Green J R, O'Donoghue D P, Edwards C R, Dawson A M
Acta Paediatr Scand. 1977 Sep;66(5):643-7. doi: 10.1111/j.1651-2227.1977.tb07962.x.
There is conflicting evidence regarding the adequacy of hypothalamic-pituitary function in children and adolescents with chronic inflammatory bowel disease complicated by growth retardation and delayed sexual maturation. A child with Crohn's disease, who has never received corticosteroid therapy, had delay of both growth and sexual maturation and has been investigated over the course of his disease. In addition to a skull X-ray (normal) and thyroid function tests (normal), a standard insulin tolerance test (insulin 0.15 u/kg) and a standard gonadotropin-releasing hormone (Gn-RH) test (100 microgram Gn-RH i/v) were performed when the bowel disease was in relapse and again during a remission of the bowel disease, achieved by surgery. When the bowel disease was in relapse (coincident with growth arrest) results showed an inadequate release of gonadotrophins and of growth hormone (even after pre-treatment with stilboestrol) but normal release of cortisol and prolactin. During a remission of the bowel disease coinciding with a period of rapid "catch-up" growth, release of growth hormone was normal and that of gonadotrophins supranormal. The demonstration of a reversible apparent partial hypopituitarism in this boy not only re-questions the adequacy of hypothalamic-pituitary function in inflammatory bowel disease but also indicates a potential diagnostic pitfall in the routine investigation of growth retardation if gastrointestinal symptoms are not prominent at presentation.
关于患有慢性炎症性肠病并伴有生长发育迟缓及性成熟延迟的儿童和青少年，下丘脑 - 垂体功能是否充足，现有证据相互矛盾。一名从未接受过皮质类固醇治疗的克罗恩病患儿，出现了生长和性成熟延迟的情况，并在其病程中接受了调查。除了颅骨X光检查（正常）和甲状腺功能测试（正常）外，在肠道疾病复发时以及通过手术实现肠道疾病缓解期间，分别进行了标准胰岛素耐量试验（胰岛素0.15 u/kg）和标准促性腺激素释放激素（Gn-RH）试验（100微克Gn-RH静脉注射）。当肠道疾病复发时（与生长停滞同时发生），结果显示促性腺激素和生长激素释放不足（即使在己烯雌酚预处理后），但皮质醇和催乳素释放正常。在肠道疾病缓解且恰逢快速“追赶”生长阶段时，生长激素释放正常，促性腺激素释放超常。该男孩可逆性明显部分垂体功能减退的表现，不仅再次质疑了炎症性肠病中下丘脑 - 垂体功能的充足性，还表明如果在就诊时胃肠道症状不突出，在生长发育迟缓的常规调查中可能存在潜在的诊断陷阱。
