Growth hormone deficiency as a complication of haemophilia - a case report and literature data.

Severe haemophilia carries an increased risk of life-threatening intracranial haemorrhages. Studies in adult survivors show a relatively high percentage of anterior pituitary hypofunction reported as the most frequent complication. We report the case of isolated growth hormone deficiency in a boy with severe haemophilia A. He experienced several intracranial haemorrhages in early childhood. At the age of seven years, growth hormone deficiency was diagnosed. The MRI scan of the pituitary gland was normal, but many focal changes in brain tissue were found. The function of pituitary-dependent hormonal axes beyond GH/IGF1 axis was sufficient. Therapy with rhGH was introduced and continued for over nine years. Growth velocity increased and the height normalised appropriately to parental height. We did not observe any complications besides sporadic subcutaneous bleedings. Patients with haemophilia should be considered as a high-risk group for hypopituitarism. Subcutaneous rhGH injections can be safe even in severe haemophilia.