Rapid growth rate

[camboranch]

My 9 yo old daughter was born with a mild case of hemi-hypertrophy dx at 7 months.  She has been going every 3-6 months for abdominal ultrasounds and afp blood test to rule adrenal tumors since which have been negative.  She has always been growing rapidly, two years greater then her actually age.  March of  07 she had a huge growth spurt and weight gain and developed a goiter in her thyroid.  At that time a ultrasound of thyroid showed non specific cysts and mri showed a probable  Rathke cyst on the pituitary.  Bone age and hormone were in the high normal range.  On repeat mri this month it showed a  2.5 mm "congenital structure" in the pituitary plus the cyst.  My question is could these abnormalities in pituitary be causing the change in thyroid and the rapid growth even though blood hormone levels and bone age are "normal high."

[Deanna L Aftab Guy, MD]

Doubtful, usually it is the cause of less gh secreting tissue there and usually gh deficiency, excessive gh is acromegaly and usually due to a pituitary adenoma and can be seen on mri at times if large enough. A blood test for gh and somatomedin C can help look at whether there is excessive gh. My thought is that if the growth is too fast we need to consider early puberty.

[camboranch]

Could the Rathke's cyst and other structure be putting out growth hormone contributing to her fast growth rate and large size?  Do Rathke's ever grow and do they every have to be removed??

[Deanna L Aftab Guy, MD]

Usually a Rathke's cyst is a developmental thing, as the pituitary develops off the roof of the mouth in the fetus the remnant can remain as a cyst and this can be seen in children with imaging, I have 2 patients,  both have deficiencies due to the cyst mostly due to poorly functioning pituitary glands. The hemihypertrophy can go along with several syndromes, I am glad they are ruling out Wilm's tumor, be sure that they have you with a genetics specialist as well as there are endocrine problems that are also associated with hemihypertrophy and the genetics and endocrine specialists work together.
You sound like she is well monitored.