Possible exogenous growth hormone induced mood disorder with mixed features in a child.

Abstract

[Author Affiliation]Taha Can Tuman. 1 Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.Zehra Topal. 1 Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.Nuran Demir. 1 Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.Ozden Arisoy. 1 Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.Sarper Taskiran. 2 Department of Psychiatry, Koc University Medical Faculty, Istanbul, Turkey.Ali Evren Tufan. 1 Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.Part of this case report was presented as a poster at the 6th International Congress of Psychopharmacology and the 2nd International Symposium on Child and Adolescent Psychopharmacology (April 4-20, 2014, Antalya, Turkey).Address correspondence to: Evren Ali Tufan, MD, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey, E-mail: tevrenus@yahoo.comTo the Editor:The incidence of growth hormone (GH) deficiency in infants is reported to be 1 in 3800 live births (Rogol and Hayden 2014). Growth failure caused by GH deficiency is treated with exogenous hormone replacement (Rogol and Hayden 2014). Treatment with GH in childhood is generally without serious complications, and the most common side effects reported are headaches, dizziness, joint/muscle pains, and fluid retention (Fuller and Sjatovic 2007). Here, we report a case of mood disorder with mixed features in a prepubertal child, which was thought to be possibly related to exogenous GH replacement.Case ReportThe patient was an 11-year-old male who had been brought to our department with complaints of talkativeness, increased energy, and spending. He was inattentive, hyperactive, and euphoric, and it was reported that felt he could do anything. Upon questioning, it was learned that the complaints had been present continuously for the past 3 months. The patient's grades had suffered, and within the past month he had verbalized suicidal ideations to his teachers. Mental status examination revealed auditory hallucinations, and grandiose delusions alternating with depressive ruminations and limited insight.Past medical and psychiatric history were unremarkable, except growth failure that had led to a referral to the pediatrics department 4 months earlier. The patient was diagnosed with GH deficiency, and somatropin injections (0.5 mg/day) had been commenced 3 months earlier and titrated to 0.7 mg/day in the past month. Apart from mild inattention and irritability, no distinct depressive episode had been reported prior to treatment with GH. Family history was negative for psychopathology. Neurological examination ruled out papillary edema, and no signs or symptoms of intracranial hypertension were reported. Laboratory evaluations as well as electroencephalogram (EEG) were normal. Psychometric evaluation with the Childhood Mania Scale as completed by the parents revealed a score of 35 (chief complaints: auditory hallucinations, paranoid ideations, impulsivity, grandiosity, pressured speech, insomnia, increased energy, euphoria, and irritability). …