Research Article
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Clinical Features of Children Treated with Growth Hormone: Single Center Experience

Year 2021, Volume: 15 Issue: 4, 287 - 293, 16.07.2021
https://doi.org/10.12956/tchd.754570

Abstract

Objective: In this study, we aimed to investigate the clinical features of children who received growth hormone (GH) treatment with a diagnosis of GH deficiency (GHD).

Material and Methods: The clinical features of children treated with GH treatment between 01.06.2013-31.12.2018 in a tertiary healthcare service were retrospectively analyzed. Children with isolated GHD and children with panhipopituitarism were compared.

Results: In total, 70 boys 118 children were included in the study. 78 (66.3%) of patients were treated with GH due to isoleted GHD, 14 (11.9%) due to bio-inactive GH syndrome, 9 (7.6%) due to panhypopituitarism, 6 (5.1%) due to GH neurosecretory dysfunction, 6 (5.1%) due to Turner syndrome and 5 (4.2%) due to off-label reasons.There were no significant diffrence between groups of isoleted GHD and panhipopituitarism regarding gender, age of diagnosis and oxological features at diagnosis. Serum IGF-1 SDS, IGFBP-3 SDS, TSH and pik GH response to klonidine test were lower in panhipopituitarism group (p=0.026, p=0.002, p=0.009 ve p=0.005, respectively). Significantly higher growth rates in the first 2 years in the patient with panhypopituitarism were determined (p<0.001 and p=0.005, respectively). A correlation was found between the growth rate in the first year and age of diagnosis, GH stimulation test responses, serum IGFBP-3 SDS and difference between chronologic age and bone age.


Conclusion:
Patients with panhypopituitarism had more significant laboratory findings for GHD at admission and better GH treatment responses in follow-up compared to patients with isolated GHD.

References

  • 1. Grimberg A, Lifshitz F. Worrisome growth. In: Lifshitz F, ed. Pediatric Endocrinology. 5th ed. New York: Infroma Heathcare USA; 2007:1-50.
  • 2. Esen İ, Demirel F, Tepe D, Demir B. Bir Çocuk Endokrinolojisi Ünitesine Başvuran Çocukların Klinik Özellikleri. Türkiye Çocuk Hastalıkları Dergisi 2011; 5: 133-8.
  • 3. Thomas M, Massa G, Craen M, et al. Prevalence and demographic features of childhood growth hormone deficiency in Belgium during the period 1986-2001. Eur J Endocrinol 2004; 151: 67-72.
  • 4. Bao XL, Shi YF, Du YC, Liu R, Deng JY, Gao SM. Prevalence of growth hormone deficiency of children in Beijing. Chinese medical journal 1992; 105: 401-5.
  • 5. Murray PG, Dattani MT, Clayton PE. Controversies in the diagnosis and management of growth hormone deficiency in childhood and adolescence. Arch Dis Child 2016; 101: 96-100.
  • 6. Neyzi O, Bundak R, Gokcay G, et al. Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. J Clin Res Pediatr Endocrinol 2015; 7: 280-93.
  • 7. Growth Hormone Research S. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. GH Research Society. J Clin Endocrinol Metab 2000; 85: 3990-3. 8. Sari S, Sari E, Akgun V, et al. Measures of pituitary gland and stalk: from neonate to adolescence. J Pediatr Endocrinol Metab 2014; 27: 1071-6.
  • 9. Soyöz Ö, Dündar B. Büyüme Hormonu Tedavisi Alan Çocukların Klinik Özellikleri ve Tedaviye Yanıtı Etkileyen Faktörler. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2016; 1: 7-13.
  • 10. Reiter EO, Price DA, Wilton P, Albertsson-Wikland K, Ranke MB. Effect of growth hormone (GH) treatment on the near-final height of 1258 patients with idiopathic GH deficiency: analysis of a large international database. J Clin Endocrinol Metab 2006; 91: 2047-54.
  • 11. Vuralli D, Gonc EN, Ozon ZA, Alikasifoglu A, Kandemir N. Clinical and laboratory parameters predicting a requirement for the reevaluation of growth hormone status during growth hormone treatment: Retesting early in the course of GH treatment. Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society 2017; 34: 31-7.
  • 12. Darendeliler F, Berberoğlu M, Öcal G, et al. Büyüme hormonu eksikliği etiyolojisi, demografik veriler ve tedavi sonuçlarının değerlendirilmesi: Türkiye verileri. KIGS (Pfizer Uluslar Arası Büyüme Veri Tabanı) analiz sonuçları. Çocuk Dergisi 2004; 3: 141-8.
  • 13. Rachmiel M, Rota V, Atenafu E, Daneman D, Hamilton J. Final height in children with idiopathic growth hormone deficiency treated with a fixed dose of recombinant growth hormone. Hormone research 2007; 68: 236-43.
  • 14. Polak M, Blair J, Kotnik P, Pournara E, Pedersen BT, Rohrer TR. Early growth hormone treatment start in childhood growth hormone deficiency improves near adult height: analysis from NordiNet(R) International Outcome Study. Eur J Endocrinol 2017; 177: 421-9.
  • 15. Çetinkaya E, Aycan Z, Kibar AE, Özkan S. Büyüme Hormonu Eksikliği Olan Çocuklarda Klasik Büyüme Hormonu Tedavisi Dozunu Azaltmak Mümkün mü? Türkiye Çocuk Hast Derg 2010; 4: 69-76.
  • 16. Kara O, Esen I, Tepe D, Gulleroglu NB, Tayfun M. Relevance of Pituitary Gland Magnetic Resonance Imaging Results with Clinical and Laboratory Findings in Growth Hormone Deficiency. Medical science monitor : international medical journal of experimental and clinical research 2018; 24: 9473-8.
  • 17. Kör Y. Büyüme hormonu eksikliği olgularında tanı ve tedaviye yanıtın değerlendirilmesi (Çocuk Endokrinolojisi Uzmanlık Tezi). Gaziantep: Gaziantep Üniversitesi, 2012.
  • 18. Centonze C, Guzzetti C, Orlando G, Loche S, Italian EI. Adherence to growth hormone (GH) therapy in naive to treatment GH-deficient children: data of the Italian Cohort from the Easypod Connect Observational Study (ECOS). J Endocrinol Invest 2019; 42: 1241-4.
  • 19. Witkowska-Sedek E, Borowiec A, Majcher A, Sobol M, Ruminska M, Pyrzak B. Thyroid function in children with growth hormone deficiency during long-term growth hormone replacement therapy. Central-European journal of immunology 2018; 43: 255-61.
  • 20. Keskin M, Bayramoglu E, Aycan Z. Effects of 1-year growth hormone replacement therapy on thyroid volume and function of the children and adolescents with idiopathic growth hormone deficiency. J Pediatr Endocrinol Metab 2017; 30: 1187-90.
  • 21. Giavoli C, Porretti S, Ferrante E, et al. Recombinant hGH replacement therapy and the hypothalamus-pituitary-thyroid axis in children with GH deficiency: when should we be concerned about the occurrence of central hypothyroidism? Clin Endocrinol (Oxf) 2003; 59: 806-10.
  • 22. Maghnie M, Lindberg A, Koltowska-Haggstrom M, Ranke MB. Magnetic resonance imaging of CNS in 15,043 children with GH deficiency in KIGS (Pfizer International Growth Database). Eur J Endocrinol 2013; 168: 211-7.
  • 23. Acharya SV, Gopal RA, Lila A, et al. Phenotype and radiological correlation in patients with growth hormone deficiency. Indian J Pediatr 2011; 78: 49-54.
  • 24. Huang YH, Wai YY, Van YH, Lo FS. Effect of growth hormone therapy on Taiwanese children with growth hormone deficiency. Journal of the Formosan Medical Association = Taiwan yi zhi 2012; 111: 355-63.
  • 25. Tanaka T, Cohen P, Clayton PE, Laron Z, Hintz RL, Sizonenko PC. Diagnosis and management of growth hormone deficiency in childhood and adolescence--part 2: growth hormone treatment in growth hormone deficient children. Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society 2002; 12: 323-41.
  • 26. Erdağ E. Büyüme hormonu eksikliğinin derecesini ve tedaviye alınacak yanıtı öngörmede bazal IGF-1 ve IGFBP 3 değerlerinin önemi (Çocuk Sağlığı ve Hastalıkları Uzmanlık Tezi). Ankara: Ankara Üniversitesi, 2012.
  • 27. Bekfilavioğlu S. Ondokuz Mayıs Üniversitesi Tıp Fakültesi Çocuk Endokrinolojisi Bilim Dalında Büyüme Hormonu tedavisi alan çocukların verilerinin retrospektif olarak değerlendirilmesi (Çocuk Sağlığı ve Hastalıkları Uzmanlık Tezi). Samsun: Ondokuz Mayıs Üniversitesi, 2017.
  • 28. Salı E, Sağlam H, Tarım Ö. Büyüme Hormonu Eksikliğinin Tanı Kriterleri Yeniden Değerlendirilmelidir. Güncel Pediatri 2012; 10: 74-9.
  • 29. Yılmaz Ö. İzole büyüme hormon eksikliği tanılı hastaların büyüme hormonu tedavisine yanıtları (Çocuk Sağlığı ve Hastalıkları Uzmanlık Tezi). Düzce: Düzce Üniversitesi, 2015.

Büyüme Hormonu Tedavisi Alan Çocukların Klinik  Çzellikleri: Tek Merkez Deneyimi

Year 2021, Volume: 15 Issue: 4, 287 - 293, 16.07.2021
https://doi.org/10.12956/tchd.754570

Abstract

Amaç: Bu çalışmada büyüme hormonu (BH) eksikliği tanısı ile BH tedavisi uygulanan çocukların klinik özelliklerinin incelenmesi amaçlanmıştır.


Gereç ve Yöntemler:
Bir üçüncü basamak sağlık merkezinde 01.06.2013-31.12.2018 tarihleri arasında BH tedavisi almış çocukların oksolojik, biyokimyasal, radyolojik bulguları ve tedavi yanıtları geriye dönük olarak incelendi. İzole büyüme hormon eksikliği (İBHE) ve panhipopitüitarizmli hasta grupları karşılaştırıldı.

Bulgular: Çalışmaya alınan 70’i erkek 118 hastanın 78’i (%66.3) İBHE, 14’ü (%11.9) biyoinaktif BH sendromu, 9’u (%7.6) panhipopitüitarizm, 6’sı (%5.1) BH nörosekretuar disfonksiyonu, 6’sı (%5.1) Turner sendromu, 5’i (%4.2) endikasyon dışı nedenler ile BH tedavisi almışlardı. İBHE ve panhipopitüarizmli çocuklar karşılaştırıldığında cinsiyet dağılımı, tanı yaşı ve başvuru oksolojik özellikleri açısından gruplar arasında bir fark saptanmadı. Panhipopituitarizmli çocuklarda serum IGF-1 SDS, IGFBP-3 SDS, TSH düzeyleri ve klonidin testinde zirve BH yanıtı daha düşük saptandı (sırası ile p=0.026, p=0.002, p=0.009 ve p=0.005). BH tedavisi ile uzama hızı panhipopitüitarizmli grupta ilk 2 yılda anlamlı olarak daha fazla saptandı (1. yıl p<0.001, 2. yıl p=0.005). Hastaların 1. yıl uzama hızı ile tanı yaşı, tanıda takvim yaşı kemik yaşı farkı, BH uyarı testi yanıtları ve IGFBP-3 SDS arasında korelasyon saptandı.

Sonuç: Panhipopitüitarizmli hastaların İBHE olanlara nazaran başvuruda BH eksiliği lehine laboratuvar bulgularının daha belirgin ve izlemde BH tedavi yanıtlarının daha iyi olduğu gözlendi.

Thanks

Bu makale Doç. Dr. İhsan ESEN’ın danışmanlığında Dr. Serap KILIÇ tarafın yapılmış “Büyüme Hormonu Tedavisi Alan Çocuk Hastaların Klinik Özellikleri” isimli çocuk sağlığı ve hastalıkları uzmanlık tezinden türetilmiştir.

References

  • 1. Grimberg A, Lifshitz F. Worrisome growth. In: Lifshitz F, ed. Pediatric Endocrinology. 5th ed. New York: Infroma Heathcare USA; 2007:1-50.
  • 2. Esen İ, Demirel F, Tepe D, Demir B. Bir Çocuk Endokrinolojisi Ünitesine Başvuran Çocukların Klinik Özellikleri. Türkiye Çocuk Hastalıkları Dergisi 2011; 5: 133-8.
  • 3. Thomas M, Massa G, Craen M, et al. Prevalence and demographic features of childhood growth hormone deficiency in Belgium during the period 1986-2001. Eur J Endocrinol 2004; 151: 67-72.
  • 4. Bao XL, Shi YF, Du YC, Liu R, Deng JY, Gao SM. Prevalence of growth hormone deficiency of children in Beijing. Chinese medical journal 1992; 105: 401-5.
  • 5. Murray PG, Dattani MT, Clayton PE. Controversies in the diagnosis and management of growth hormone deficiency in childhood and adolescence. Arch Dis Child 2016; 101: 96-100.
  • 6. Neyzi O, Bundak R, Gokcay G, et al. Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. J Clin Res Pediatr Endocrinol 2015; 7: 280-93.
  • 7. Growth Hormone Research S. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. GH Research Society. J Clin Endocrinol Metab 2000; 85: 3990-3. 8. Sari S, Sari E, Akgun V, et al. Measures of pituitary gland and stalk: from neonate to adolescence. J Pediatr Endocrinol Metab 2014; 27: 1071-6.
  • 9. Soyöz Ö, Dündar B. Büyüme Hormonu Tedavisi Alan Çocukların Klinik Özellikleri ve Tedaviye Yanıtı Etkileyen Faktörler. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2016; 1: 7-13.
  • 10. Reiter EO, Price DA, Wilton P, Albertsson-Wikland K, Ranke MB. Effect of growth hormone (GH) treatment on the near-final height of 1258 patients with idiopathic GH deficiency: analysis of a large international database. J Clin Endocrinol Metab 2006; 91: 2047-54.
  • 11. Vuralli D, Gonc EN, Ozon ZA, Alikasifoglu A, Kandemir N. Clinical and laboratory parameters predicting a requirement for the reevaluation of growth hormone status during growth hormone treatment: Retesting early in the course of GH treatment. Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society 2017; 34: 31-7.
  • 12. Darendeliler F, Berberoğlu M, Öcal G, et al. Büyüme hormonu eksikliği etiyolojisi, demografik veriler ve tedavi sonuçlarının değerlendirilmesi: Türkiye verileri. KIGS (Pfizer Uluslar Arası Büyüme Veri Tabanı) analiz sonuçları. Çocuk Dergisi 2004; 3: 141-8.
  • 13. Rachmiel M, Rota V, Atenafu E, Daneman D, Hamilton J. Final height in children with idiopathic growth hormone deficiency treated with a fixed dose of recombinant growth hormone. Hormone research 2007; 68: 236-43.
  • 14. Polak M, Blair J, Kotnik P, Pournara E, Pedersen BT, Rohrer TR. Early growth hormone treatment start in childhood growth hormone deficiency improves near adult height: analysis from NordiNet(R) International Outcome Study. Eur J Endocrinol 2017; 177: 421-9.
  • 15. Çetinkaya E, Aycan Z, Kibar AE, Özkan S. Büyüme Hormonu Eksikliği Olan Çocuklarda Klasik Büyüme Hormonu Tedavisi Dozunu Azaltmak Mümkün mü? Türkiye Çocuk Hast Derg 2010; 4: 69-76.
  • 16. Kara O, Esen I, Tepe D, Gulleroglu NB, Tayfun M. Relevance of Pituitary Gland Magnetic Resonance Imaging Results with Clinical and Laboratory Findings in Growth Hormone Deficiency. Medical science monitor : international medical journal of experimental and clinical research 2018; 24: 9473-8.
  • 17. Kör Y. Büyüme hormonu eksikliği olgularında tanı ve tedaviye yanıtın değerlendirilmesi (Çocuk Endokrinolojisi Uzmanlık Tezi). Gaziantep: Gaziantep Üniversitesi, 2012.
  • 18. Centonze C, Guzzetti C, Orlando G, Loche S, Italian EI. Adherence to growth hormone (GH) therapy in naive to treatment GH-deficient children: data of the Italian Cohort from the Easypod Connect Observational Study (ECOS). J Endocrinol Invest 2019; 42: 1241-4.
  • 19. Witkowska-Sedek E, Borowiec A, Majcher A, Sobol M, Ruminska M, Pyrzak B. Thyroid function in children with growth hormone deficiency during long-term growth hormone replacement therapy. Central-European journal of immunology 2018; 43: 255-61.
  • 20. Keskin M, Bayramoglu E, Aycan Z. Effects of 1-year growth hormone replacement therapy on thyroid volume and function of the children and adolescents with idiopathic growth hormone deficiency. J Pediatr Endocrinol Metab 2017; 30: 1187-90.
  • 21. Giavoli C, Porretti S, Ferrante E, et al. Recombinant hGH replacement therapy and the hypothalamus-pituitary-thyroid axis in children with GH deficiency: when should we be concerned about the occurrence of central hypothyroidism? Clin Endocrinol (Oxf) 2003; 59: 806-10.
  • 22. Maghnie M, Lindberg A, Koltowska-Haggstrom M, Ranke MB. Magnetic resonance imaging of CNS in 15,043 children with GH deficiency in KIGS (Pfizer International Growth Database). Eur J Endocrinol 2013; 168: 211-7.
  • 23. Acharya SV, Gopal RA, Lila A, et al. Phenotype and radiological correlation in patients with growth hormone deficiency. Indian J Pediatr 2011; 78: 49-54.
  • 24. Huang YH, Wai YY, Van YH, Lo FS. Effect of growth hormone therapy on Taiwanese children with growth hormone deficiency. Journal of the Formosan Medical Association = Taiwan yi zhi 2012; 111: 355-63.
  • 25. Tanaka T, Cohen P, Clayton PE, Laron Z, Hintz RL, Sizonenko PC. Diagnosis and management of growth hormone deficiency in childhood and adolescence--part 2: growth hormone treatment in growth hormone deficient children. Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society 2002; 12: 323-41.
  • 26. Erdağ E. Büyüme hormonu eksikliğinin derecesini ve tedaviye alınacak yanıtı öngörmede bazal IGF-1 ve IGFBP 3 değerlerinin önemi (Çocuk Sağlığı ve Hastalıkları Uzmanlık Tezi). Ankara: Ankara Üniversitesi, 2012.
  • 27. Bekfilavioğlu S. Ondokuz Mayıs Üniversitesi Tıp Fakültesi Çocuk Endokrinolojisi Bilim Dalında Büyüme Hormonu tedavisi alan çocukların verilerinin retrospektif olarak değerlendirilmesi (Çocuk Sağlığı ve Hastalıkları Uzmanlık Tezi). Samsun: Ondokuz Mayıs Üniversitesi, 2017.
  • 28. Salı E, Sağlam H, Tarım Ö. Büyüme Hormonu Eksikliğinin Tanı Kriterleri Yeniden Değerlendirilmelidir. Güncel Pediatri 2012; 10: 74-9.
  • 29. Yılmaz Ö. İzole büyüme hormon eksikliği tanılı hastaların büyüme hormonu tedavisine yanıtları (Çocuk Sağlığı ve Hastalıkları Uzmanlık Tezi). Düzce: Düzce Üniversitesi, 2015.
There are 28 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Serap Kılıç This is me 0000-0002-4743-6245

İhsan Esen 0000-0003-1700-6778

Publication Date July 16, 2021
Submission Date June 18, 2020
Published in Issue Year 2021 Volume: 15 Issue: 4

Cite

Vancouver Kılıç S, Esen İ. Büyüme Hormonu Tedavisi Alan Çocukların Klinik  Çzellikleri: Tek Merkez Deneyimi. Türkiye Çocuk Hast Derg. 2021;15(4):287-93.


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