Büyüme Hormon Tedavisi Kemik Yaşını İlerletir mi? Does Growth Hormone Treatment Advance Bone Age?

Year 2017, Volume: 15 Issue: 2, 38 - 43, 01.08.2017

Enes Salı Halil Sağlam Erdal Eren Ömer Tarım

Abstract

GİRİŞ ve AMAÇ: Büyüme hormonu (BH)
tedavisi, erken epifiz kapanmasına neden olan kemik matürasyonundaki ilerleme
konusunda artan endişelerle, kemik matürasyonuna uyarıcı etkide bulunabilir. Bu
çalışmada, bu olasılığın araştırılması ve ilerlemiş kemik matürasyonunun
tahmini veya son boya etkisinin olup olmadığının saptanmasını amaçladık.

YÖNTEM ve GEREÇLER: 1995-2005 tarihleri arasında BH tedavisi alan toplam 230
hastanın verileri retrospektif olarak değerlendirildi. Hastalar; izole BH
eksikliği (Grup 1), Turner sendromu (Grup 2) ve diğer (Grup 3) olarak ayrıldı.
Önceki el bileği X-ray verileri tıbbi kayıtlardan çıkarıldı ve klinik
vizitlerde el bilek X-ray istendi. Kemik yaşı (KY) değerlendirilmesi Greulich
ve Pyle atlasına göre yapıldı. Tahmini yetişkin boyu, KY kullanılarak Bayley ve
Pinneau metoduna göre yapıldı. Bazal tahmini boy ile tedavinin 1. ve 2.
yılındaki tahmini boy, takvim yaş (TY)-KY ve TY/KY değişkenlikleri kullanılarak
değerlendirildi.

BULGULAR: Her üç grupta boy SDS anlamlı olarak arttı (p<0,05). Grup 1 ve
2'deki TY-KY, tedavinin 1. ve 2. yılı süresince azaldı (p<0,05). KY'ndaki
ilerleme, TY/KY oranındaki azalma ile teyit edildi. Bununla beraber, KY
ilerlemesine karşın öngörülen boy olumsuz etkilenmedi.

TARTIŞMA ve SONUÇ: TY-KY ve TY/KY oranındaki azalma kanıtı olarak BH, KY'nı
artırdı. Bununla beraber, tahmini boy iki yıllık tedavi kohortumuzda ilerlemiş
kemik matürasyonuna ters olarak etkilenmedi. Bu konu, kemik yaşının daha çok
ilerlediği puberte prekoks gibi hasta gruplarında araştırılmalıdır.

ABSTRACT

INTRODUCTION: Growth hormone (GH) treatment may have a stimulatory
affect on bone maturation which raises concern about acceleration of bone
maturation leading to early epiphyseal fusion. In this study, we aimed to
investigate this possibility and determine whether or not accelerated bone
maturation affects predicted or final height.

METHODS: A total of 230 patients who received GH treatment between 1995 and
2005 were retrospectively studied. The patients were classified as isolated
growth hormone deficiency (GHD) (Group-1), Turner syndrome (Group-2), and others
(Group-3). The previous X rays were obtained from the medical records and
follow-up X rays were requested during the clinic visit. Bone age (BA)
assessment was done according to the atlas of Greulich and Pyle. Based on BA,
adult height prediction was calculated by the method of Bayley and Pinneau. The
predicted height (PH) at baseline and after the first and second years of
treatment were evaluated along with the change in chronological age (CA)-BA and
CA/BA.

RESULTS: Height SDS significantly increased in all three groups (p<0.05).
CA-BA decreased in Groups-1 and 2 during the first and second years of
treatment (p<0.05). The BA acceleration was verified by the decrement in
CA/BA ratio. However, predicted height was not negatively influenced despite BA
advancement.

DISCUSSION AND CONCLUSION: BA advances with GH treatment as evident from the
reduction in CA-BA and CA/BA. However, predicted height is not adversely
affected by accelerated bone maturation in our cohort over two years of
treatment. This issue needs to be investigated in other patient groups such as
precocious puberty where bone maturation is further accelerated. 

Keywords

Büyüme hormon eksikliği, Büyüme hormon tedavisi, Turner sendromu, Growth hormone deficiency, Growth hormone treatment, Turner syndrome

References

• 1. Zadik Z, Chalew S, Zung A, Landau H, Leiberman E, Koren R et al. Effect of long-term growth hormone therapy on bone age and pubertal maturation in boys with and without classic growth hormone deficiency. J Pediatr. 1994;125(2):189-95.
• 2. Crowe BJ, Rekers-Mombarg LT, Robling K, Wolka AM, Cutler GB Jr, Wit JM; European Idiopathic Short Stature Group. Effect of growth hormone dose on bone maturation and puberty in children with idiopathic short stature. J Clin Endocrinol Metab. 2006;91(1):169-75.
• 3. Bundak R, Neyzi O. Buyume. In: Neyzi O, Ertugrul T. (eds). Pediatri 1. 3rd edition. Istanbul: Nobel; 2002. 79-99.
• 4. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. Stanford University Press. Stanford, California, 1959.
• 5. Bayley N, Pinneau SR. Tables for predicting adult height from skeletal age: Revised for use with the Greulich-Pyle hand standards. In: Greulich WW, Pyle SI (eds) Radiographic atlas of skeletal development of the hand and wrist. Second edition, Stanford University Press 1959; 231-251.
• 6. Lifshitz F, Botero D. Growth and growth disorders. In: Liftshitz F (ed). Pediatric Endocrinology. 4th edition. Newyork: Marcel- Dekker; 2004;1-18.
• 7. Günöz H. Büyüme Bozuklukları. In: Günöz H, Öcal G, Yordam N, Kurtoğlu S (eds). Pediatrik Endokrinoloji. 1. Baskı. Ankara: Kalkan Matbaacılık; 2003;65-136.
• 8. Tanner JM, Whitehouse RH. A note on the bone age at which patients with true isolated growth hormone deficiency enter puberty. J Clin Endocrinol Metab. 1975;41(4):788–90.
• 9. Goodman HG, Grumbach MM, Kaplan SL. Growth and growth hormone. II. A comparison of isolated growth-hormone deficiency and multiple pituitary-hormone deficiencies in 35 patients with idiopathic hypopituitary dwarfism. N Engl J Med. 1968;278(2):57-68.
• 10. Stanhope R, Albanese A, Hindmarsh P, Brook CG. The effects of growth hormone therapy on spontaneous sexual development. Horm Res. 1992;38 Suppl 1:9-13.
• 11. Tanaka T: Pubertal aspects of idiopathic growth hormone deficiency. In: Ranke MB, Gunnarsson R (eds): Progress in Growth Hormone Therapy – 5 years of KIGS. Mannheim, J & J Verlag, 1994;112–28.
• 12. Allen DB, Johanson AJ, Blizzard RM: Growth hormone treatment. In; Lifshitz F (ed): Pediatric Endocrinology. 3rd edition. New York: Marcel Dekker; 1996;61–81.
• 13. Kemp SF. Growth hormone treatment of idiopathic short stature: history and demographic data from the NCGS. Growth Horm IGF Res. 2005 Jul;15 Suppl A:S9-12.
• 14. Milner RD, Preece MA, Tanner JM. Growth in height compared with advancement in skeletal maturity in patients treated with human growth hormone. Arch Dis Child. 1980;55(6):461-6.
• 15. Radetti G, Buzi F, Paganini C, Martelli C, Adami S. A four year dose-response study of recombinant human growth hormone treatment of growth hormone deficient children: effects on growth, bone growth and bone mineralization. Eur J Endocrinol. 2000;142(1):42-6. 16. Frindik JP, Kemp SF, Sy JP. Effects of recombinant human growth hormone on height and skeletal maturation in growth hormone-deficient children with and without severe pretreatment bone age delay. Horm Res. 1999;51(1):15-9. 17. Bundak R, Hindmarsh PC, Smith PJ, Brook CG. Long-term auxologic effects of human growth hormone. J Pediatr. 1988;112(6):875-9.
• 18. Bettendorf M, Graf K, Nelle M, Heinrich UE, Tröger J. Metacarpal index in short stature before and during growth hormone treatment. Arch Dis Child. 1998;79(2):165-8.
• 19. Dündar B, Böber E, Büyükgebiz A. Results of growth hormone treatment applied during twelve years period in Dokuz Eylül University, school of medicine, Department of Pediatric Endocrinology. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi 2004;18: 55-65.
• 20. Leschek EW, Troendle JF, Yanovski JA, Rose SR, Bernstein DB, Cutler GB et al. Effect of growth hormone treatment on testicular function, puberty, and adrenarche in boys with non-growth hormone-deficient short stature: a randomized,double-blind, placebo-controlled trial. J Pediatr. 2001;138(3):406-10.
• 21. Cutler GB, Wit JM, Rekers-Mombarg LTM, Gill AM, Konkoy CS, Crowe BJ. Effect of growth hormone dose on bone maturation and puberty in children with idiopathic short stature. Pediatr Res. 2004;55(4):151a-a.