Started on hydrocortisone 10mg three times daily for 1 week, then started on levothyroxine 50 μg/day.
Started on recombinant human growth hormone 0.18 mg/kg per week (0.026 mg/kg per day) at 1 month after the Free T4 level had increased into the normal range.
Continued on hydrocortisone, levothyroxine, and growth hormone with excellent compliance.
Latest bone age at chronological age 17 years and 5 months is 12 years.
There was discussion with the parents and patient about maximising growth potential before introducing oestrogen, but patient was started on oestrogen replacement (oestradiol transdermal patch 0.375 mg/day) for psychosocial reasons.
By Author Wendy Schwarz
Clinical Resource Nurse, Alberta Children’s Hospital, Calgary, Canada