4TF United Kingdom; Laboratory of Bone and Joint Diseases (A.I., Z.W., S.I.), Center for Integrative Medical Sciences, RIKEN, Tokyo 108-8639, Japan; Department of Human Genetics (N.M.), Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; and Department of Biochemistry (J.M.), Southern General Hospital, 1345 Govan Rd, Glasgow, G51 4TF United Kingdom.
Insights
Ciliopathies, rare genetic disorders, can cause early growth retardation and pituitary issues. This case shows how IFT172 mutations link ciliopathies to growth failure, highlighting the importance of ciliary function in development.
Area of Science:
- Pediatric Endocrinology
- Genetics
- Rare Diseases
Background:
- Ciliopathies are rare genetic disorders with diverse clinical features.
- Defects in the Growth Hormone/Insulin-like Growth Factor-I (GH/IGF-I) axis are common in children with short stature.
- The connection between ciliopathies and GH/IGF-I axis dysfunction requires further investigation.
Observation:
- A male infant presented with early growth retardation and weight gain.
- He exhibited low IGF-I levels, pituitary hypoplasia, and an ectopic posterior pituitary.
- Growth improved with recombinant human growth hormone (rhGH) therapy.
Findings:
- The patient developed retinopathy, metaphyseal dysplasia, hypertension, and renal failure.
- Whole-exome sequencing revealed compound heterozygous mutations in IFT172, confirming a ciliopathy diagnosis.
- This is the first reported case of an IFT172 mutation presenting with early growth retardation managed as GH deficiency.
Implications:
- This case underscores the critical role of ciliary function in pituitary development.
- It highlights a significant link between early-onset growth failure and ciliopathies.
- Early diagnosis and management of growth issues in suspected ciliopathy patients are crucial.
Context:
Ciliopathies are a group of rare conditions that present through a wide range of manifestations. Given the relative common occurrence of defects of the GH/IGF-I axis in children with short stature and growth retardation, the association between ciliopathies and these defects needs further attention.
Case:
Our patient is a boy who was born at term and noted to have early growth retardation and weight gain within the first 18 months of life. Biochemical tests demonstrated low IGF-I but a normal peak GH on stimulation and an adequate increase in IGF-I on administration of recombinant human growth hormone (rhGH). A magnetic resonance imaging scan revealed pituitary hypoplasia and an ectopic posterior pituitary. His growth responded well to rhGH therapy. Subsequently he also developed a retinopathy of his rods and cones, metaphyseal dysplasia, and hypertension with renal failure requiring renal replacement therapy. Whole-exome sequencing demonstrated compound heterozygous mutations of IFT172, thus consistent with a ciliopathy.
Conclusions:
This is the first reported case of a child with a mutation in IFT172 who presented with growth retardation in early childhood and was initially managed as a case of functional GH deficiency that responded to rhGH therapy. This case highlights the importance of ciliary function in pituitary development and the link between early onset growth failure and ciliopathies.
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