Retinal Neural and Vascular Structure in Isolated Growth Hormone Deficiency Children and Evaluation of Growth Hormone Treatment Effect

Abstract

Objective:To evaluate neural and vascular retinal morphology of children with isolated growth hormone deficiency (GHD) and to determine any retinal changes due to GH treatment.Methods:Twenty-eight children with isolated GHD and 53 age-, gender- and body mass index-matched healthy volunteers were enrolled in this prospective study. The retinal nerve fibre layer (RNFL) and macular thickness (MT) were measured, as well as intraocular pressure (IOP). The number of retinal vascular branching points were calculated. Effect of GH treatment on the retina and IOP was evaluated after one year of treatment. Measurements were also made in the control group at baseline and following the initial examination. Pre- and post-treatment changes were compared. The findings were also compared with those of the controls. The correlation between ocular dimensions and insulin-like growth factor-I (IGF-1) levels were also analysed.Results: The number of branching points was significantly lower in GHD patients as compared with control subjects (15.11±2.67 and 19.70±3.37, respectively, p=0.05 for all comparisons). No statistically significant differences were found in mean RNFL, MT and IOP values between GHD patients and control subjects. GH treatment did not create any significant changes in the retinal vascularization or other retinal neural parameters and IOP either within the patient group or when compared with the control group. No correlations were observed between ocular dimensions and IGF-1 levels.Conclusion:Our findings suggest that isolated GHD may lead to decreased retinal vascularization. However, retinal neural growth and differentiation were not affected by GHD. These findings may be related to the fetal development process of pituitary somatotropic cells and the retina. Additionally, GH treatment did not cause any changes in retinal neural and vascular tissues.

Quantitative measures of the vascular and neural components of the retina in adult individuals with congenital and untreated growth hormone deficiency

“…GH-producing cells can be identified in the retina at nine weeks of gestation, while embryonic neural development occurs at an earlier period [37]. The normality of the normal nerve fiber layer thickness in our subjects argues against a possible role of pituitary GH and circulating IGF-I on the neural development of the retina as previously suggested [35]. It is commonly accepted that IGF-II has a greater effect when fetal somatic and ocular development is considered.…”

“…Another novel finding of the present study is the normal nerve fiber layer thickness in these subjects, coinciding with the normality of the macular thickness. Nerve fiber layer thickness was reported as thinner in congenital (not proven genetically) treated GHD children [ 34 ], in children with acquired GH deficiency [ 35 ], and in adult women with Sheehan syndrome, a model of acquired hypopituitarism with GH deficiency [ 36 ]. GH-producing cells can be identified in the retina at nine weeks of gestation, while embryonic neural development occurs at an earlier period [ 37 ].…”

Assessment of the retinal vasculature in healthy Chinese preschool children aged 4–6 years old using optical coherence tomography angiography

“…The relationships seemed comparable to the findings in the macula (vascular density increased with aging and then decreased with eye age). As a result, the developmental maturity of retinal vasculature in different regions is accomplished at almost the same periods, which might be due to elevation of certain growth-related hormones in preschool children [40].…”