This is a case discussion on a 13-year-old boy with short stature due to chronic recurrent multifocal osteomyelitis of bilateral knees. His short stature was attributed to the chronic use of steroids, poor bone density and growth hormone deficiency. Hence, growth hormone was initiated. Five months after commencement of growth hormone, he developed episodes of acute breathlessness and stridor, especially during sleep. There were some episodes complicated with hypoxic seizures. Further investigations subsequently diagnosed growth hormone induced soft tissue hyperplasia at subglottic region. Growth hormone was withheld and tracheostomy was inserted. Currently, he remains well off GH therapy but still on tracheostomy.
This case will lead the participants to reflect on critical thinking in a multidisciplinary approach of a child with stridor as well as to consider risk versus benefits of any treatment.