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

Yıl 2017, Cilt: 15 Sayı: 2, 38 - 43, 01.08.2017

Enes Salı Halil Sağlam Erdal Eren Ömer Tarım

Öz

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. 

Anahtar Kelimeler

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

Kaynakça

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