Browse > Article
http://dx.doi.org/10.3345/kjp.2009.52.2.227

Factors for persistent growth hormone deficiency in young adults with childhood onset growth hormone deficiency  

Lee, Young Ah (Department of Pediatrics, College of Medicine, Seoul National University)
Chung, Hye Rim (Department of Pediatrics, College of Medicine, Seoul National University)
Lee, Se Min (Department of Pediatrics, College of Medicine, Hanyang University)
Kim, Jae Hyun (Department of Pediatrics, College of Medicine, Seoul National University)
Kim, Ji Hyun (Department of Pediatrics, College of Medicine, Seoul National University)
Lee, Sun Hee (Department of Pediatrics, College of Medicine, Seoul National University)
Shin, Choong Ho (Department of Pediatrics, College of Medicine, Seoul National University)
Yang, Sei Won (Department of Pediatrics, College of Medicine, Seoul National University)
Publication Information
Clinical and Experimental Pediatrics / v.52, no.2, 2009 , pp. 227-233 More about this Journal
Abstract
Purpose : Growth hormone (GH) replacement after retesting is necessary because impairment of body composition and cardiovascular health has been more severe in adult patients with persistent GH deficiency (GHD) from childhood to adulthood. This study aimed to investigate the factors for persistent GHD and define a highly probable group of persistent GHD in young adults with childhood-onset GHD. Methods : GHD was reassessed by insulin tolerance test (ITT) in 55 adult patients (39 males, 16 females) with childhood-onset GHD. Twelve patients presented with idiopathic GHD and 43 patients presented with organic GHD caused by tumors involving the hypothalamus-pituitary (H-P) region (n=33), other brain tumors (n=3), meningitis (n=3), leukemia (n=2) and others (n=2). Results : Forty-nine (89.1%) of 55 patients had persistent GHD. IGF-I was positively correlated with log of peak GH (r=0.57, P<0.001). There was no difference in the proportion of persistent GHD between idiopathic and organic GHD. The percentage of patients with persistent GHD was 40%, 80%, and 95.6% for patients with zero, one, two or more additional pituitary hormone deficiencies (PHDs), respectively (P=0.002). The probability of persistent GHD was higher in patients with diseases involving the H-P region (P=0.003). GHD persisted in 15 of 18 patients treated with cranial irradiation. Conclusion : We suggest that the probability of persistent GHD in adulthood was high in patients with 2 or more additional PHDs, and diseases involving the H-P region.
Keywords
Growth hormone deficiency; Insulin tolerance test; Adult; Child;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Johannsson G, Albertsson-Wikland K, Bengtsson BA. Discontinuation of growth hormone (GH) treatment: metabolic effects in GH-deficient and GH-sufficient adolescent patients compared with control subjects. Swedish Study Group for Growth Hormone Treatment in Children. J Clin Endocrinol Metab 1999:84:4516-24   DOI   ScienceOn
2 Hoffman DM, O'Sullivan AJ, Freund J, Ho KK. Adults with growth hormone deficiency have abnormal body composition but normal energy metabolism. J Clin Endocrinol Metab 1995;80:72-7   DOI   ScienceOn
3 Radovick S, DiVall S. Approach to the growth hormone- deficient child during transition to adulthood. J Clin Endocrinol Metab 2007;92:1195-200   DOI   ScienceOn
4 Clayton PE, Cuneo RC, Juul A, Monson JP, Shalet SM, Tauber M. Consensus statement on the management of the GH-treated adolescent in the transition to adult care. Eur J Endocrinol 2005;152:165-70   DOI   ScienceOn
5 Consensus guidelines for the diagnosis and treatment of adults with growth hormone deficiency: summary statement of the Growth Hormone Research Society Workshop on Adult Growth Hormone Deficiency. J Clin Endocrinol Metab 1998;83:379-81   DOI   ScienceOn
6 Guo SS, Chumlea WC, Roche AF, Siervogel RM. Age- and maturity-related changes in body composition during adolescence into adulthood: the Fels Longitudinal Study. Int J Obes Relat Metab Disord 1997;21:1167-75   DOI
7 Juul A, Kastrup KW, Pedersen SA, Skakkebaek NE. Growth hormone (GH) provocative retesting of 108 young adults with childhood-onset GH deficiency and the diagnostic value of insulin-like growth factor I (IGF-I) and IGF-binding protein-3. J Clin Endocrinol Metab 1997;82:1195-201   DOI   ScienceOn
8 Vestergaard P, Hoeck HC, Jakobsen PE, Laurberg P. Reproducibility of growth hormone and cortisol responses to the insulin tolerance test and the short ACTH test in normal adults. Horm Metab Res 1997;29:106-10   DOI   ScienceOn
9 Aimaretti G, Baffoni C, DiVito L, Bellone S, Grottoli S, Maccario M, et al. Comparisons among old and new provocative tests of GH secretion in 178 normal adults. Eur J Endocrinol 2000;142:347-52   DOI   ScienceOn
10 Biller BM, Samuels MH, Zagar A, Cook DM, Arafah BM, Bonert V, et al. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab 2002;87:2067-79   DOI   ScienceOn
11 Attanasio AF, Howell S, Bates PC, Blum WF, Frewer P, Quigley C, et al. Confirmation of severe GH deficiency after final height in patients diagnosed as GH deficient during childhood. Clin Endocrinol (Oxf) 2002;56:503-7   DOI   ScienceOn
12 Clayton PE, Price DA, Shalet SM. Growth hormone state after completion of treatment with growth hormone. Arch Dis Child 1987;62:222-6   DOI   ScienceOn
13 Maccario M, Grottoli S, Procopio M, Oleandri SE, Rossetto R, Gauna C, et al. The GH/IGF-I axis in obesity: influence of neuro-endocrine and metabolic factors. Int J Obes Relat Metab Disord 2000 ;24 Suppl 2:S96-9
14 DH Kim, EG Yoo. Reassessment of growth hormone status and metabolic disturbance in young adults with childhood- onset GH deficiency. Korean J Pediatr 2002;7:190-8
15 Nandagopal R, Laverdiere C, Mulrooney D, Hudson MM, Meacham L. Endocrine late effects of childhood cancer therapy: a report from the Children's Oncology Group. Horm Res 2008;69:65-74   DOI   ScienceOn
16 Maghnie M, Moretta A, Valtorta A, Larizza D, Sayegh M, Greco AM, et al. Growth hormone response to growth hormone-releasing hormone varies with the hypothalamic-pituitary abnormalities. Eur J Endocrinol 1996;135:198-204   DOI   ScienceOn
17 Hoeck HC, Jakobsen PE, Vestergaard P, Falhof J, Laurberg P. Differences in reproducibility and peak growth hormone responses to repeated testing with various stimulators in healthy adults. Growth Horm IGF Res 1999;9:18-24   DOI   ScienceOn
18 Nilsson AG, Svensson J, Johannsson G. Management of growth hormone deficiency in adults. Growth Horm IGF Res 2007;17:441-62   DOI   ScienceOn
19 Brennan BM, Rahim A, Mackie EM, Eden OB, Shalet SM. Growth hormone status in adults treated for acute lymphoblastic leukaemia in childhood. Clin Endocrinol (Oxf) 1998; 48:777-83   DOI   ScienceOn
20 Tauber M, Moulin P, Pienkowski C, Jouret B, Rochiccioli P. Growth hormone (GH) retesting and auxological data in 131 GH-deficient patients after completion of treatment. J Clin Endocrinol Metab 1997;82:352-6   DOI   ScienceOn
21 Jorgensen JO, Vahl N, Hansen TB, Skjaerbaek C, Fisker S, Orskov H, et al. Determinants of serum insulin-like growth factor I in growth hormone deficient adults as compared to healthy subjects. Clin Endocrinol (Oxf) 1998;48:479-86   DOI   ScienceOn
22 Cacciari E, Tassoni P, Parisi G, Pirazzoli P, Zucchini S, Mandini M, et al. Pitfalls in diagnosing impaired growth hormone (GH) secretion: retesting after replacement therapy of 63 patients defined as GH deficient. J Clin Endocrinol Metab 1992;74:1284-9   DOI
23 Ghigo E, Aimaretti G, Corneli G. Diagnosis of adult GH deficiency. Growth Horm IGF Res 2008;18:1-16   DOI   ScienceOn
24 Maghnie M, Strigazzi C, Tinelli C, Autelli M, Cisternino M, Loche S, et al. Growth hormone (GH) deficiency (GHD) of childhood onset: reassessment of GH status and evaluation of the predictive criteria for permanent GHD in young adults. J Clin Endocrinol Metab 1999;84:1324-8   DOI   ScienceOn
25 Attanasio AF, Shalet SM. Growth hormone and the transition from puberty into adulthood. Endocrinol Metab Clin North Am 2007;36:187-201   DOI   ScienceOn
26 Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML, et al. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2006;91: 1621-34   DOI   ScienceOn
27 Wacharasindhu S, Cotterill AM, Camacho-Hubner C, Besser GM, Savage MO. Normal growth hormone secretion in growth hormone insufficient children retested after completion of linear growth. Clin Endocrinol (Oxf) 1996;45:553-6   DOI   ScienceOn
28 Clayton PE, Shalet SM. Dose dependency of time of onset of radiation-induced growth hormone deficiency. J Pediatr 1991;118:226-8   DOI
29 Hartman ML, Crowe BJ, Biller BM, Ho KK, Clemmons DR, Chipman JJ. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency? J Clin Endocrinol Metab 2002;87:477-85   DOI   ScienceOn
30 Attanasio AF, Lamberts SW, Matranga AM, Birkett MA, Bates PC, Valk NK, et al. Adult growth hormone (GH)-deficient patients demonstrate heterogeneity between childhood onset and adult onset before and during human GH treatment. Adult Growth Hormone Deficiency Study Group. J Clin Endocrinol Metab 1997;82:82-8   DOI   ScienceOn