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Dr. Andrew Rynne

Family Physician

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What does the following blood test report indicate?

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Dr. Eric Goldstein

Pediatrician

Practicing since :1999

Answered : 1295 Questions

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Posted on Wed, 8 Mar 2017 in Child Health
Question: Hello Doctor, My son age 13 (14 in July) and short stature sits in the 1%. Has had blood work that has come back abnormal but doctor does not seem to think anything of it. I am wondering your thoughts as it seems his short stature could be caused by low growth hormone. Doctor thinks poor nutrition but he eats the same as my other kids and is a level 8 gymnasts strong as can be. He eats a balanced diet.
Low IGF-1(SOMAT-C) 113ng/ml
Low RBC Distr/CV 11.1%
High MCH 33.8pg
Low OSMO/CALC 276 mOsm/kg
High Bun/Cre ratio 27:1
Low AP 140 IU/L
Testosterone ESO 16ng
IGF Bind Prot-3 3.8 mg/L

His birthdate is 7-02-03
Weight 36.5 Kg
Height 139.2 cm
Mom is 5'1"
Dad 5'11"
10 year old sister is 139cm
14 year sister is 5'3"
doctor
Answered by Dr. Eric Goldstein 25 minutes later
Brief Answer:
Growth

Detailed Answer:
Hello. I just read through your question.
I agree, this could very well be do to low growth hormone. If this is the case, he could be potentially helped. However, there is one more piece of in formation we would want to know before investigating that. We would need to do his bone age. this is an xray of the hand. An advanced bone age would mean there is little time left to do anything. A bone less than his chronological age would mean there is still plenty of growth left for him.
This test is usually done by a pediatric endocrinologist. In any case, it would be a good idea to get an endocrinologists opinion.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Eric Goldstein 1 hour later
Thank you so much for your response. This is where my concern comes in. We have been seeing an endocrinologist annually since 2008. At our last visit the doctor did these labs and then contacted us and said that she saw no endocrinologist reason for his short stature. She instead recommended us to a G.I./nutritionist. She said she felt like poor nutrition was causing his failure to grow. Although he eats just like our other kids eat and they grow.

At his annual visit last year his IGF-I was in normal range. This year it dropped as well as he dropped from the 3% to the 1 %. He had a bone age done and the radiologist said his bone age matched his true age. But the endocrinologist felt like his bone age at the time was 11 1/2 when he was 12 1/2. This year she said he had short stature with decreased growth. I am upset at the fact that if his failure to grow is due to poor nutrition and we have been seeing the endocrinology for the last six years why hasn't this been said before. I am also concerned as to why the IGF-I being low is not being taken into consideration. I feel like time is of the essence to give him testosterone or growth hormone but I am just getting put off. At this rate how tall would he end up being if nothing is done?
doctor
Answered by Dr. Eric Goldstein 20 minutes later
Brief Answer:
Follow up

Detailed Answer:
I completely understand your frustration. And I agree, time is of the essence. His decreased bone age is a good sign, though it is curious that the radiologist read it differently. Regarding the decreasing IGF-1, I'm not sure why your endocrinologist isn't acting on it, or at least giving you a clear explanation as to why it is decreasing.
There is no way to predict at this time what his final height would be. Plus, the fact that you are in the shorter range while his father is in the taller range, makes predicting his final height even more difficult.
I would offer two suggestions:
1. Demand a clearer explanation from your endocrinologist, and..
2. Seek a second opinion.

the idea of seeing a nutritionist is not a bad one. all kids could benefit from the guidance of a good nutritionist. But a second endocrinologists opinion would also be very helpful here.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Eric Goldstein 45 minutes later
Thank you so much. My gut was telling me I should get a second opinion but I did not know if I was just overreacting. I will first reach out to our endocrinologist and ask that direct question and then seek a second opinion.
doctor
Answered by Dr. Eric Goldstein 1 minute later
Brief Answer:
Follow up

Detailed Answer:
You are very welcome.

Good luck.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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