Malabsorption and developmental retardation due to secondary trypsin deficiency

A 1.5-year-old girl was admitted with chronic diarrhea of 10 months duration and retarded physical and psychomotor development. Duodenal tryptic activity was absent on testing with secretin and cholecystokinin. With pancreatic enzyme replacement diarrhea ceased and growth recommenced. Duodenal tryptic activity returned to normal within 6 months. A 10-year follow-up revealed normal physical and mental growth. Secondary deficiency of trypsin is a rare cause of malabsorption in childhood; correct and timely treatment can avoid severe, irreversible developmental defects.