{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T19:01:43Z","timestamp":1774551703302,"version":"3.50.1"},"reference-count":20,"publisher":"Bioscientifica","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>\n                      Panhypopituitarism, characterized by multiple pituitary hormone deficiencies, is most often diagnosed in infancy or early childhood with adolescent presentation being uncommon. We present a 12-year-old female with late-onset panhypopituitarism presenting with short stature and concomitant bilateral distal arthrogryposis. Her height at presentation was 140.7 cm (6th percentile) with a growth velocity of 0.75 cm\/year, Tanner stage 1, bone age consistent with chronological age, and predicted adult height of approximately 152.4 cm despite a mid-parental target near 167.6 cm. Laboratory testing supported growth hormone (GH) deficiency, central hypothyroidism, and adrenal insufficiency, with stimulation tests being subnormal. MRI showed hypoplasia of the anterior pituitary, an absent infundibulum, and an ectopic posterior pituitary, consistent with pituitary stalk interruption syndrome. Hydrocortisone (9 mg\/m\n                      <jats:sup>2<\/jats:sup>\n                      \/day) and levothyroxine (37.5 \u03bcg daily) were first initiated. Although GH was initially deferred due to concerns about worsening preexisting distal hand contractures, the family elected to begin weekly subcutaneous lonapegsomatropin-tcgd (Skytrofa, 7.6 mg, 0.24 mg\/kg\/week). At 3 months, the growth velocity increased to 8.7 cm\/year with early breast development, and at 6 months, it reached 17.4 cm\/year, bone age remained concordant with chronological age, and predicted adult height improved to approximately 162.6 cm. By 10 months, height percentile rose to the 12th percentile and Tanner stage 2 breast development was observed. Throughout treatment, there were no reported or observed changes in distal arthrogryposis hand contractures. This case report highlights that initiation of GH therapy may lead to a significant growth improvement without aggravating arthrogryposis-related contractures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>To report the rare co-occurrence of arthrogryposis and panhypopituitarism and discuss management.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Distal arthrogryposis coexisting with GH deficiency did not worsen with GH therapy in this patient, supporting individualized risk\u2013benefit analysis.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Shared decision making is key when theoretical risks (e.g. joint symptoms) are weighed against the consequences of untreated GH deficiency.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-25-0146","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T17:21:49Z","timestamp":1767806509000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Impact of growth hormone treatment on a 12-year-old female with newly diagnosed panhypopituitarism and distal arthrogryposis"],"prefix":"10.1530","volume":"2026","author":[{"given":"Leo L T","family":"Meller","sequence":"first","affiliation":[{"name":"UC San Diego Health, Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3081-9546","authenticated-orcid":true,"given":"Ghassan","family":"Akkad","sequence":"additional","affiliation":[{"name":"UC San Diego Health, Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Patterson","sequence":"additional","affiliation":[{"name":"UC San Diego Health, Rady Children\u2019s Hospital, San Diego, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Arch Pediatr","first-page":"165","article-title":"Diagnosis and management of congenital hypopituitarism in children","volume":"31","author":"Castets S","year":"2024","unstructured":"Castets S\n, \nThomas-Teinturier C\n, \nVillanueva C\n, et al.\n Diagnosis and management of congenital hypopituitarism in children. Arch Pediatr 2024 31 165\u2013171. (https:\/\/doi.org\/10.1016\/j.arcped.2024.01.003)"},{"key":"bib2","series-title":"J Pediatr Endocrinol Metab","first-page":"139","article-title":"Onset of pituitary hormone deficiencies in optic nerve hypoplasia: a temporal trend analysis of 32 children at Mayo clinic","volume":"33","author":"Wadams HD","year":"2020","unstructured":"Wadams HD\n, \nGupta N\n, \nNovotny P\n, et al.\n Onset of pituitary hormone deficiencies in optic nerve hypoplasia: a temporal trend analysis of 32 children at Mayo clinic. J Pediatr Endocrinol Metab 2020 33 139\u2013145. (https:\/\/doi.org\/10.1515\/jpem-2019-0269)"},{"key":"bib3","series-title":"J Clin Endocrinol Metab","first-page":"2475","article-title":"Diagnosis and incidence of congenital combined pituitary hormone deficiency in Denmark-A national observational study","volume":"108","author":"Jakobsen LK","year":"2023","unstructured":"Jakobsen LK\n, \nJensen RB\n, \nBirkeb\u00e6k NH\n, et al.\n Diagnosis and incidence of congenital combined pituitary hormone deficiency in Denmark-A national observational study. J Clin Endocrinol Metab 2023 108 2475\u20132485. 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