Title

Pseudohypoparathyroidism type 1a and insulin resistance in a child

UMMS Affiliation

Department of Pediatrics; Department of Cell Biology;Department of Medicine, Division of Endocrinology and Metabolism

Date

5-26-2009

Document Type

Article

Medical Subject Headings

Child, Preschool; Female; Growth Hormone; Humans; *Insulin Resistance; Pseudohypoparathyroidism; Thyroxine

Disciplines

Cell Biology

Abstract

Background. A 5-year-old white girl with a history of hypothyroidism in infancy presented to the endocrinology clinic of a tertiary hospital. Her physical examination noted a stocky physique, broad chest, short neck and short digits. Two years later, skin examination revealed subcutaneous nodules and acanthosis nigricans.

Investigations. Measurement of levels of serum phosphate, parathyroid hormone, ionized calcium and insulin; measurement of peak growth hormone by the arginine-levodopa stimulation test; calculation of homeostasis model assessment of insulin resistance; assessment of bone age; DNA analysis of the GNAS gene.

Diagnosis. Pseudohypoparathyroidism type 1a in a patient with Albright hereditary osteodystrophy, characterized by hypocalcemia, hypothyroidism, growth-hormone deficiency and insulin resistance.

Management. The child continued to take levothyroxine 25 microg once daily, and at 5 years of age she was started on 40 mg/kg elemental calcium as calcium carbonate daily, and calcitriol (active vitamin D) 0.25 microg twice daily. Lifestyle modifications were also recommended for weight control. At 6 years and 4 months of age, treatment with growth hormone was initiated at a dose of 0.3 mg/kg weekly.

Rights and Permissions

Citation: Nat Rev Endocrinol. 2009 Jun;5(6):345-50. Link to article on publisher's site

Related Resources

Link to Article in PubMed