Growth Hormone Deficiency: Diagnosis and Therapy in Children

Abstract

Short stature has been defined as a height below the 2 standard deviation for age, sex and ethnicity. Growth hormone deficiency (GHD) represents a condition characterized by reduced GH secretion, isolated or associated with other pituitary hormone deficiencies. In a child with short stature and growth deceleration, after the exclusion of other causes of growth failure, the diagnosis of GHD has to be confirmed by measurement of GH secretion after at least two stimulation tests. Patients with GHD should be treated with rhGH as soon as possible, to obtain normalization of growth and normal final height. The catch-up growth in response to rhGH therapy is maximal during the first years and could be affected by many variables, such as birth-weight, age and height at start of treatment and of puberty, and duration of treatment. Overall, rhGH is believed to be safe and significant side-effects in children are very rare, including benign intracranial hypertension, hyperglycaemia, arthralgia and myalgia. Patients with childhood onset GHD are usually retested in late adolescence to confirm the GHD persistence and to continue of GH therapy. In conclusion, the present chapter provides useful and updated information about the diagnosis, treatment and follow-up of children with GHD.

Deficitul Izolat De Hormon De Creştere – Cauză Rară, Dar Tratabilă De Hipostatură

“…S-a efectuat IRM hipotalamo-hipofizar (conform protocolului naţional de diagnostic şi tratament cu Somatropinum), ce a evidenţiat adenohipofiză aplatizată cu dimensiuni mici 5,1/9/1,5 mm, volum 35 mm 3 (volum normal pentru vârstă: 119 ± 36 mm 3 ) - fig. 3 şi tijă pituitară filiformă -fig.…”

“…Prevalenţa acestei afecţiuni variază în studii între 1/3-4.000 şi 1/10.000 (1,2). DGH la copil poate fi prezent de la naştere (congenital) din cauza unor mutaţii genetice sau anomalii structurale de linie mediană, dobândit în timpul vieţii în urma unor infecţii, traumatisme, tumori, intervenţii chirurgicale, iradiere sau idiopatic (3). Deficitul congenital sever de GH cu debut neonatal este o boală rară, dar cu potenţial de a evolua cu glicemii ameninţătoare de viaţă din prima săptămână.…”

“…Abordarea practică în ceea ce priveşte diagnosticul neonatal nu este susţinută de prea multe dovezi în literatură (4). DGH poate fi izolat sau acompaniat de alte deficite hipofizare (1,3).…”

“…Clinic, DGH se caracterizează prin retard al creşterii cu statură joasă şi întârziere în maturare (3). Pe lângă hipoglicemie neonatală, alte manifestări precoce pot fi micropenis sau icter prelungit cu bilirubină conjugată.…”

Isolated growth hormone deficiency – a rare, but treatable cause of low stature

“…The prevalence of GHD is estimated at approximately 1/3-4 000 to 1/10,000 (1,2). GHD in children may be present at birth (congenital) due to a number of genetic mutation and structural anomalies of the midline or acquired (infections, trauma, tumors, surgical procedures, radiation or idiopathic) (3). Severe congenital GHD of the newborn is a rare disease, but it can cause life-threatening hypoglycemias from the first week of life.…”