International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: http://www.sciepub.com/journal/ijcd Editor-in-chief: Samasca Gabriel
Open Access
Journal Browser
Go
International Journal of Celiac Disease. 2016, 4(4), 146-149
DOI: 10.12691/ijcd-4-4-11
Open AccessCase Report

A 21-year-old Man with Delayed Puberty

Ketabimoghaddam Pardis1, Dadvar Zohreh2, , Salehi Babak3, Aletaha Najmeh2, Allameh Seyed Farshad2, Hassanpour Akbar1 and Talayi M.A3

1Arak university of medical sciences, Internal medicine department

2Tehran university of medical sciences,gastrointestinal department

3Shahid Beheshty university of medical sciences, gastrointestinal department

Pub. Date: December 03, 2016

Cite this paper:
Ketabimoghaddam Pardis, Dadvar Zohreh, Salehi Babak, Aletaha Najmeh, Allameh Seyed Farshad, Hassanpour Akbar and Talayi M.A. A 21-year-old Man with Delayed Puberty. International Journal of Celiac Disease. 2016; 4(4):146-149. doi: 10.12691/ijcd-4-4-11

Abstract

Delayed puberty is defined clinically by the absence or incomplete development of secondary sexual characteristics bounded by an age at which 95 percent of children of that sex and culture have initiated sexual maturation. The upper 95th percentile in the for age for boys is 14 (an increase in testicular size being the first sign) and for girls is 12 (breast development being the first sign). Delayed puberty pathophysiologically is classified according to the circulating levels of the gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in to two groups of high serum LH/FSH and low or normal serum LH/FSH concentrations which are related to primary hypogonadism and hypothalamic dysfunction respectively. Patient Presentation. A 21 year old boy presented with severe respiratory distress syndrome due to pneumonia and generalized edema. Laboratory studies showed pancytopenia which made clinicians work up for hematologic disorders, leading to bone marrow aspiration and biopsy which was consistent with megaloblastic anemia resulting from vit B12 deficiency. Another manifestation of this patient was delayed puberty which had been ignored over these years. Evaluation of delayed puberty revealed a low serum LH/FSH concentration. Accompaniment of delayed puberty resulting from hypothalamic origin with edema and hypoalbuminemia made clinicians work up for a malabsorption syndrome. Therefore upper endoscopy and colonoscopy were done and duodenal biopsies were consistent with celiac sprue. The unusual symptom of this patient was vit B12 deficiency which is rare in celiac disease. Conclusion. Neglected celiac sprue can be accompanied by vit B12 deficiency probably because of involvement of more distal parts of small intestine over the time.

Keywords:
delayed puberty hematologic changes celiac disease

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  , Palmert MR. Delayed puberty: analysis of a large case series from an academic center. J ClinEndocrinolMetab 2002; 87: 1613.
 
[2]  Pugliese MT, Lifshitz F, Grad G, et al. Fear of obesity. A cause of short stature and delayed puberty. N Engl J Med 1983; 309: 513.
 
[3]  Sedlmeyer IL, Hirschhorn JN, Palmert MR. Pedigree analysis of constitutional delay of growth and maturation: determination of familial aggregation and inheritance patterns. J Clin Endocrinol Metab 2002; 87: 5581.
 
[4]  Raivio T, Falardeau J, Dwyer A, et al. Reversal of idiopathic hypogonadotropichypogonadism. N Engl J Med 2007; 357:863.
 
[5]  Booth CC. History of celiac disease. BMJ 1989; 298: 527.
 
[6]  Farthing MJ, Rees LH, Edwards CR, et al. Male gonadal function in coeliac disease: 2. Sex hormones. Gut 1983; 24: 127.
 
[7]  Ludvigsson JF, Montgomery SM, Ekbom A. Risk of pancreatitis in 14,000 individuals with celiac disease. Clin Gastroenterol Hepatol 2007; 5: 1347.
 
[8]  Lee OY, Eun CS, Roh BJ, et al. A case of protein-losing enteropathy associated with small bowel villous atrophy. Korean J Gastroenterol. 2007; 49: 31-6.
 
[9]  Rick T. Waldo. Iron-deficiency anemia due to silent celiac sprue. Proc (BaylUniv Med Cent). 2002; 15: 16-17.
 
[10]  Thorvardur RH, Mark RL,Joseph AM. Hematologic manifestations of celiac disease Blood. 2007; 109: 412-421.