RUSSIAN ASSOCIATION OF ENDOCRINOLOGISTS NATIONAL PRACTICE GUIDELINES(CLINICAL SIGNS, DIAGNOSIS, DIFFERENTIAL DIAGNOSIS, TREATMENT). Hypopituitarism in children and adolescents

Nagaeva, Elena; Витальевна, Нагаева Елена

doi:10.14341/probl201359627-43

Cited by 4 publications

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“…Вторичный гипокортицизм (ВГК) также является одной из составляющих гипопитуитаризма. Диагностика дефицита СТГ и ВГК основана на оценке пиков концентраций СТГ и кортизола в ходе провокационных тестов [1].…”

Section: Abstract: Growth Hormone Deficiency Dwarfism; Adrenal Insufficiency; Children; Adolescentsunclassified

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Comparative study of glucagon and insulin tests for diagnostics of secondary adrenal insufficiency and growth hormone deficiency in children and adolescents

Vitebskaya

Писарева

Попович

2020

Probl Endokrinol (Mosk)

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BACKGROUND: Diagnostics of growth hormone deficiency (GHD) and secondary adrenal insufficiency (SAI) is based on estimation of peak GH and cortisol concentrations in provocation tests. Russian consensus on diagnostics and treatment of hypopituitarism in children and adolescences recommends to measure GH and cortisol concentrations in every time-point of insulin test (IT). Glucagon test (GT) is discussed in literature as alternative to IT.AIMS: To estimate the possibility to use provocation GT for diagnostics of SAI and GHD in children and adolescents.MATERIALS AND METHODS: We investigated blood and urine cortisol levels, IT, and GT in 20 patients 6.5–17.8 years (Me 13.0 (10.4; 15.3)) after surgery and/or radiology and/or chemical therapy of head and neck tumors; remission for 0.4–7.5 years (Ме 2.1 (1.5; 5.2)).RESULTS: With cut-off point 550 nmol/L sensitivity and specifity of IT was 100% and 60%, GT — 100% and 53% respectively. Minimal cortisol cut-off level for GT with sensitivity 100% was 500 nmol/L, maximal with specifity 100% — 400 nmol/L.Early morning cortisol levels did not exceed 250 nmol/l in 2 patients with SAI; and were above 500 nmol/l in 8 patients without SAI while primary or repeated examination.GHD was reviled by IT in all patients. Maximal GH concentrations in GT and IT did not differ significantly (p>0.05) but GT results of 4 patients exceeded or met cut-off for this test (7 ng/ml).GT was characterized by less severity compared with IT.CONCLUSIONS: For diagnostics of SAI by GT we can advise cut-off points of cortisol level 500 (sensitivity 100%, specifty 53%) and 400 nmol/L (sensitivity 80%, specifity 100%). Measuring of cortisol levels in 2–3 early morning blood samples allows to exclude or to suspect SAI in half of patients before tests. GH peaks in GT can exceed similarly data in IT that needs future investigation.

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Section: Abstract: Growth Hormone Deficiency Dwarfism; Adrenal Insufficiency; Children; Adolescentsunclassified

“…1). В связи с отсутствием клинических проявлений ВГК и достаточно высоким пиком кортизола в ходе ТГ пациенту №16 через год после основного обследования повторно проведен ТИ.…”

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Comparative study of glucagon and insulin tests for diagnostics of secondary adrenal insufficiency and growth hormone deficiency in children and adolescents

Vitebskaya

Писарева

Попович

2020

Probl Endokrinol (Mosk)

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“…Ауксологические показатели: 7. SDS роста при рождении -рассчитывался по формуле: SDS роста=(х-Х)/SD, где х -рост ребенка, Х -средний рост для данного хронологического возраста и пола, SD -стандартное отклонение роста для данного хронологического возраста и пола (при рождении для мальчиков российской популяции SD=2,02 см, Х=54,79 см, для девочек SD=2,02 см, Х=53,71 см [12]).…”

Section: методы регистрации исходовunclassified

Mathematical models for predicting final achieved height and its standard deviation rate in children with growth hormone deficiency in the Russian population

Gavrilova

Евгеньевна²,

Nagaeva

et al. 2017

Probl Endokrinol (Mosk)

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Background. Predicting the efficacy of rGH therapy in patients with GH deficiency, based on the final achieved height (FAH) criterion, is an important tool for the clinician. It enables a personalized approach to the treatment of patients with GH deficiency: to recommend careful adherence to the regimen and dosage of the drug, evaluate the efficacy of therapy in different groups of patients, and clearly demonstrate the factors affecting the FAH indicator. Aim — to develop mathematical models for predicting FAH and its standard deviation score (SDS) in patients with GH deficiency in the Russian population. Material and methods. For simulation, we used the data of 121 patients diagnosed with GH deficiency who received rGH since the time of diagnosis to the time of final height and were followed-up at the Institute of Pediatric Endocrinology of the Endocrinology Research Centre in the period between 1978 and 2016. As model predictors, we used 11 indicators: the gender, chronological age at the time of GH deficiency diagnosis, puberty status, disease form, regularity of rGH therapy, height SDS at birth, height SDS at the time of GH deficiency diagnosis, bone age at the time of GH deficiency diagnosis, bone age/chronological index, SDS of a genetically predicted height, and maximum stimulated GH level in a clonidine test. To generate models, we used multiple linear regression, artificial neural networks (ANNs), and the Statistica 13 software. Results. The developed ANNs demonstrated a high accuracy of predicting FAH (the root-mean-square error was 4.4 cm, and the explained variance fraction was 76%) and a lower accuracy of predicting the FAH SDS (the root-mean-square error was 0.601 SDS, and the explained variance fraction was 42%). Linear regression models that were based on quantitative predictors only had a substantially worse quality. Free software implementation was developed for the best produced ANN. Conclusion. An ANN-based software-implemented model for predicting FAH uses indicators available for any clinician as predictors and can be used for individual prediction of FAH. In the future, the use of larger databases for simulation will improve the quality of predicting the efficacy of rGH therapy.

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“…The relevance and practical significance of the study is determined by: -the need to achieve accelerated growth rates of the patient in the first years of treatment of hypopituitarism and their normalization in the future [5];…”

Section: Introductionmentioning

confidence: 99%

Information system for monitoring of hypopituitarism in childhood and adolescence

Rusakov

Krotova

2021

J. Phys.: Conf. Ser.

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The article is devoted to the development of a medical information system (MIS) designed to monitor and predict hypopituitarism in children and teenagers. MIS combines the medical information storage and management system with an intellectual system of medical decision-making support. The information system is based on a database with information obtained from impersonal medical discharge papers of children and adolescents of the Altai Territory diagnosed with hypopituitarism. Medical discharge papers provide information about the patient’s health status while in the hospital, the results of examinations and treatment. Discharges form a complete medical history of the patient, and the information system allows assessing the disease in dynamics. The purpose of the intelligent information system is to predict the patient's growth in order to select the optimal treatment strategy. The intelligent decision support system is based on a machine-learning model trained on data from a database. The model was trained in the Python programming language. The MIS interface is developed using the C # programming language. The use of MIS in medical institutions will allow doctors to carry out a personalized approach to the monitoring and predicting the growth for patients, and to choose the optimal trajectory of treatment.

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RUSSIAN ASSOCIATION OF ENDOCRINOLOGISTS NATIONAL PRACTICE GUIDELINES(CLINICAL SIGNS, DIAGNOSIS, DIFFERENTIAL DIAGNOSIS, TREATMENT). Hypopituitarism in children and adolescents

Cited by 4 publications

References 0 publications

Comparative study of glucagon and insulin tests for diagnostics of secondary adrenal insufficiency and growth hormone deficiency in children and adolescents

Comparative study of glucagon and insulin tests for diagnostics of secondary adrenal insufficiency and growth hormone deficiency in children and adolescents

Mathematical models for predicting final achieved height and its standard deviation rate in children with growth hormone deficiency in the Russian population

Information system for monitoring of hypopituitarism in childhood and adolescence

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