A toddler with failure to thrive and impaired vision
Endocrinology
Those patients with documented hormonal insufficiency require supplementation. Any patient at risk for developing a deficiency should also be closely monitored so that a change in hormone levels can be quickly recognized and treated. This will help avoid such complications as impaired growth and development—or even death.1,4
Parent education
It’s very important to teach parents about the critical signs and symptoms of dangerous hormone insufficiencies. In patients with cortisol deficiency or diabetes insipidus, febrile illnesses or extreme dehydration require an immediate stress dose of injectable parenteral corticosteroids and hospitalization.3,4 Parents should also be told to monitor their child for the development of other hormone insufficiencies by paying close attention to his growth pattern.1
Outcome
Our patient had deficiencies of growth hormone, thyroid stimulating hormone, and corticotropic hormone. As a result, we started him on supplements, including somatropin, levothyroxine, and hydrocortisone sodium succinate.
Our patient was also diagnosed with oral aversion, so a gastric tube was placed to ensure adequate nutrition. His parents were instructed to follow-up with ophthalmology, neurology, and endocrinology, as well as his primary care physician.
Five months after discharge, the patient had gained 3 kg and adjustments were made to his hormone therapy.
CORRESPONDENCE
Madhu Agarwal, MD Loma Linda University Department of Ophthalmology, 11370 Anderson, Suite 1800, Loma Linda, CA 92354. magarwal@llu.edu
