Öz
Amaç: Çocuk Endokrinoloji ve Metabolizma polikliniğinde izlenen büyüme hormonu eksikliği tanısı alan olguların klinik ve laboratuar özellikleri saptanarak bundan sonraki olguların değerlendirilmesinde kullanılmasını amaçladık.
Yöntemler: Dr. Behçet Uz Çocuk Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi endokrinoloji polikliniğinde büyüme hormonu eksikliği tanısı alan 185 hastanın dosyaları geriye dönük olarak tarandı. Hastaların demografik ve klinik bulguları BH eksikliği tanısına göre dört gruba ayrılarak değerlendirildi.
Bulgular: Toplam 154 olgu (%83,2) idiopatik büyüme hormon eksikliği (İBHE) tanısı alırken, 16 olgu (%8,6) kombine büyüme hormon eksikliği (KBHE), 13 olgu (%7) Turner sendromu, 2 olgu (%1,1) kronik böbrek yetmezliği tanıları ile büyüme hormonu eksikliği tanısı almıştı. Diğer yandan en sık eşlik eden hormon eksikliği 21 hasta (%11,4) ile TSH eksikliği idi. Hastaların 10’unda (%5,4) iki veya daha fazla sayıda hormon eksikliği bulunmaktaydı. İBHE grubunun %15,6’sında intrakraniyal patolojiler mevcutken KBHE’i grubunun %81,2’sinde intrakraniyal patolojik bulgular bulunmaktaydı. KBHE grubunda uyarı testleri yanıtlarının pik değerleri diğer gruplara göre anlamlı olarak daha düşüktü (p<0,0001)
Sonuç: Büyüme hormonu eksikliği tanısı alan olguların prognozunu belirleyen en önemli risk faktörü etiyolojik tanı, eşlik eden diğer hormonal ya da kromozomal bozukluklar ve erken tedavidir.
Anahtar Kelimeler
Kaynakça
- 1. Growth Hormone Research Society. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: Summary statement of the GH Research Society. GH Research Society. Clin Endocrinol Metab. 2000;85:3990-3. DOI: 10.1210/jcem.85.11.6984.
- 2. Murray P, Dattani M, Clayton P. Controversies in the diagnosis and management of growth hormone deficiency in childhood and adolescence. Arch Dis Child. 2016;101:96-100. DOI: 10.1136/archdischild-2014-307228.
- 3. Pfaffle R. Hormone replacement therapy in children: The use of growth hormone and IGF-I. Best Pr Res Clin Endocrinol Metab. 2015;29:339-52. DOI: 10.1016/j.beem.2015.04.009.
- 4. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, Baş F. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı ve Hastalıkları Derğisi;2008, 51:1-14.
- 5. Bayley N, Pinneau SR. Tables for predicting adult height from skeletal age: revised for use with the Greulich- Pyle hand standards. J Pediatr XL 1952; 432-441.
- 6. Tanner JM, White House RH, Takaishi M. Standart from birth to maturity for height, weight, height velocity and weight velocity: British children 1965. Part II. Arch Dis Child 41:613.
- 7. Rogol AD, Hayden GF. Etiologies and early diagnosis of short stature and growth failure in children and adolescents. J Pediatr. 2014;164(Suppl 5):1–14.
- 8. Smuel K, Kauli R, Lilos P, Laron Z. Growth, development, puberty and adult height before and during treatment in children with conjenital isolated growth hormone deficiency. Growth Horm IGF Res. 2015;25:182-8. DOI: 10.1016/j.ghir.2015.05.001.
- 9. Vimpani GV, Vimpani AF, Lidgard G P, Cameron E H D, Farquar J W. Prevalence of severe growth hormone deficiency.Br.Med J 1977;2:427-430. DOI: 10.1136/bmj.2.6084.427.
- 10. Ranke MB, Price DA Albertson-Wikland K, Maes M, Lindberg A. Factors determining pubertal growth and final height in growth hormone treatment of idiopathic growth hormone deficiency. Analysis of 195 Patients of the Kabi Pharmacia International Growth Study. Horm Res. 1997;48(2):62-71. DOI: 10.1159/000317380.
- 11. Dodrill PM1, Atkin LM, Davies PS; OZGROW Advisory Committee of the Australasian Paediatric Endocrine Group. A comparison of published criteria for assuming attainment of adult height in girls who have received growth hormone treatment. J Pediatr Endocrinol Metab. 2008 May;21(5):433-7.
- 12. Huang, Y.H., Wai, Y.Y., Van, Y.H., & Lo, F.S. (2012). Effect of growth hormone therapy on Taiwanese children with growth hormone deficiency. J Formos Med Assoc., 111(7), 355-363. doi: 10.1016/j. jfma.2011.06.011. DOI: 10.1016/j.jfma.2011.06.011
- 13. Kirk J.Indications for growth hormone therapy in children. Arch Dis Child. 2012; 97:63-8. DOI: 10.1136/adc.2010.186205
- 14. Naderi F, Eslami SR, Mirak SA, Khak M, Amiri J, Beyrami B, et al. Effect of growth hormone deficiency on brain MRI findings among children with growth restrictions. J Pediatr Endocrinol Metab. 2015:117-23. DOI: 10.1515/jpem-2013-0294
- 15. Kandemir N, Cila A, Besim A, Yordam N. Magnetic resonance imaging (MRI) Findings in isolated growth hormone deficiency. Turk J Pediatr. 1998 Jul-Sep;40(3):385-92.
- 16. Desdicioğlu R, Desdicioğlu K, Kelekçi S. [An Investigation of the Effects of Maternal Age and Smoking on Biometric Parameters in the Fetal Period]. Acta Med. Alanya 2018;2(2):69-74 [Turkish] DOI:10.30565/medalanya.403799
Öz
Aim:The purpose of this study was to elicit data concerning the clinical and laboratory features of children with growth hormone deficiency monitored by the Pediatric Endocrinology and Metabolism Polyclinic in order to produce useful information for future cases.
Methods: The medical records of 185 patients diagnosed with growth hormone deficiency at the Dr. Behçet Uz Pediatrics and Pediatric Surgery Research Hospital Pediatric Endocrinology and Metabolism Polyclinic were examined retrospectively. The subjects were allocated into 4 groups according to the cause of growth hormone deficiency. Demographic and clinical characteristics of the patients were assessed and compared across these groups.
Results: One hundred and fifty-four patients were diagnosed with idiopathic growth hormone deficiency, 16 (8.6%) with combined growth hormone deficiency, 13 (7%) with Turner’s Syndrome, and 2 (1.1%) with chronic renal failure. On the other hand, the most common accompanying hormone deficiency was TSH deficiency, determined in 21 (11.4%) patients. Two or more hormone deficiencies were present in 10 (5.4%) patients. Intracranial pathologies were present in 15.6% of the idiopathic growth hormone deficiency group and 81.2% of the combined growth hormone deficiency group. Bone age, height SDS, and stimulation test peak responses were significantly lower in the combined growth hormone deficiency group than in the other groups.
Conclusion: The principal risk factors determining prognosis in cases of growth hormone deficiency are etiology, accompanying hormonal or chromosomal disorders, and early treatment.
Anahtar Kelimeler
Kaynakça
- 1. Growth Hormone Research Society. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: Summary statement of the GH Research Society. GH Research Society. Clin Endocrinol Metab. 2000;85:3990-3. DOI: 10.1210/jcem.85.11.6984.
- 2. Murray P, Dattani M, Clayton P. Controversies in the diagnosis and management of growth hormone deficiency in childhood and adolescence. Arch Dis Child. 2016;101:96-100. DOI: 10.1136/archdischild-2014-307228.
- 3. Pfaffle R. Hormone replacement therapy in children: The use of growth hormone and IGF-I. Best Pr Res Clin Endocrinol Metab. 2015;29:339-52. DOI: 10.1016/j.beem.2015.04.009.
- 4. Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, Baş F. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı ve Hastalıkları Derğisi;2008, 51:1-14.
- 5. Bayley N, Pinneau SR. Tables for predicting adult height from skeletal age: revised for use with the Greulich- Pyle hand standards. J Pediatr XL 1952; 432-441.
- 6. Tanner JM, White House RH, Takaishi M. Standart from birth to maturity for height, weight, height velocity and weight velocity: British children 1965. Part II. Arch Dis Child 41:613.
- 7. Rogol AD, Hayden GF. Etiologies and early diagnosis of short stature and growth failure in children and adolescents. J Pediatr. 2014;164(Suppl 5):1–14.
- 8. Smuel K, Kauli R, Lilos P, Laron Z. Growth, development, puberty and adult height before and during treatment in children with conjenital isolated growth hormone deficiency. Growth Horm IGF Res. 2015;25:182-8. DOI: 10.1016/j.ghir.2015.05.001.
- 9. Vimpani GV, Vimpani AF, Lidgard G P, Cameron E H D, Farquar J W. Prevalence of severe growth hormone deficiency.Br.Med J 1977;2:427-430. DOI: 10.1136/bmj.2.6084.427.
- 10. Ranke MB, Price DA Albertson-Wikland K, Maes M, Lindberg A. Factors determining pubertal growth and final height in growth hormone treatment of idiopathic growth hormone deficiency. Analysis of 195 Patients of the Kabi Pharmacia International Growth Study. Horm Res. 1997;48(2):62-71. DOI: 10.1159/000317380.
- 11. Dodrill PM1, Atkin LM, Davies PS; OZGROW Advisory Committee of the Australasian Paediatric Endocrine Group. A comparison of published criteria for assuming attainment of adult height in girls who have received growth hormone treatment. J Pediatr Endocrinol Metab. 2008 May;21(5):433-7.
- 12. Huang, Y.H., Wai, Y.Y., Van, Y.H., & Lo, F.S. (2012). Effect of growth hormone therapy on Taiwanese children with growth hormone deficiency. J Formos Med Assoc., 111(7), 355-363. doi: 10.1016/j. jfma.2011.06.011. DOI: 10.1016/j.jfma.2011.06.011
- 13. Kirk J.Indications for growth hormone therapy in children. Arch Dis Child. 2012; 97:63-8. DOI: 10.1136/adc.2010.186205
- 14. Naderi F, Eslami SR, Mirak SA, Khak M, Amiri J, Beyrami B, et al. Effect of growth hormone deficiency on brain MRI findings among children with growth restrictions. J Pediatr Endocrinol Metab. 2015:117-23. DOI: 10.1515/jpem-2013-0294
- 15. Kandemir N, Cila A, Besim A, Yordam N. Magnetic resonance imaging (MRI) Findings in isolated growth hormone deficiency. Turk J Pediatr. 1998 Jul-Sep;40(3):385-92.
- 16. Desdicioğlu R, Desdicioğlu K, Kelekçi S. [An Investigation of the Effects of Maternal Age and Smoking on Biometric Parameters in the Fetal Period]. Acta Med. Alanya 2018;2(2):69-74 [Turkish] DOI:10.30565/medalanya.403799
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Ağustos 2019 |
| Gönderilme Tarihi | 28 Aralık 2018 |
| Kabul Tarihi | 8 Mayıs 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 3 Sayı: 2 |
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