ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
REVIEW

Growth Hormone Deficiency in the Transition Period
Çocukluktan Erişkinliğe Geçiş Döneminde Büyüme Hormonu Eksikliği
Received Date : 15 Mar 2019
Accepted Date : 19 Jun 2019
Doi: 10.25179/tjem.2019-65793 - Makale Dili: EN
Turk J Endocrinol Metab 2019;23:181-186
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
The importance of continuing growth hormone therapy in the transition and adulthood periods must be studied in adolescents with growth hormone deficiency with childhood onset. Continuation of growth hormone therapy during the transition period in patients with permanent growth hormone deficiency is recommended as the therapy has positive effects on adult body composition and regional body fat distribution as well as its promotion of an increase in bone mineral content. The chance of having permanent growth hormone deficiency is higher in patients with a mass lesion involving the pituitary area, multiple pituitary hormone deficiency, isolated growth hormone deficiency associated with an identified mutation (i.e., growth hormone 1 (GH1) gene, growth hormone releasing hormone receptor (GHRHR) gene, sex determining region Y(SRY)-box 3 (SOX3) gene), midline defects, and congenital structural hypothalamo-pituitary disorders, such as an ectopic posterior pituitary; thus, such patients do not require retesting. The patients with idiopathic isolated growth hormone deficiency are recommended to undergo retesting. The most appropriate time for a retest is the age when the child achieves 98-99% of the adult height. The insulin tolerance test is preferred during the transition period and a threshold level of <5 ng/mL is recommended as the diagnostic criterion for complete growth hormone deficiency. Growth hormone doses higher than those used in adults (e.g., 70 mcg/kg/day) should be used until linear growth has been achieved. Decreased quality of life is another criterion for the initiation of therapy. This review addresses the definition of growth hormone deficiency and indications and usage of growth hormone therapy during the transition period.
ÖZET
Çocukluk döneminde büyüme hormonu eksikliği (BHE) başlayan ve büyüme hormonu tedavisi kullanan ergenlerin, geçiş ve erişkin dönemde büyüme hormonu tedavisine devam etmesinin önemi araştırılmalıdır. Büyüme hormonu tedavisinin erişkin vücut kompozisyonu ve bölgesel yağ dağılımı üzerine pozitif etkisi ve kemik mineral yoğunluğunda artış sağlaması nedeniyle kalıcı büyüme hormonu eksikliği olan olgularda geçiş döneminde büyüme hormonu tedavisine devam edilmesi önerilmektedir. Hipofizer bölgeyi ilgilendiren kitle lezyonu, çoğul hipofizer hormon eksiklikleri, tanımlanmış bir mutasyonla ilişkilendirilen izole büyüme hormonu eksikliği (örn. büyüme hormonu 1 (BH-1) geni, büyüme hormonu salgılatıcı hormon reseptör (BHRHR) geni, Y kromozomu üzerindeki cinsiyet farklılaşmasını kontrol eden bölge (SRY)-box 3 (SOX3) geni), orta hat kusurları ve ektopik posterior hipofiz gibi konjenital yapısal hipotalamo-hipofizer bozuklukları olan olgularda kalıcı büyüme hormonu eksikliği olasılığı çok yüksek olduğundan, tekrar testlerinin yapılmasına gerek yoktur. İdiyopatik izole büyüme hormonu eksikliği olanlara tekrar testlerinin yapılması önerilmektedir. Test tekrarı için en uygun zaman çocuğun boyunun erişkin boyun %98-99’una ulaştığı yaştır. Geçiş döneminde insülin tolerans testi tercih edilmektedir ve eşik değerin <5 ng/mL olması tam büyüme hormonu eksikliği eksikliği için tanı kriteri olarak önerilmektedir. Lineer büyüme tamamlanıncaya kadar erişkinlerde kullanılan dozlardan daha yüksek dozlarda (örneğin; 70 mcg/kg/gün) büyüme hormonu kullanılması gerekmektedir. Yaşam kalitesinde azalma, tedaviye başlamak için kullanılan başka bir kriterdir. Bu çalışmada, büyüme hormonu eksikliğinin tanımı ve büyüme hormonu tedavisinin geçiş döneminde kullanılma endikasyonları üzerinde durulması amaçlanmıştır.
KAYNAKLAR
  1. Clayton PE, Cuneo RC, Juul A, Monson JP, Shalet SM, Tauber M. Consensus statement on the management of the GH-treated adolescent in the transition to adult care. Eur J Endocrinol. 2005;152:165-170. [Crossref] [PubMed]
  2. Mauras N. GH use in the transition of adolescence to adulthood. Endocr Dev. 2010;18:109-125. [Crossref] [PubMed]
  3. Rosenfeld RG, Nicodemus BC. The transition from adolescence to adult life: physiology of the 'transition' phase and its evolutionary basis. Horm Res. 2003;60:74-77. [Crossref] [PubMed]
  4. Cook DM, Rose SR. A review of guidelines for use of growth hormone in pediatric and transition patients. Pituitary. 2012;15:301-310. [Crossref] [PubMed]
  5. Cook DM, Yuen KC, Biller BM, Kemp SF, Vance ML. American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in growth hormone-deficient adults and transition patients-2009 update. Endocr Pract. 2009;15:580-586. [Crossref] [PubMed]
  6. Kuppens RJ, Bakker NE, Siemensma EP, Tummers-de Lind van Wijngaarden RF, Donze SH, Festen DA, van Alfen-van der Velden JA, Stijnen T, Hokken-Koelega AC. Beneficial effects of GH in young adults with prader-willi syndrome: a 2-year crossover trial. J Clin Endocrinol Metab. 2016;101:4110-4116. [Crossref] [PubMed]
  7. Deal CL, Tony M, Höybye C, Allen DB, Tauber M, Christiansen JS. Growth Hormone Research Society workshop summary: consensus guidelines for recombinant human growth hormone therapy in Prader-Willi syndrome. J Clin Endocrinol Metab. 2013;98:E1072-1087. [Crossref] [PubMed] [PMC]
  8. Vuralli D, Gonc EN, Ozon ZA, Alikasifoglu A, Kandemir N. Clinical and laboratory parameters predicting a requirement for the reevaluation of growth hormone status during growth hormone treatment: retesting early in the course of GH treatment. Growth Horm IGF Res. 2017;34:31-37. [Crossref] [PubMed]
  9. Radovick S, DiVall S. Approach to the growth hormone-deficient child during transition to adulthood. J Clin Endocrinol Metab. 2007;92:1195-1200. [Crossref] [PubMed]
  10. Gleeson HK, Gattamaneni HR, Smethurst L, Brennan BM, Shalet SM. Reassessment of growth hormone status is required at final height in children treated with growth hormone replacement after radiation therapy. J Clin Endocrinol Metab. 2004;89:662-666. [Crossref] [PubMed]
  11. Hartman ML, Crowe BJ, Biller BM, Ho KK, Clemmons DR, Chipman JJ. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency? J Clin Endocrinol Metab. 2002;87:477-485. [Crossref] [PubMed]
  12. Maghnie M, Strigazzi C, Tinelli C, Autelli M, Cisternino M, Loche S, Severi F. Growth hormone (GH) deficiency (GHD) of childhood onset: reassessment of GH status and evaluation of the predictive criteria for permanent GHD in young adults. J Clin Endocrinol Metab. 1999;84:1324-1328. [Crossref] [PubMed]
  13. Shalet SM, Toogood A, Rahim A, Brennan BM. The diagnosis of growth hormone deficiency in children and adults. Endocr Rev. 1998;19:203-223. [Crossref] [PubMed]
  14. Lebrethon MC, Bourguignon JP. Management of central isosexual precocity: diagnosis, treatment, outcome. Curr Opin Pediatr. 2000;12:394-399. [Crossref] [PubMed]
  15. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML, Stephens PA. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006;91:1621-1634. [Crossref] [PubMed]
  16. Saggese G, Ranke MB, Saenger P, Rosenfeld RG, Tanaka T, Chaussain JL, Savage MO. Diagnosis and treatment of growth hormone deficiency in children and adolescents: towards a consensus. Ten years after the Availability of Recombinant Human Growth Hormone Workshop held in Pisa, Italy, 27-28 March 1998. Horm Res. 1998;50:320-340. [Crossref] [PubMed]
  17. Jensen LB, Bartlett JM, Witton CJ, Kirkegaard T, Brown S, Müller S, Campbell F, Cooke TG, Nielsen KV. Frequent amplifications and deletions of G1/S-phase transition genes, CCND1 and MYC in early breast cancers: a potential role in G1/S escape. Cancer Biomark. 2009;5:41-49. [Crossref] [PubMed]
  18. Ghigo E, Bellone J, Aimaretti G, Bellone S, Loche S, Cappa M, Bartolotta E, Dammacco F, Camanni F. Reliability of provocative tests to assess growth hormone secretory status. Study in 472 normally growing children. J Clin Endocrinol Metab. 1996;81:3323-3327. [Crossref] [PubMed]
  19. Consensus guidelines for the diagnosis and treatment of adults with growth hormone deficiency: summary statement of the Growth Hormone Research Society Workshop on Adult Growth Hormone Deficiency. J Clin Endocrinol Metab. 1998;83:379-381. [Crossref] [PubMed]
  20. 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. J Clin Endocrinol Metab. 2000;85:3990-3993. [Crossref] [PubMed]
  21. Maghnie M, Aimaretti G, Bellone S, Bona G, Bellone J, Baldelli R, de Sanctis C, Gargantini L, Gastaldi R, Ghizzoni L, Secco A, Tinelli C, Ghigo E. Diagnosis of GH deficiency in the transition period: accuracy of insulin tolerance test and insulin-like growth factor-I measurement. Eur J Endocrinol. 2005;152:589-596. [Crossref] [PubMed]
  22. Biller BM, Samuels MH, Zagar A, Cook DM, Arafah BM, Bonert V, Stavrou S, Kleinberg DL, Chipman JJ, Hartman ML. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab. 2002;87:2067-2079. [Crossref] [PubMed]
  23. Ho KK. Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol. 2007;157:695-700. [Crossref] [PubMed]
  24. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metabo. 2011;96:1587-1609. [Crossref] [PubMed]
  25. Rosilio M, Blum WF, Edwards DJ, Shavrikova EP, Valle D, Lamberts SW, Erfurth EM, Webb SM, Ross RJ, Chihara K, Henrich G, Herschbach P, Attanasio AF. Long-term improvement of quality of life during growth hormone (GH) replacement therapy in adults with GH deficiency, as measured by questions on life satisfaction-hypopituitarism (QLS-H). J Clin Endocrinol Metab. 2004;89:1684-1693. [Crossref] [PubMed]
  26. McKenna SP, Doward LC, Alonso J, Kohlmann T, Niero M, Prieto L, Wíren L. The QoL-AGHDA: an instrument for the assessment of quality of life in adults with growth hormone deficiency. Qual Life Res. 1999;8:373-383. [Crossref] [PubMed]