GROWTH AND PUBERTY IN A 36 YR. OLD MALE AFTER INTRAVENOUS ALIMENTATION

Abstract

We are reporting the unusual case of a 36 yr. old man who at age 3½ yr. had an ileocecal intussusception which required massive resection of his small and part of his large bowel. At age 7 yr. he underwent a second resection of the gut, leaving only 30 cm. of proximal small intestine. Since then his growth remained extremely stunted. At age 18 yr. his height was 117 cm., and at 35 yr. it was 122 cm. (corresponding to a mean height of a 6 yr. old boy), while his bone age was 13 yr. (± 11 m.SD). A growth hormone deficiency was excluded. From age 10 yr. onward he developed tetany, secondary to hypocalcemia, hypomagnesemia, anemia due to intestinal blood loss, and vit. B12 deficiency. At age 35 yr. his serum Zn was low normal, but levels of Cu, Cr, Se and Mn were very low. After a period of rapid deterioration (weight loss, hypoproteinemia), the patient finally accepted home parenteral nutrition. This was continued for 15 months and resulted in a weight gain of 16 kg. and an increase in height of 8.5 cms. A small increment in serum somatonedin-C was observed (16 to 29 ng/ml). Concomitantly, he developed secondary sexual characteristics (Tanner III), with a surge in serum testosterone levels up to 926 ng/dl, from a low of 20 ng/dl (normal 300-900). Serum Ca and Mg levels were normal. We conclude that growth failure and delayed puberty, secondary to prolonged malnutrition, will respond to appropriate intravenous alimentation, even at an advanced age.

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