Failure To Thrive: Endocrine Causes

Yesterday I wrote about the clinical entity failure to thrive (FTT).  This morning I realized that I had not really addressed the question of endocrine gland disorders that can be associated with FTT.  Probably, the reason I did not mention endocrine disorders was that they do not often cause FTT and if they do, the signs and symptoms usually make it easy to make a diagnosis.

As I discussed in the previous entry, the key feature in all patients with FTT is poor weight gain, with or without short stature.  With only a few exceptions, endocrine disorders that cause short stature are rarely associated with poor weight gain.  For example, patients with either growth hormone deficiency, hypothyroidism or Cushing’s disease (glucocorticoid excess) typically present with short stature, but are generally overweight for height.  The endocrine conditions that typically present with poor weight gain (with or without short stature include type 1 diabetes mellitus, adrenal insufficiency (i.e., Addison’s disease), and conditions associated with hypercalcemia such as hyperparathyroidism.  Usually, the signs and symptoms for these disorders are such that very little detective work is needed to figure out what the problem is.  The one exception might be adrenal insufficiency; I have been amazed at how often that diagnosis is delayed for a long time if the patient is being followed by a primary care doctor, despite many clues from the medical history and physical examination.  I suspect the main difficulty in diagnosing adrenal insufficiency, is that the various disorders that cause adrenal insufficiency are rare and many physicians (not pediatric endocrinologists) have little or no experience in dealing with the problem.  Be warned.

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