Growth without growth hormone (GH): a case report.

Growth without growth hormone (GH) has occasionally been described in patients with organic pituitary pathology, and even more rarely in patients with idiopathic pituitary hormone deficiency. The mechanism of growth without GH remains a mystery. We describe a 17-year old male who grew 38.5 cm in height over a 7-year period, despite the fact that he had established panhypopituitarism. The hypopituitarism was initially attributed to a presumptive hypothalamic hamartoma which was not, however, confirmed on subsequent and prolonged follow-up. Regular endocrine evaluation confirmed persistent anterior and posterior pituitary hormonal deficiencies with severe concomitant hyperinsulinemia as shown by an exaggerated insulin response to a standard oral glucose tolerance test. In our patient, a postulated mechanism could be the severe hyperinsulinemia, acting either through the insulin and/or IGF receptors and thus potentiating the mitogenic effect. This case illustrates that final height attainment within or above target height may occur in patients with idiopathic pituitary hormonal deficiency despite persistent, severe GH insufficiency.