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Doknic M, Stojanovic M, Soldatovic I, Milenkovic T, Zdravkovic V, Jesic M, Todorovic S, Mitrovic K, Vukovic R, Miljic D, Savic D, Milicevic M, Stanimirovic A, Bogosavljevic V, Pekic S, Manojlovic-Gacic E, Djukic A, Grujicic D, Petakov M. Mapping the journey of transition: a single-center study of 170 childhood-onset GH deficiency patients. Endocr Connect 2021; 10:935-946. [PMID: 34259648 PMCID: PMC8428021 DOI: 10.1530/ec-21-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/14/2021] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To analyze metabolic parameters, body composition (BC), and bone mineral density (BMD) in childhood-onset GH deficiency (COGHD) patients during the transition period (TP). DESIGN Single- center, retrospective study was performed on 170 consecutive COGHD patients (age 19.2 ± 2.0 years, range 16-25) transferred after growth completion from two pediatric clinics to the adult endocrine unit. Two separate analyses were performed: (i) cross-sectional analysis of hormonal status, metabolic parameters, BC, and BMD at first evaluation after transfer from pediatrics to the adult department; (ii) longitudinal analysis of BC and BMD dynamics after 3 years of GH replacement therapy (rhGH) in TP. RESULTS COGHD was of a congenital cause (CONG) in 50.6% subjects, tumor-related (TUMC) in 23.5%, and idiopathic (IDOP) in 25.9%. TUMC patients had increased insulin and lipids levels (P < 0.01) and lower Z score at L-spine (P < 0.05) compared to CONG and IDOP groups. Patients treated with rhGH in childhood demonstrated lower fat mass and increased BMD compared to the rhGH-untreated group (P < 0.01). Three years of rhGH after growth completion resulted in a significant increase in lean body mass (12.1%) and BMD at L-spine (6.9%), parallel with a decrease in FM (5.2%). CONCLUSION The effect of rhGH in childhood is invaluable for metabolic status, BC, and BMD in transition to adulthood. Tumor-related COGHD subjects are at higher risk for metabolic abnormalities, alteration of body composition, and decreased BMD, compared to those with COGHD of other causes. Continuation of rhGH in transition is important for improving BC and BMD in patients with persistent COGHD.
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Affiliation(s)
- Mirjana Doknic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Correspondence should be addressed to M Doknic:
| | - Marko Stojanovic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Medical Statistics and Informatics, Belgrade, Serbia
| | - Tatjana Milenkovic
- Mother and Child Health Care Institute of Serbia ‘Dr Vukan Cupic’, Belgrade, Serbia
| | - Vera Zdravkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- University Children’s Clinic, Belgrade, Serbia
| | - Maja Jesic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- University Children’s Clinic, Belgrade, Serbia
| | - Sladjana Todorovic
- Mother and Child Health Care Institute of Serbia ‘Dr Vukan Cupic’, Belgrade, Serbia
| | - Katarina Mitrovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Mother and Child Health Care Institute of Serbia ‘Dr Vukan Cupic’, Belgrade, Serbia
| | - Rade Vukovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Mother and Child Health Care Institute of Serbia ‘Dr Vukan Cupic’, Belgrade, Serbia
| | - Dragana Miljic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Savic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Mihajlo Milicevic
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Vojislav Bogosavljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sandra Pekic
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Emilija Manojlovic-Gacic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Djukic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Danica Grujicic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Petakov
- Neuroendocrine Department, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Ahmid M, Ahmed SF, Shaikh MG. Childhood-onset growth hormone deficiency and the transition to adulthood: current perspective. Ther Clin Risk Manag 2018; 14:2283-2291. [PMID: 30538484 PMCID: PMC6260189 DOI: 10.2147/tcrm.s136576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Childhood-onset growth hormone deficiency (CO-GHD) is an endocrine condition associated with a broad range of health issues from childhood through to adulthood, which requires particular attention during the transition period from adolescence to young adulthood. There is uncertainty in the clinical practice of the management of CO-GHD during transition regarding the clinical assessment and management of individual patients during and after transition to obtain optimal follow-up and improved health outcomes. Despite the availability of clinical guidelines providing the framework for transition of young adults with CO-GHD, there remains substantial variation in approaching transitional care among pediatric and adult services. A well-structured and coordinated transitional plan with clear communication and direct collaboration between pediatric and adult health care to ensure optimal management of adolescents with CO-GHD during transition is needed.
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Affiliation(s)
- M Ahmid
- Development Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK,
| | - S F Ahmed
- Development Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK,
| | - M G Shaikh
- Development Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK,
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Çamtosun E, Şıklar Z, Berberoğlu M. Prospective Follow-up of Children with Idiopathic Growth Hormone Deficiency After Termination of Growth Hormone Treatment: Is There Really Need for Treatment at Transition to Adulthood? J Clin Res Pediatr Endocrinol 2018; 10:247-255. [PMID: 29553045 PMCID: PMC6083473 DOI: 10.4274/jcrpe.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Continuation of growth hormone (GH) treatment in adolescents with severe childhood onset idiopathic GH deficiency (IGHD) during the transition period, irrespective of achievement of final height, is still debatable. We aimed to prospectively investigate the metabolic profile, bone mineral density (BMD) and body composition of patients with IGHD in whom GH treatments were terminated after they had reached their final height, six months after the cessation of therapy. METHODS Twelve patients, six of whom had peak GH levels <5 ng/mL [permanent GH deficiency (GHD), group 1], and six who had peak GH levels >5 ng/mL (transient GHD, group 2) after insulin stimulation test were evaluated for anthropometric and laboratory parameters including fasting blood glucose (FBG), fasting insulin, lipid profile, BMD, body composition measurements and 24-hour ambulatory blood pressure monitoring before (baseline) and at six months after discontinuation of GH. RESULTS No differences were found in clinical, laboratory, BMD and body composition measures between groups 1 and 2 at baseline. All IGHD patients had significant increments of body weight (BW), body mass index (BMI), BMD, total body fat (TBF), TBF%, truncal fat (TF) and TF% after GH cessation. Six months later BW, BMI, BMD and TF% was increased significantly while FBG and lipids showed no change in group 1. In group 2, TBF% and TF% were increased, FBG, total cholesterol and high-density lipoprotein decreased after six months. Changes in these parameters in group 2 were not statistically different from group1. CONCLUSION TF% increase in both groups after cessation of therapy. We did not observe a clinical condition requiring GH treatment in any of the study subjects during the follow-up period.
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Affiliation(s)
- Emine Çamtosun
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey Phone: +90 505 342 21 69 E-mail:
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Amer NM, Modesto MJ, Dos Santos CD, Erichsen O, Mascarenhas LPG, Nesi-França S, Marques-Pereira R, De Lacerda L. Resistance exercise alone improves muscle strength in growth hormone deficient males in the transition phase. J Pediatr Endocrinol Metab 2018; 31:887-894. [PMID: 30052519 DOI: 10.1515/jpem-2017-0369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 05/28/2018] [Indexed: 11/15/2022]
Abstract
Background During the transition phase (TP), patients with growth hormone deficiency (GHD) exhibit decreased muscle strength. Studies assessing the effects of resistance exercise alone on muscle strength in these individuals are scarce. The objective of this study was to evaluate the effects of a program of resistance exercise (PRE) on parameters of muscle strength in subjects in the TP and with childhood-onset GHD treated with recombinant GH (rGH). Methods Sixteen male patients were enrolled and divided into two groups: GHD (n=9) and GH sufficiency (GHS, n=7). Patients with GHD underwent a 12-week PRE followed by another 12-week PRE plus rGH, while GHS patients underwent a 12-week PRE alone. Dynamic knee muscle strength was evaluated using an isokinetic dynamometer. Results Before PRE, there were significant differences between the groups regarding the results of flexor peak torque (FPT) normalized to body weight (BW-FPT) in the dominant (DO, p=0.008) and non-dominant (ND, p=0.01) limbs, and in the agonist/antagonist (A/A) ratio in the DO (p=0.02) and ND (p=0.006) limbs. After PRE in the GHD group, values of FPT and BW-FPT in both limbs increased significantly (p<0.001) and independently of rGH, while the A/A ratio value improved significantly (p<0.001) in the ND limb. Conclusions A short period of PRE alone was sufficient to improve parameters of muscle strength in young male adults with childhood-onset GHD.
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Affiliation(s)
- Nadia Mohamad Amer
- Children and Adolescent Health Post-Graduate Program, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Marilza J Modesto
- Children and Adolescent Health Post-Graduate Program, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Cláudia Duarte Dos Santos
- Children and Adolescent Health Post-Graduate Program, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Oscar Erichsen
- Department of Physiology, Clube Atlético Paranaense, Curitiba, Paraná, Brazil
| | - Luis P G Mascarenhas
- Children and Adolescent Health Post-Graduate Program, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Suzana Nesi-França
- Pediatric Endocrinology Unit, Department of Pediatrics, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Rosana Marques-Pereira
- Pediatric Endocrinology Unit, Department of Pediatrics, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Luiz De Lacerda
- Pediatric Endocrinology Unit, Department of Pediatrics, Federal University of Paraná, Curitiba, Paraná, Brazil
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Improda N, Capalbo D, Esposito A, Salerno M. Muscle and skeletal health in children and adolescents with GH deficiency. Best Pract Res Clin Endocrinol Metab 2016; 30:771-783. [PMID: 27974190 DOI: 10.1016/j.beem.2016.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In addition to promoting linear growth, GH plays a key role in the regulation of bone and muscle development and metabolism. Although GH deficiency is frequently listed among the causes of secondary osteoporosis in children, its impact on bone and muscle health and on fracture risk is still not completely established. Current data suggest that childhood-onset GH deficiency can affect bone and muscle mass and strength, with GH replacement therapy exerting beneficial effects. Moreover, GH withdrawal at final height can result in reduced peak bone and muscle mass, potentially leading to increased fracture risk in adulthood. Thus, the muscle-bone unit in GH deficient subjects should be monitored during childhood and adolescence in order to prevent osteoporosis and increased fracture risk and GH replacement should be tailored to ensure an optimal bone and muscle health.
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Affiliation(s)
- Nicola Improda
- Department of Medical Translational Sciences, Paediatric Endocrinology Section, Federico II University, Via S. Pansini 5, 80131 Naples, Italy.
| | - Donatella Capalbo
- Department of Paediatrics, Federico II University, Via S. Pansini 5, 80131 Naples, Italy.
| | - Andrea Esposito
- Department of Medical Translational Sciences, Paediatric Endocrinology Section, Federico II University, Via S. Pansini 5, 80131 Naples, Italy.
| | - Mariacarolina Salerno
- Department of Medical Translational Sciences, Paediatric Endocrinology Section, Federico II University, Via S. Pansini 5, 80131 Naples, Italy.
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Ahmid M, Perry CG, Ahmed SF, Shaikh MG. Growth hormone deficiency during young adulthood and the benefits of growth hormone replacement. Endocr Connect 2016; 5:R1-R11. [PMID: 27129699 PMCID: PMC5002964 DOI: 10.1530/ec-16-0024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/28/2016] [Indexed: 02/05/2023]
Abstract
Until quite recently, the management of children with growth hormone deficiency (GHD) had focussed on the use of recombinant human GH (rhGH) therapy to normalise final adult height. However, research over the past two decades that has demonstrated deficits in bone health and cardiac function, as well as impaired quality of life in adults with childhood-onset GHD (CO-GHD), has questioned this practice. Some of these studies suggested that there may be short-term benefits of rhGH in certain group of adolescents with GHD during transition, although the impact of GHD and replacement during the transition period has not been adequately investigated and its long-term benefits remain unclear. GH therapy remains expensive and well-designed long-term studies are needed to determine the cost effectiveness and clinical benefit of ongoing rhGH during transition and further into adulthood. In the absence of compelling data to justify widespread continuation of rhGH into adult life, there are several questions related to its use that remain unanswered. This paper reviews the effects of growth hormone deficiency on bone health, cardiovascular function, metabolic profile and quality of life during transition and young adulthood.
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Affiliation(s)
- M Ahmid
- Developmental Endocrinology Research GroupRoyal Hospital for Children, School of Medicine, University of Glasgow, Glasgow, UK
| | - C G Perry
- Department of EndocrinologyQueen Elizabeth University Hospitals, Glasgow, UK
| | - S F Ahmed
- Developmental Endocrinology Research GroupRoyal Hospital for Children, School of Medicine, University of Glasgow, Glasgow, UK
| | - M G Shaikh
- Developmental Endocrinology Research GroupRoyal Hospital for Children, School of Medicine, University of Glasgow, Glasgow, UK
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Filipsson Nyström H, Barbosa EJL, Nilsson AG, Norrman LL, Ragnarsson O, Johannsson G. Discontinuing long-term GH replacement therapy--a randomized, placebo-controlled crossover trial in adult GH deficiency. J Clin Endocrinol Metab 2012; 97:3185-95. [PMID: 22791760 DOI: 10.1210/jc.2012-2006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Adult GH deficiency (GHD) is associated with impaired quality of life (QoL) and increased cardiovascular risk. Continued long-term efficacy in terms of QoL and cardiovascular risk factors has been indicated in open surveillance studies. OBJECTIVES The aim was to study the impact of discontinuation of long-term GH replacement on QoL, body composition, and metabolism. DESIGN AND SETTING We conducted a randomized, double-blind, placebo-controlled 4-month crossover trial in a referral center. PATIENTS Sixty adult hypopituitary patients with GHD and more than 3 yr of continuous GH replacement therapy (mean treatment duration, 10 yr) participated in the study. INTERVENTION Patients received GH or placebo. MAIN OUTCOME MEASUREMENTS We measured QoL using validated questionnaires; body composition using computer tomography, dual-energy x-ray absorptiometry, and bioelectrical impedance spectroscopy; and insulin sensitivity using the short insulin tolerance test. RESULTS Mean serum IGF-I decreased from 168 ± 52 to 98 ± 47 μg/liter during the placebo period (P < 0.001). Two QoL domains (emotional reactions and positive well-being) in the Nottingham Health Profile and Psychological General Well-Being questionnaires deteriorated during placebo, compared with GH treatment (P < 0.05). Waist circumference and sc and visceral fat mass increased, and extracellular water and muscle area decreased during the placebo period (all P < 0.05). C-reactive protein and total-, low-density lipoprotein-, and high-density lipoprotein-cholesterol increased, and insulin sensitivity improved during placebo, compared to GH treatment (P < 0.05). CONCLUSION After more than 3 yr of GH replacement therapy, a 4-month period of placebo treatment caused self-perceived deterioration in QoL and increased abdominal fat accumulation. Moreover, markers of systemic inflammation and lipid status deteriorated, whereas insulin sensitivity improved. Long-term continuous GH replacement is needed to maintain therapeutic effects of GH on QoL and cardiovascular risk factors.
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Affiliation(s)
- Helena Filipsson Nyström
- Department of Endocrinology, Sahlgrenska University Hospital, and Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-41345 Göteborg, Sweden.
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Impacto presupuestario de la utilización de hormona de crecimiento de la edad pediátrica a la adulta. FARMACIA HOSPITALARIA 2012; 36:3-10. [DOI: 10.1016/j.farma.2010.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 11/17/2010] [Accepted: 11/22/2010] [Indexed: 11/20/2022] Open
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Bechtold S, Bachmann S, Putzker S, Dalla Pozza R, Schwarz HP. Early changes in body composition after cessation of growth hormone therapy in childhood-onset growth hormone deficiency. J Clin Densitom 2011; 14:471-7. [PMID: 21723762 DOI: 10.1016/j.jocd.2011.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 11/15/2022]
Abstract
At final height, somatic maturity has not been reached yet. We investigated bone and body composition in patients, who completed pediatric growth hormone (GH) treatment at final height. After a mean period of 0.55 ± 0.17 yr off GH treatment 90 (66 m/24 f) childhood-onset growth hormone deficiency (GHD) patients were reinvestigated for GHD by insulin tolerance testing at a mean age of 17.52 ± 1.50 yr. Thirty-seven (25 m/12 f) patients remained GH deficient (persistent GHD). Bone and body composition were measured using peripheral quantitative computed tomography of the nondominant forearm. Bone mineral density (BMD) was within normal limits. Total cross-sectional bone area Z-score (0.64 ± 1.3) was significantly higher as a result of an enlarged medullary cavity Z-score (1.12 ± 1.2) leading to reduction of cortical thickness Z-score (-1.21 ± 1.0). Patients with persistent GHD had a significantly higher fat mass (13.3 ± 8.7 and 6.8 ± 4.6 cm(2), p<0.05), which was more pronounced in multiple pituitary hormone deficiency patients. Shortly after cessation of GH treatment in patients treated for childhood-onset GHD age adequate normal BMD and enlarged diaphysis was detectable. Patients with persistent GHD status had a significant higher fat mass.
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Affiliation(s)
- Susanne Bechtold
- University Children's Hospital, Division of Endocrinology and Diabetology, Munich, Germany.
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Conway GS, Szarras-Czapnik M, Racz K, Keller A, Chanson P, Tauber M, Zacharin M. Treatment for 24 months with recombinant human GH has a beneficial effect on bone mineral density in young adults with childhood-onset GH deficiency. Eur J Endocrinol 2009; 160:899-907. [PMID: 19324976 DOI: 10.1530/eje-08-0436] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Discontinuation of growth hormone (GH) therapy on completion of linear growth may adversely affect bone mineral density (BMD) in young adults with childhood-onset GH-deficiency (GHD). In the present study, we analyzed the impact of GH treatment on bone in young adults with GHD. METHODS BMD at the lumbar spine (L2-L4), total hip, and total body was measured at baseline and after 24 months in a cohort of young adults (18-25 years; n=160) with severe GHD treated with GH during childhood who were randomized to GH (n=109) or no treatment (n=51) in a multicenter, multinational, open-label study. GH starting doses (0.2 mg/day (males), 0.4 mg/day (females)) were increased after 1 month to 0.6 mg/day (males) and 0.9 mg/day (females) and then to 1.0 mg/day (males) and 1.4 mg/day (females) at 3 months for the remainder of the study. RESULTS After 24 months, lumbar spine BMD had increased significantly more in GH-treated patients than in controls (6 vs 2%; estimated treatment difference; 3.5% (95% confidence interval, 1.52-5.51) P<0.001). GH also had a significant positive effect on total hip BMD (P=0.015). Total body BMD was unchanged from baseline (P=0.315). CONCLUSIONS In young adults treated for childhood-onset GHD, there is a beneficial effect of continued GH treatment on BMD in adult life. Twenty-four months of GH treatment in these young adults was associated with an estimated 3.5% greater increase in BMD of the lumbar spine compared with controls.
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Affiliation(s)
- G S Conway
- Department of Endocrinology and Diabetes, University College London Hospitals, 250 Euston Road, London NW1 2PQ, UK.
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Portes ES, Barbosa E. [Management of the growth hormone (GH)-treated patients with diagnosis of GH deficiency (DGH) during transition from childhood to adulthood]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2008; 52:854-860. [PMID: 18797593 DOI: 10.1590/s0004-27302008000500018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Accepted: 06/08/2008] [Indexed: 05/26/2023]
Abstract
Growth hormone (GH) has many beneficial effects in patients with childhood-onset GH deficiency (GHD) in addition to its promotion of linear growth. The discontinuation of GH treatment in GHD patients, during the transition from childhood to adulthood, induces significant unfavorable changes in body composition, skeletal integrity, exercise capacity, and an adverse cardiovascular risk profile. These changes are reversed after the resumption of GH treatment. As the benefits of continuing GH therapy into adulthood has been well established, it is possible that GH replacement therapy will not be stopped once growth has been completed, but it will continue into adult life. Considering that a high proportion of patients with diagnosis of DGH in childhood are no longer GHD in adolescence, the GH status must be retested when growth is completed. Other factors such as clinical history, GH response in childhood, hipotalamic-pituitary MRI and IGF-1 concentration must be considered. Reconfirmation of GHD diagnosis through stimulation testing is usually required, unless there is a proven genetic or structural lesion persistent from childhood.
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Affiliation(s)
- Evandro S Portes
- Serviço de Endocrinologia e Metabologia, Hospital do Servidor Estadual de São Paulo, SP, Brazil.
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Clayton P, Gleeson H, Monson J, Popovic V, Shalet SM, Christiansen JS. Growth hormone replacement throughout life: insights into age-related responses to treatment. Growth Horm IGF Res 2007; 17:369-382. [PMID: 17560153 DOI: 10.1016/j.ghir.2007.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 04/19/2007] [Accepted: 04/23/2007] [Indexed: 11/23/2022]
Abstract
The adult growth hormone deficiency (GHD) syndrome is a well-defined clinical entity. Although the symptoms of GHD are not age specific, their relative importance differs depending on the patient's age, and the impact of GHD varies throughout adult life. Ceasing growth hormone (GH) therapy soon after final height in patients with severe GHD potentially limits somatic development by reducing accrual of bone and muscle mass. It is now recognized that the continuation of GH therapy in the transition years is required to achieve adult levels of somatic development. In middle age, the most worrying feature of GHD is the increase in cardiovascular risk, an important component of which is GHD-related dyslipidemia. One of the most profound effects of GH therapy in this age group is the durable reduction in cholesterol levels. Elderly GH-deficient patients experience the symptoms of GHD over and above the signs of normal aging. Perhaps most importantly, these patients have impaired quality of life, with fatigue as a major component. Evidence is growing for improved quality of life with GH therapy in the elderly. This review describes the diagnosis, symptoms and treatment of GHD specific to the different age groups.
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Affiliation(s)
- Peter Clayton
- Endocrine Science Research Group, Division of Human Development, The Medical School, University of Manchester, UK
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Gonc EN, Kandemir N. Long-term effects of growth hormone (GH) on bone mineral status and bone turnover markers in patients with isolated GH deficiency and multiple pituitary hormone deficiency. Clin Endocrinol (Oxf) 2007; 66:672-7. [PMID: 17381489 DOI: 10.1111/j.1365-2265.2007.02799.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was designed to assess the long-term effects of growth hormone (GH) replacement therapy on bone mass and bone turnover markers in children with isolated GH deficiency (IGHD) and multiple pituitary hormone deficiency (MPHD). MATERIALS AND METHODS Fifty children (35 IGHD, 15 MPHD) receiving GH replacement therapy were enrolled in the study. The patients were followed for 38.6 +/- 15.7 months (1-5 years). Bone mineral density (BMD) of the lumbar region and bone turnover markers [PTH, osteocalcin, bone-specific alkaline phosphatase (boneALP), and the carboxyterminal propeptide of type-1 collagen (CPP-I)] were assessed annually. RESULTS The height standard deviation score (SDS) of patients with IGHD and MPHD at diagnosis was statistically significant (P = 0.012), and the change in height SDS during 3 years (Deltaheight SDS(3 years)) was statistically similar between these two groups (P = 0.651). The BMD z-scores of the two groups were comparable at the start of GH therapy (P = 0.083), and then increased in both groups similarly during 5 years of GH replacement therapy (F = 0.349, P = 0.567). When the BMD z-scores during 5 years of GH therapy were analysed in the IGHD and MPHD groups separately, it was found that the BMD z-score increased significantly in IGHD (P < 0.001) but the increase was not significant in MPHD (P = 0.140). Multiple regression analysis showed that the change in BMD z-score during 3 years of GH therapy (DeltaBMD z-score(3 years)) was predicted by the BMD z-score and height SDS at the start of GH therapy and by Deltaheight SDS(3 years) in the IGHD group (t = -2.582, P = 0.02; t = 2.322, P = 0.034 and t = 2.908, P = 0.01, respectively). Age and BMD z-score and height SDS at diagnosis were found to have predictive values for the DeltaBMD z-score(3 years) (t = -3.652, P = 0.022; t = -4.073, P = 0.015 and t = 3.389, P = 0.028, respectively) in the MPHD group. The changes in boneALP, osteocalcin, CPP-1 and PTH levels during the therapy were statistically similar between the IGHD and MPHD groups. CONCLUSION BMD increased during GH therapy in the IGHD and MPHD groups. GH had a positive effect on bone mass in the short as well as the long term. Early diagnosis and treatment could improve peak bone mass in patients with MPHD. The time and dose of sex steroids for pubertal induction and progression, which mimics physiological secretion, might also contribute to bone accretion in patients with MPHD.
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Affiliation(s)
- E Nazli Gonc
- Department of Paediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Radovick S, DiVall S. Approach to the growth hormone-deficient child during transition to adulthood. J Clin Endocrinol Metab 2007; 92:1195-200. [PMID: 17409338 DOI: 10.1210/jc.2007-0167] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The observation that some adults with childhood-onset GH deficiency have low bone mineral density, low lean body mass, diminished quality of life, abnormal lipids, and impaired cardiac function, all of which may improve after treatment with GH, has prompted pediatric endocrinologists to reevaluate the practice of discontinuing GH in all patients after attainment of final adult height. The treatment of adolescents to prevent the metabolic complications of GH deficiency is an emerging practice. Studies addressing the evaluation and care of adolescents during this period and the benefits of GH in this setting are conflicting. Our approach in determining which adolescents to retest, when and how to test for persistent GH deficiency, and which subjects to treat is discussed in the context of available clinical data.
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Affiliation(s)
- Sally Radovick
- Division of Pediatric Endocrinology, Department of Pediatrics, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, CMSC 406, Baltimore, Maryland 21287, USA.
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Petraroli M, D'Alessio E, Ausili E, Barini A, Caradonna P, Riccardi R, Caldarelli M, Rossodivita A. Bone mineral density in survivors of childhood brain tumours. Childs Nerv Syst 2007; 23:59-65. [PMID: 17058089 DOI: 10.1007/s00381-006-0175-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Osteopenia has been reported in children surviving acute lymphoblastic leukaemia, apparently as consequence of therapy. Few studies have been published on bone mineral density (BMD) evaluation in children surviving from brain tumours. The endocrine system in these patients is frequently affected as consequence of therapeutic interventions such as cranial irradiation and anti-neoplastic agents: growth hormone deficiency is the most common adverse sequel. The pathogenesis of osteopenia in brain cancer survivors is multi-factorial but still uncertain. OBJECTIVE The aim of this study is to examine bone mass in 12 brain cancer survivors and its relationship with their hormonal status. RESULTS AND DISCUSSION We observed that most of the patients had a BMD that was lower than normal in both the lumbar column and in the femoral neck. Bone mass loss was higher in the lumbar region rather than in the femoral neck, due to spinal radiation therapy and to the effect of hormonal deficiencies. Particularly hypogonadism, but also multiple hormonal deficiencies, are associated with lower BMD values. Experience in clinical care of these patients suggests the importance of periodic evaluations of BMD, especially in those with secondary hormone deficiencies. Moreover, the periodic assessment of the hypothalamus-pituitary function is essential for an early diagnosis of hormonal insufficiency, primarily hypogonadism, to precociously detect bone mineral loss and to prevent pathological fractures, thus improving the quality of life.
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Affiliation(s)
- M Petraroli
- Department of Paediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
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Mukherjee A, Murray RD, Shalet SM. Impact of growth hormone status on body composition and the skeleton. HORMONE RESEARCH 2005; 62 Suppl 3:35-41. [PMID: 15539797 DOI: 10.1159/000080497] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Severe growth hormone (GH) deficiency (GHD) induces a well-defined clinical entity encompassing, amongst the most reported features, abnormalities of body composition, in particular increased fat mass, especially truncal, and reduced lean body mass. The results from virtually all treatment studies are in agreement that GH replacement improves the body composition profile of GHD patients by increasing lean body mass and reducing fat mass. More recently, the observations have been extended to adults with partial GHD, defined by a peak GH response to insulin-induced hypoglycaemia of 3-7 microg/l. These patients exhibit abnormalities of body composition similar in nature to those described in adults with severe GHD; these include an increase in total fat mass of around 3.5 kg and a reduction of lean body mass of around 5.5 kg. The increase in fat mass is predominantly distributed within the trunk. The degree of abnormality of body composition is intermediate between that of healthy subjects and that of adults with GHD. The impact of GH replacement on body composition in adults with GH insufficiency, although predictable, has not been formally documented. The skeleton is another biological endpoint affected by GH status: in adults with severe GHD, low bone mass has been reported using dual energy x-ray absorptiometry (DEXA) and other quantitative methodologies. The importance of low bone mass, in any clinical setting, is as a surrogate marker for the future risk of fracture. Several retrospective studies have documented an increased prevalence of fractures in untreated GHD adults. Hypopituitary adults with severe GHD have reduced markers of bone turnover which normalize with GH replacement, indicating that GH, directly or via induction of insulin-like growth factor-I, is intimately involved in skeletal modelling. Whilst the evidence that GH plays an important role in the acquisition of bone mass during adolescence and early adult life is impressive, the impact of GHD acquired later in adulthood is less clear. Recently we examined the relationship between bone mineral density (BMD) and age in 125 untreated adults with severe GHD using DEXA. A significant positive correlation was observed between BMD (z-scores) and age at all skeletal sites studied. Overall, few patients, except those aged less than 30 years, had significantly reduced bone mass (i.e. a BMD z-score of less than -2); correction of BMD to provide a pseudo-volumetric measure of BMD suggested that reduced stature of the younger patients may explain, at least in part, this higher frequency of subnormal BMD z-scores. Despite normal BMD, however, an increase in fracture prevalence may still be observed in elderly GHD adults as a consequence of increased falls related to muscle weakness and visual field defects.
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Affiliation(s)
- S M Shalet
- Department of Endocrinology, Christie Hospital, Manchester, UK.
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Saggese G, Baroncelli GI, Vanacore T, Fiore L, Ruggieri S, Federico G. Indications and strategies for continuing GH treatment during transition from late adolescence to early adulthood in patients with GH deficiency: the impact on bone mass. J Endocrinol Invest 2004; 27:596-602. [PMID: 15717661 DOI: 10.1007/bf03347486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GH plays an important role in longitudinal bone growth and maturation during childhood and adolescence. However, GH has important metabolic functions other than bone growth, which become more apparent during young adulthood, when growth has been completed. Indeed, GH deficiency (GHD) in adult life is a recognized clinical syndrome which includes symptoms such as increased central adiposity, decreased lean body mass, reduced bone mineral density (BMD), increased atherogenic risk, cerebrovascular and cardiac morbidity and mortality, and reduced quality of life. As approximately one quarter of the children with GHD should continue GH administration in adulthood, it is important to reconfirm GHD at the end of growth in order to select patients with severe GHD who need to resume GH therapy with an appropriate age-related dosage. Some evidence indicates that most peak bone mass (PBM) is achieved by the end of adolescence but small increases in BMD continue during the period of transition from late adolescence to young adulthood. Some young adults with GHD show a persistent increase of lumbar BMD after the completion of growth even after discontinuation of treatment suggesting a spontaneous progression towards lumbar PBM or a continuing effect of the treatment. The data indicates that adolescents with GHD who do not reach lumbar PBM at the time of discontinuation of GH treatment can achieve a BMD lower than their genetic potential if they are not treated during the transition to young adulthood.
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Affiliation(s)
- G Saggese
- Department of Reproductive Medicine and Pediatrics, University of Pisa, Pisa, Italy.
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Baroncelli GI, Bertelloni S, Sodini F, Saggese G. Longitudinal changes of lumbar bone mineral density (BMD) in patients with GH deficiency after discontinuation of treatment at final height; timing and peak values for lumbar BMD. Clin Endocrinol (Oxf) 2004; 60:175-84. [PMID: 14725678 DOI: 10.1046/j.1365-2265.2003.01949.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE GH treatment has an important role in the acquisition of bone mass in children and adolescents with GH deficiency (GHD). However, there is no information concerning the timing and value of peak bone mass in treated patients with GHD. In adolescents with GHD we longitudinally measured lumbar bone mineral density (BMD) after discontinuation of GH treatment at final height until they achieved lumbar peak BMD (pBMD). Moreover, the changes of lumbar BMD after the attainment of the peak were assessed for a period of 2 years. The results of patients were compared with those obtained in age- and sex-matched healthy controls. PATIENTS AND MEASUREMENTS Lumbar BMDarea [bone mineral content (BMC) corrected by the vertebral surface area scanned] and lumbar BMDvolume (BMC corrected by vertebral volume estimated by a mathematical model), by dual energy X-ray absorptiometry, were assessed in 16 patients (nine males, seven females; aged 14.9-18.8 years) with isolated GHD and 157 healthy subjects (78 males, aged 16.2-24.9 years; 79 females, aged 14.1-22.8 years) as controls. In patients, lumbar BMDarea and lumbar BMDvolume were measured at final height and approximately every year up to 21-24 years and 19-22 years in males and females, respectively; BMD values of the patients were plotted on the reference curves for age and sex obtained in controls. RESULTS At final height, seven male (78%) and five female (71%) patients had a value for lumbar BMDarea below 2SD of normal mean, whereas all patients had a value of lumbar BMDvolume between 0 and -2SD of normal mean. In patients, lumbar pBMDarea and lumbar pBMDvolume were achieved approximately 1-3 years after final height. The timing of lumbar pBMDarea and lumbar pBMDvolume was significantly (P < 0.0001) delayed in patients in comparison with controls (pBMDarea: males, 19.8 +/- 0.6 years and 18.4 +/- 0.6 years; females, 18.0 +/- 0.3 years and 16.7 +/- 0.6 years, respectively; pBMDvolume: males, 19.8 +/- 0.7 years and 18.6 +/- 0.6 years; females, 18.0 +/- 0.4 years and 16.7 +/- 0.6 years, respectively). In addition, mean values for lumbar pBMDarea and lumbar pBMDvolume were significantly (P < 0.01 to P < 0.0001) reduced in patients compared with controls (pBMDarea: males, 1.129 +/- 0.055 g/cm2 and 1.225 +/- 0.048 g/cm2; females, 1.122 +/- 0.053 g/cm2 and 1.227 +/- 0.060 g/cm2, respectively; pBMDvolume: males, 0.326 +/- 0.010 g/cm3 and 0.352 +/- 0.036 g/cm3; females, 0.348 +/- 0.010 g/cm3 and 0.388 +/- 0.039 g/cm3, respectively). In patients, mean values of lumbar BMDvolume declined significantly (P < 0.03 to P < 0.01) 2 years after its peak. At any rate, mean values of lumbar BMDarea and lumbar BMDvolume of patients one and two years after their peak remained significantly lower (P < 0.01 to P < 0.0001) than those of controls. CONCLUSIONS The results show that treated adolescents with GHD have an increase of lumbar BMDarea and lumbar BMDvolume after discontinuation of GH treatment at final height, but they have delayed timing and reduced mean values of lumbar pBMDarea and lumbar pBMDvolume in comparison with controls. In patients, mean values of lumbar BMDvolume declined 2 years after its peak. Although the number of the patients was small, the results seem to indicate that GH has a role in the acquisition of lumbar BMD after final height in patients with GHD, suggesting that GH treatment should be continued up to the achievement of lumbar pBMD.
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Affiliation(s)
- Giampiero Igli Baroncelli
- Endocrine Unit, Division of Pediatrics, Department of Reproductive Medicine and Pediatrics, University of Pisa, Pisa, Italy.
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Leong GM, Johannsson G. Growth hormone deficiency: strategies and indications to continue growth hormone therapy in transition from adolescence to adult life. Horm Res Paediatr 2004; 60:78-85. [PMID: 12955023 DOI: 10.1159/000071231] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The most common practice in children with growth hormone (GH) deficiency is to discontinue GH treatment in adolescence after attainment of final height. Childhood-onset GH deficiency (GHD) that continues into adulthood and is not treated may be associated with more severe consequences than GHD acquired as an adult. This raises the question of the importance of GH for continuing tissue maturation after longitudinal growth has stopped. Data from recent studies suggest that muscle and bone maturation is arrested when GH treatment is discontinued at final height in adolescents in whom severe GHD continues into adulthood. These patients also develop, even in the short term, well-known cardiovascular risk factors associated with GHD in adults. Retesting for GHD is crucial in adolescence because a considerable number of patients will not have severe GHD according to the criteria set for adults. Continuing replacement therapy in these patients is warranted, but cost-benefit comparisons of treatment are still under debate and a lack of acceptance, and hence reimbursement, for such treatment is still common. In this review, the management and organization of transition, with and without continuing GH replacement therapy, are also discussed.
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Affiliation(s)
- Gary M Leong
- Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, NSW, Australia
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Abstract
The period of growth from late puberty to full adult maturation, termed the transition period, is important for tissue maturation. Peak bone mass, muscle mass and strength are usually attained in this period. However, it is common clinical practice in children with growth hormone deficiency (GHD) to discontinue growth hormone (GH) treatment in adolescence after attainment of final height. Therefore, patients with childhood-onset GHD that continues into adulthood and who do not receive treatment as adults may experience more severe consequences than patients who acquire GHD as an adult. Recent studies indicate that bone and muscle maturation are attenuated if GH treatment is discontinued at final height. Furthermore, these patients will also develop cardiovascular risk factors that are normally associated with GHD in adults. Much debate surrounds when retesting for GHD should be carried out and when GH treatment should be restarted in adolescents; many of these patients will not have severe GHD according to the criteria set for adults. The transition period is an appropriate time to modify GH doses. Finally, registries exist that have recorded clinical treatment experiences for children and adults. Tools that collect and analyse data provide an important opportunity to investigate issues related to transition.
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Affiliation(s)
- S Shalet
- Christie Hospital NHS Trust, Manchester, UK.
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Tauber M, Jouret B, Cartault A, Lounis N, Gayrard M, Marcouyeux C, Pienkowski C, Oliver I, Moulin P, Otal P, Joffre F, Arnaud C, Rochiccioli P. Adolescents with partial growth hormone (GH) deficiency develop alterations of body composition after GH discontinuation and require follow-up. J Clin Endocrinol Metab 2003; 88:5101-6. [PMID: 14602733 DOI: 10.1210/jc.2003-030392] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
It is now a consensus to resume GH treatment in adolescents with severe GH deficiency (GHD) at retesting to prevent the occurrence of adult GHD syndrome. However, we do not have any data on the follow-up of adolescents with nonsevere GHD at completion of treatment. This report presents preliminary data from a 1-yr prospective study that includes the first 91 patients retested. Anthropometric data, IGF-I and IGF binding protein-3 levels, glycemia and insulinemia, lipid profile, and body composition using dual x-ray absorptiometry and abdominal computed tomography scan were recorded at completion of GH treatment and 1 yr later. Body composition was significantly different at both evaluations, with increased total body fat and decreased lean body mass in the partial GHD group vs. the normal group. Moreover, these alterations worsened after 1 yr without GH in the partial GHD group, whereas there were no modifications in the normal group. We did not find any metabolic alterations such as elevated triglyceride, total cholesterol, or insulin levels. Adolescents with reconfirmed partial GHD exhibit alterations in body composition after 1 yr without GH, whereas those retested normal do not. These changes are similar to those described in severe GHD, although less marked, and justify a precise follow-up.
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Affiliation(s)
- Maithé Tauber
- Unit of Endocrinology, Hôpital des Enfants, TSA 70034, 31059 Toulouse Cedex 9, France.
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23
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Boot AM. Body composition and bone mineral density in adolescents with partial growth hormone deficiency. J Clin Endocrinol Metab 2003; 88:5099-100. [PMID: 14602732 DOI: 10.1210/jc.2003-031634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Mukherjee A, Shalet SM. Growth hormone replacement therapy (GHRT) in children and adolescents: skeletal impact. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 41:235-42. [PMID: 12868125 DOI: 10.1002/mpo.10343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In addition to its well-established effects on linear growth in childhood and adolescence, growth hormone has both direct and indirect actions on bone remodelling and homeostasis. In this review the limitations of methods of assessment of bone mineral density are highlighted. The influence of growth hormone deficiency of childhood-onset, on bone mineral accretion and, the specific skeletal implications of GHD in long-term survivors of childhood cancers, are discussed. Specific influential factors, which affect peak bone mass achievement and therefore skeletal health in later life, are evaluated.
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Affiliation(s)
- Annice Mukherjee
- Department of Endocrinology, Christie Hospital, Withington, Manchester, United Kingdom
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Shalet SM, Shavrikova E, Cromer M, Child CJ, Keller E, Zapletalová J, Moshang T, Blum WF, Chipman JJ, Quigley CA, Attanasio AF. Effect of growth hormone (GH) treatment on bone in postpubertal GH-deficient patients: a 2-year randomized, controlled, dose-ranging study. J Clin Endocrinol Metab 2003; 88:4124-9. [PMID: 12970274 DOI: 10.1210/jc.2003-030126] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
GH treatment in children with GH deficiency is frequently terminated at final height. However, in healthy individuals bone mass continues to accrue until peak bone mass is achieved. Because no prospective data specifically prove the role of GH in attainment of peak bone mass, we performed a multinational, controlled, 2-yr study in patients who had terminated pediatric GH at final height. Patients were randomized to: GH at 25.0 microg/kg x day (pediatric dose, n = 58) or 12.5 microg/kg x day (adult dose, n = 59), or no GH treatment (control, n = 32). Bone mineral content (BMC) and density were measured by dual-energy x-ray absorptiometry and evaluated centrally. Laboratory measurements were also performed centrally. After 2 yr, significant increases were seen with both GH treatments, compared with control in bone-specific alkaline phosphatase (P = 0.004) and type I collagen C-terminal telopeptide:creatinine ratio (P < 0.001), but there were no significant dose effects. Total BMC increased by 9.5 +/- 8.4% in the adult dose group, 8.1 +/- 7.6% in the pediatric dose group, and 5.6 +/- 8.4% in controls (analysis of covariance, P = 0.008), with no significant GH dose effect. BMC increased predominantly at the lumbar spine (11.0 +/- 10.6%, P = 0.015) rather than at the femoral neck or hip. In contrast, a significant dose-dependent increase was seen in IGF-I concentrations (adult dose: 114.5 +/- 119.4 microg/liter; pediatric dose: 178.5 +/- 143.7 microg/liter; P = 0.023). There were no gender-related differences in BMC changes with either dose, whereas the IGF-I increase was significantly higher with the pediatric than with the adult dose in females (P < 0.001) but not males (P = 0.606). In summary, reinstitution of GH replacement after final height in severely GH-deficient patients induced significant progression toward peak bone mass. Although there was a by-gender dose effect on IGF-I concentration, the treatment effect on bone was obtained in both males and females with the adult GH dose regimen.
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Affiliation(s)
- Stephen M Shalet
- Department of Endocrinology, Christie Hospital NHS Trust, Manchester M20 4BX, United Kingdom.
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Mukherjee A, Attanasio AF, Shalet SM. Skeletal requirements for optimal growth hormone replacement in the transitional years. Growth Horm IGF Res 2003; 13 Suppl A:S130-S135. [PMID: 12914741 DOI: 10.1016/s1096-6374(03)00069-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In addition to its well-established effects on linear growth in childhood and adolescence, growth hormone (GH) has both direct and indirect actions on bone remodelling and homeostasis. In this review, the discussion begins with the influence of childhood-onset growth hormone deficiency (CO-GHD) on bone mineral accretion. The limitations of methods of assessing bone mineral density (BMD) are highlighted and specific influential factors, which affect peak bone mass achievement and therefore skeletal health in later life, are evaluated.
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Affiliation(s)
- Annice Mukherjee
- Department of Endocrinology, Christie Hospital, Wilmslow Road, Withington, Manchester, UK.
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