Chong S K, Grossman A, Walker-Smith J A, Rees L H
J Pediatr Gastroenterol Nutr. 1984 Sep;3(4):529-34. doi: 10.1097/00005176-198409000-00009.
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.
对14例患有克罗恩病并伴有生长发育迟缓的儿童进行了内分泌功能障碍筛查。4例儿童存在生长发育不良。所有儿童对胰岛素诱导的低血糖的皮质醇反应均正常。10例儿童在同一测试中的生长激素反应正常，而4例反应异常。促性腺激素对促黄体生成素释放激素（LHRH）的反应与青春期的临床证据相符，或缺乏青春期的临床证据。每位患者的血清总甲状腺素均正常，而6例患者的血清总三碘甲状腺原氨酸水平较低；在这6例患者中，血清三碘甲状腺原氨酸经治疗后恢复正常。13例患者的血清叶酸水平低于正常范围，且在诊断时所有患者的红细胞沉降率均升高。我们的结果表明，克罗恩病患儿存在一系列内分泌变化，特别是青春期前促性腺激素对LHRH的反应以及生长激素和皮质醇对低血糖反应的相对保留，而重症患儿存在甲状腺素向三碘甲状腺原氨酸转化的缺陷。血清叶酸和沉降率可能是对生长发育迟缓儿童进行克罗恩病筛查的有用检测指标。
