Impact of growth hormone treatment on a 12-year-old female with newly diagnosed panhypopituitarism and distal arthrogryposis

Sep 30, 2026

Uploaded by Asher

Panhypopituitarism, a disorder marked by multiple pituitary hormone deficiencies, is usually identified in infancy or early childhood, while adolescent-onset presentation is rare. This case report describes a 12-year-old girl with late-onset panhypopituitarism accompanied by bilateral distal arthrogryposis and short stature. After initiating hydrocortisone and levothyroxine, growth hormone therapy with weekly lonapegsomatropin-tcgd was started following shared decision-making. Growth velocity rose markedly within months, predicted adult height improved, MRI supported pituitary stalk interruption syndrome, and no worsening of distal hand contractures was observed during treatment, underscoring individualized risk-benefit assessment when theoretical arthropathy concerns exist.

LanguageEnglish

CategoryHealthcare

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Pages5

Reading Time13 min

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EDM Case Reports (2026) 2026 EDM250146 [https://doi.org/10.1530/EDM-25-0146](https://doi.org/10.1530/EDM-25-0146) Received 2 November 2025 Accepted 22 December 2025 Version of Record published 7 January 2026 | Impact of growth hormone treatment on a 12-year-old female with newly diagnosed panhypopituitarism and distal arthrogryposis
Leo L T Meller, Ghassan Akkad􀀁 and Mary Patterson
UC San Diego Health, Rady Children’s Hospital, San Diego, California, USA
Correspondence should be addressed to G Akkad: [gakkad@health.ucsd.edu](gakkad@health.ucsd.edu) | | --- | | Summary
Panhypopituitarism, characterized by multiple pituitary hormone deﬁciencies, is most often diagnosed in infancy or early childhood with adolescent presentation being uncommon. We present a 12-year-old female with late-onset panhypopituitarism presenting with short stature and concomitant bilateral distal arthrogryposis. Her height at presentation was 140.7 cm (6th percentile) with a growth velocity of 0.75 cm/year, Tanner stage 1, bone age consistent with chronological age, and predicted adult height of approximately 152.4 cm despite a mid-parental target near 167.6 cm. Laboratory testing supported growth hormone (GH) deﬁciency, central hypothyroidism, and adrenal insufﬁciency, with stimulation tests being subnormal. MRI showed hypoplasia of the anterior pituitary, an absent infundibulum, and an ectopic posterior pituitary, consistent with pituitary stalk interruption syndrome. Hydrocortisone (9 mg/m2/day) and levothyroxine (37 .5 μg daily) were ﬁrst initiated. Although GH was initially deferred due to concerns about worsening preexisting distal hand contractures, the family elected to begin weekly subcutaneous lonapegsomatropin-tcgd (Skytrofa, 7.6 mg, 0.24 mg/kg/week). At 3 months, the growth velocity increased to 8.7 cm/year with early breast development, and at 6 months, it reached 17.4 cm/year, bone age remained concordant with chronological age, and predicted adult height improved to approximately 162.6 cm. By 10 months, height percentile rose to the 12th percentile and Tanner stage 2 breast development was observed. Throughout treatment, there were no reported or observed changes in distal arthrogryposis hand contractures. This case report highlights that initiation of GH therapy may lead to a signiﬁcant growth improvement without aggravating arthrogryposis-related contractures. | | Learning points
• To report the rare co-occurrence of arthrogryposis and panhypopituitarism and discuss management.
• Distal arthrogryposis coexisting with GH deﬁciency did not worsen with GH therapy in this patient, supporting individualized risk–beneﬁt analysis.
• Shared decision making is key when theoretical risks (e.g. joint symptoms) are weighed against the consequences of untreated GH deﬁciency. | | Keywords: panhypopituitarism; pituitary; growth hormone therapy; distal arthrogryposis; pediatric endocrinology | Published by Bioscientiﬁca Ltd. [https://edm.bioscienti](https://edm.bioscienti)ﬁ[ca.com](ca.com)[ ](ca.com)© 2026 the author(s) This work is licensed under a Creative Commons Attribution 4 .0 International License. L L T Meller et al. EDM Case Reports (2026) 2026 EDM250146 [https://doi.org/10.1530/EDM-25-0146](https://doi.org/10.1530/EDM-25-0146) Background Panhypopituitarism, characterized by multiple pituitary hormone deﬁciencies often including growth hormone (GH), thyroid-stimulating hormone (TSH), and adrenocorticotropic hormone (ACTH), has an estimated prevalence between 1 in 16,000 and 1 in 26,000 individuals (1) . Most diagnoses occur in infancy or early childhood when delayed developmental milestones ﬁrst become apparent and prompt evaluation, with a median age of onset varying from the ﬁrst 3–6 years of life depending on etiology (2, 3) . Early diagnosis is crucial, as untreated panhypopituitarism can lead to signiﬁcant physical and cognitive impairments. The condition may be congenital, due to genetic mutations

FAQs

Why is the diagnosis timing of panhypopituitarism important in this report?

The report notes that panhypopituitarism is most often diagnosed in infancy or early childhood, making adolescent presentation uncommon. Early diagnosis is emphasized because untreated disease can cause significant physical and cognitive impairments.

What treatment changes were made before starting growth hormone?

Hydrocortisone and levothyroxine were first initiated to address adrenal insufficiency and central hypothyroidism. Growth hormone was later started with weekly lonapegsomatropin-tcgd after initial deferral due to concerns about hand contractures.

Did growth hormone therapy worsen the patient’s distal arthrogryposis contractures?

No. Throughout the treatment period, there were no reported or observed changes in the distal arthrogryposis hand contractures.

Sep 30, 2026

Uploaded by Asher