Leg Join Pain (cold)

[Ldybreez]

My 10 year old daughter is small for her age (hight and weight of a 6 yr old). Harmone level in normal range. Growth bone scan indicates she will grow to 5'3" in hight.    For several years now,  late in the evening or durring the night she will start complaining or wake up complaining of a "cold to the bone" sensation in her legs behind the knee or in the ankles or both.  It is so severe that it will make her cry.  Her doctor has had her tested for Juvenile Arthritis and the results were negitive for arthritis.  The doctor is at a loss as to what could be causing this problem.  Warm soaks in the tub or a heating pad helps some but she cannot go back to sleep for quite sometime.  Can you offer any suggestions as to what might be causing these cold sensations and what we might test for?

Sincerely
Rose

[Deanna L Aftab Guy, MD]

Well remind him I am an endocrinologist too and hope that the workup is normal. Stay with her endocrinologist though, despite all the tests being normal I still follow my kids every 4-6 months to assess a growth velocity, if she is not growing at least 5 cm per year this is too slow even for someone who appears to be a late bloomer.
So if her pains are not increasing and don't interfere with her activity I imagine they can be watched or treated with antiinflammatory, but if you find it is increasing or associated with any other symptoms your doc may want to involve a rheumatologist or orthopedic specialist
Hate to do an unnecessary workup, lets hope this is an exaggerated form of "growing pains"
Other tests that I am sure your doc has done include a simple film of the area and a bone scan for inflammation, but honestly I would be conservative. It sounds like he has things attended to.
Hope she gets better

[Ldybreez]

Yes we have had her to an endocrinologist. He is the physician who ran the harmone and bone growth tests. The tests were within normal range.  

Her pediatrician is the one who ran the arthritis tests and the cbc all normal.  I told him that I had posted in this forum and is intrested in the answer I get.  He has consulted with another pediatrician in the area on this and they were at a loss.  Thank you for your ideas and I am printing this and taking it to him.  

Sincerely
Rose

[Deanna L Aftab Guy, MD]

You describe what sounds like extreme growing pains, have you tried anything for the relief like antiinflammotories such as ibuprofen? Also in regards to her growth, has she seen an endocrinologist? Often the tests that some docs do as screening may not suffice in telling if she is truly appropriate height for age and genetic status. Her bone age sounds delayed and this is helpful but can still be due to growth hormone deficiency.
The leg pains are not indicative though of growth hormone, separate problem, infact if she is having growing pains then this is a sign that things may be kicking in. Xrays of the area, a cbc, sed rate and c reactive peptide are helpful in general to look for inflammation or bony disease.
Other rare but important issues that a blood test can tell us is the possibility of celiac disease, this can be measured firstly with a blood test for antibodies, often this allergy to wheat gluten will present with symptoms other than the stomach, like short stature, joint pain and other symptoms. With her growth issue it is worth testing, also thyroid is important to assess, free T4 and TSH might be included, sometimes may present with some bone aches.
So start with your doc and ask about a referral to a pediatric endocrinologist more so for the height being so delayed, she may not achieve the 5'3 height despite what the bone age tells and with her height so far behind and if puberty kicks in on time she may fall well below her potential if a hormonal abnormality is not detected.