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Endocrine dysfunction in children with Crohn's disease
Insights
Children with Crohn's disease may experience growth failure due to endocrine issues, including abnormal gonadotropin responses and impaired thyroxine to triiodothyronine conversion. Folate and sedimentation rate can aid in early Crohn's disease screening.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Internal Medicine
Background:
- Crohn's disease (CD) in children can lead to growth retardation, suggesting potential endocrine involvement.
- Assessing endocrine function is crucial for managing pediatric CD and its complications.
Purpose of the Study:
- To investigate the spectrum of endocrine dysfunction in children with Crohn's disease and growth failure.
- To identify potential screening markers for pediatric Crohn's disease presenting with growth issues.
Main Methods:
- Screened 14 children with Crohn's disease and growth retardation for endocrine abnormalities.
- Assessed cortisol and growth hormone responses to insulin-induced hypoglycemia.
- Evaluated gonadotropin response to luteinizing hormone-releasing hormone (LHRH).
- Measured serum total thyroxine and total triiodothyronine levels.
- Monitored serum folate and erythrocyte sedimentation rate (ESR).
Main Results:
- Four children had growth failure; all showed normal cortisol response to hypoglycemia.
- Abnormal growth hormone response to hypoglycemia was observed in four children.
- Gonadotropin response to LHRH correlated with pubertal status.
- Serum total triiodothyronine was low in six patients, normalizing with treatment.
- Subnormal serum folate and elevated ESR were noted in most patients at diagnosis.
Conclusions:
- Children with Crohn's disease exhibit a range of endocrine changes, notably altered gonadotropin responses and impaired thyroxine to triiodothyronine conversion.
- Growth hormone and cortisol responses may be relatively preserved.
- Serum folate and ESR are potential screening tools for pediatric Crohn's disease presenting with failure to thrive.
Abstract:
A series of 14 children with Crohn's disease and growth retardation was screened for endocrine dysfunction. Four children presented with growth failure. All had normal cortisol responses to insulin-induced hypoglycaemia. Ten children had normal growth hormone responses in the same test, while four had abnormal responses. Gonadotrophin responsiveness to luteinizing hormone releasing hormone (LHRH) paralleled the clinical evidence of puberty, or its lack. Serum total thyroxine was normal in every patient, while serum total triiodothyronine was low in six; in these six patients serum triiodothyronine normalised with treatment. Serum folate was subnormal in 13 patients and the erythrocyte sedimentation rate was elevated in all at the time of diagnosis. Our results demonstrate a spectrum of endocrine changes seen in children with Crohn's disease, particularly prepubertal gonadotrophin responses to LHRH and a relative preservation of growth hormone and cortisol responsiveness to hypoglycaemia, with a defect in thyroxine to triiodothyronine conversion in severely ill children. Serum folate and sedimentation rate may be useful screening tests for Crohn's disease in a child presenting with failure of growth.