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Insulin-mediated pseudoacromegaly: a report of two pediatric patients
1Pediatric Endocrinologist, Clinical Assistant Professor, Department of Pediatrics, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N0W8, Canada.
Insights
Insulin-mediated pseudoacromegaly in children causes excessive growth and metabolic issues like type 2 diabetes. Early recognition and treatment are crucial to manage growth and prevent complications.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Growth Abnormalities
Background:
- Insulin-mediated pseudoacromegaly is a rare pediatric condition.
- Characterized by excessive growth, acanthosis nigricans, hyperinsulinemia, and metabolic dysregulation.
Observation:
- Two First Nations patients presented with significant excessive growth (height z-scores +3.75 and +5.15).
- Both exhibited normal Insulin-like Growth Factor-1 (IGF-1) levels with appropriate growth hormone suppression but marked hyperinsulinemia.
- Prepubescent growth velocities exceeded 9 cm/year, predicting final adult heights over 3 standard deviations above the mean.
Findings:
- Patients developed type 2 diabetes, severe acanthosis nigricans, and psychosocial distress.
- The condition leads to significant physical, metabolic, and psychosocial comorbidities in pediatric patients.
Implications:
- Early identification in children is vital for initiating therapies to decelerate linear growth.
- Therapeutic interventions aim to prevent the progression of metabolic dysregulation.
- Increased recognition can enhance pathophysiological understanding, diagnostic criteria, and treatment options for this condition.
Background:
Insulin-mediated pseudoacromegaly is a rarely described pediatric phenotype. We present two patients displaying excessive growth associated with marked acanthosis nigricans, hyperinsulinemia and metabolic dysregulation.
Case Presentation:
Both patients, of First Nations descent, presented with excessive growth - patient one at 3.92 years (height z-score +3.75) and patient two at 9.0 years (height z-score 5.15). Insulin-like growth factor-1 (IGF-1) levels were normal with appropriate growth hormone suppression, yet marked hyperinsulinemia. Prepubescent growth velocities exceeded 9 cm/year, resulting in final adult height predictions exceeding 3 standard deviations (SDs) of predicted. Clinical courses were complicated by type 2 diabetes, marked acanthosis nigricans and long-standing psychosocial distress.
Conclusions:
Pediatric patients with insulin-mediated pseudoacromegaly are at risk of significant physical, metabolic and psychosocial comorbidities. Unlike adults, the implications in childhood prompt consideration for therapies to decelerate linear growth and avert progression to metabolic dysregulation. Increased recognition of this condition may improve pathophysiological understanding, diagnostic criteria and therapeutic options.
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