A Boy with Nutritional Growth Retardation due to Achalasia

A 6-yr-old boy was seen at our hospital due to short stature (-2.0 SD) and frequent vomiting. Peak GH response to arginine and insulin was >10 ng/ml at 10.5 yr of age. Growth retardation was progressive. At 12 yr of age, he was still in prepubertal status with a bone age of 8. His height and body weight were 121.6 cm (-3.57 SD) and 19.0 kg (-2.05 SD). Serum level of IGF-1 was low (35 ng/ml), with marginal hypothyroidism due to non-thyroidal illness (T3 0.93 ng/ml, T4 6.7 μg/dl and TSH 0.08 μU/ml). Serum levels of prealbumin and retinol binding protein were also decreased. Achalasia was diagnosed by esophagography. At the age of 12 yr and 6 mo he underwent laparoscopic extramucosal myectomy with fundoplication, and subsequently his nutritional status improved dramatically. At 15.5 yr old, he had gained height and body weight, 153.2 cm (-2.61 SD) and 38.9 kg (-1.95 SD), respectively, and sexual development had advanced too. The clinical course of this boy revealed that achalasia should be added to the list of causes of nutritional growth retardation in children.