Rapid Pterygium Progression in a Child on Growth Hormone Therapy: A Case Report and Literature Review.

Pterygium is rare in children, and the effects of growth hormone (GH) therapy on its progression have not been previously described. Because GH and GH-releasing hormone receptor pathways influence cellular proliferation and inflammation, GH supplementation may contribute to accelerated pterygium growth in susceptible patients. This case highlights a rapidly progressive pterygium in an adolescent receiving GH therapy. A 13-year-old male presented with blurred vision and a rapidly enlarging nasal pterygium in the left eye. A small red nodule had first been noted in this patient at six years of age. He received a six-month course of GH in China for short stature and later resumed GH therapy in Hawaii with a one-year prescription. During this second course, the lesion grew significantly, accompanied by worsening visual impairment. On presentation, visual acuity was measured at 20/20 OD and 20/100 OS. Slit-lamp examination showed a thick fibrovascular pterygium extending toward the pupil. The patient underwent pterygium excision with mitomycin C and amniotic membrane grafting. Four days postoperatively, pinhole visual acuity improved to 20/40 OS, with residual central corneal opacity and persistent with-the-rule astigmatism. The temporal association between GH therapy and rapid pterygium enlargement in this patient suggests a potential link between GH exposure and accelerated fibrovascular proliferation. Given the established presence of GH and GH receptors in ocular tissues, clinicians should consider GH therapy as a possible contributing factor when evaluating pediatric patients with progressive ocular surface lesions such as pterygium. Further research is needed to clarify the role of endocrine signaling in pterygium pathogenesis.