THE INFLUENCE OF GROWTH HORMONE TREATMENT ON INSULIN SENSITIVITY IN CHILDREN AND ADOLESCENTS

Öz

Objective: It has been reported that long-term growth hormone (GH) treatment may impair insulin sensitivity, hepatic glucose production, and insulin-dependent glucose utilization. In our study, we examined the effects of GH treatment on insulin sensitivity in patients with GH deficiency after one year treatment. Materials and Methods: Fifty-nine patients (22 female, 37 male) with GH deficiency who received GH therapy were included in this study. Anthropometric measurements and pubertal examination of the patients were done. Fasting plasma glucose (FPG), fasting plasma insulin (FPI), HbA1c levels were measured and OGTT (1.75 g/kg, max. 75 g) was performed before and one year after treatment. HOMA-IR and Matsuda indices were calculated. Result: The mean age of the patients at the start of GH treatment was 11.6±2.6 years old. The height standard deviation score (SDS) of the patients was -2.5±0.7, and the body mass index (BMI) SDS was -0.2±1.2. After one year, height SDS was-1.8±1.0 and BMI SDS was similar compared to baseline measurements. No difference was found between the initial and firstyear pubertal stages of the patients. At the end of the first year, FPG and HbA1c levels did not change. When baseline and the first year results were compared, FPI, peak insulin, and total insulin were significantly higher at the first year (p=0.037; p=0.05; p=0.017), and the Matsuda index was found to be significantly lower (p=0.009). While HOMA-IR was higher in the first year, the Conclusion: We observed that short-term GH treatment caused a decrease in insulin sensitivity, but did not reach disease-causing levels. It is important to monitor children receiving GH treatment for insulin resistance. We recommend further measurements of FPI and FPG, and performing OGTT to evaluate the degree of deterioration of glucose metabolism in risky patients.

Anahtar Kelimeler

• Growth hormone
• glucose metabolism
• insulin resistance
• oral glucose tolerance test

ÇOCUK VE ADOLESANLARDA BÜYÜME HORMONU TEDAVİSİNİN İNSÜLİN DUYARLILIĞI ÜZERİNE ETKİSİ

Öz

Amaç: Uzun dönem büyüme hormonu (BH) tedavisinin insülin duyarlılığını azaltabileceği, karaciğerde glukoz üretimi ve insülin bağımlı glukoz kullanımını bozabileceği bildirilmektedir. Çalışmamızda bir yıllık BH tedavisinin insülin duyarlılığı üzerine etkilerini incelemeyi amaçladık. Gereç ve Yöntem: Çalışmaya BH eksikliği tanısı ile BH kullanan59 hasta (22 kız, 37 erkek) dahil edildi. Antropometrik ölçümler ve puberte muayeneleri yapıldı. Tedavi öncesi ve tedavi sonrası birinci yılda plazma açlık glukoz (PAG), plazma açlık insülin (PAİ), HbA1c düzeyleri ölçüldü ve OGTT (1,75 g/kg maks 75 g) yapıldı. HOMA-IR ve Matsuda indeksleri hesaplandı. Bulgular: Tedavi öncesi hastaların ortalama yaşı (ort±SD) 11,6±2,6 yıl idi. Hastaların ortalama boy standart deviasyon skoru (SDS) değeri -2,5±0,7, vücut kitle indeksi (VKİ) -0,2±1,2 idi. Tedavi sonrası birinci yılda boy SDS -1,8±1,0, VKİ SDS başlangıç değerleri ile benzer idi. Tedavi öncesi ve sonrasında puberte evresi benzerdi. Birinci yıl sonunda PAG ve HbA1c düzeylerinde değişiklik saptanmadı. Tedavi öncesi ve tedavi sonrası karşılaştırıldığında, birinci yılda PAİ, zirve insülin ve toplam insülin düzeyleri anlamlı olarak daha yüksek idi (p=0,037; p=0,05; p=0,017). Matsuda indeks anlamlı olarak düşük saptandı (p=0,009). Tedavi sonrası HOMA-IR daha yüksek olmasına rağmen istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Çalışmamızın sonucunda, kısa dönem BH tedavisinin insülin duyarlılığında azalmaya sebep olduğunu ancak yine de hastalığa sebep olacak seviyelere ulaşmadığı sonucuna vardık. BH tedavisi alan hastaları insülin direnci açısından izlemek önemlidir. İzlem sırasında PAG ve PAİ ölçümü ve riskli hastalarda glukoz metabolizmasındaki bozulmaları belirlemek için OGTT yapılmasını önermekteyiz.

Anahtar Kelimeler

• Büyüme hormonu
• glukoz metabolizması
• insülin direnci
• oral glukoz tolerans testi

Kaynakça

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