Effect of growth hormone therapy on thyroid function in isolated growth hormone deficient and short small for gestational age children: a two-year study, including on assessment of the usefulness of the thyrotropin-releasing hormone (TRH) stimulation test

2020 ◽  
Vol 33 (11) ◽  
pp. 1417-1423
Author(s):  
Yuki Ebuchi ◽  
Toshihide Kubo ◽  
Mahoko Furujo ◽  
Yousuke Higuchi ◽  
Shoko Fujinaga ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Replacement Therapy ◽  
Thyroid Function ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Stimulation Test ◽  
Gh Therapy ◽  
Central Hypothyroidism ◽  
Trh Stimulation ◽  
Group 3

AbstractBackgroundThe relationship between growth hormone (GH)-replacement therapy and the thyroid axis in GH-deficient (GHD) children remains controversial. Furthermore, there have been few reports regarding non-GHD children. We aimed to determine the effect of GH therapy on thyroid function in GHD and non-GHD children and to assess whether thyrotropin-releasing hormone (TRH) stimulation test is helpful for the identification of central hypothyroidism before GH therapy.MethodsWe retrospectively analyzed data from patients that started GH therapy between 2005 and 2015. The free thyroxine (FT4) and thyroid-stimulating hormone (TSH) concentrations were measured before and during 24 months of GH therapy. The participants were 149 children appropriate for gestational age with GHD (IGHD: isolated GHD) (group 1), 29 small for gestational age (SGA) children with GHD (group 2), and 25 short SGA children (group 3).ResultsIn groups 1 and 2, but not in group 3, serum FT4 concentration transiently decreased. Two IGHD participants exhibited central hypothyroidism during GH therapy, and required levothyroxine (LT4) replacement. They showed either delayed and/or prolonged responses to TRH stimulation tests before start of GH therapy.ConclusionsGH therapy had little pharmacological effect on thyroid function, similar changes in serum FT4 concentrations were not observed in participants with SGA but not GHD cases who were administered GH at a pharmacological dose. However, two IGHD participants showed central hypothyroidism and needed LT4 replacement therapy during GH therapy. TRH stimulation test before GH therapy could identify such patients and provoke careful follow-up evaluation of serum FT4 and TSH concentrations.

scholarly journals Delayed Bone Age Might Accelerate the Response to Human Growth Hormone Treatment in Small for Gestational Age Children with Short Stature

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Jung-Eun Moon ◽  
Cheol Woo Ko
Keyword(s):  
Growth Hormone ◽  
Short Stature ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Human Growth ◽  
Bone Age ◽  
Pediatric Endocrinology ◽  
Gh Therapy ◽  
Gh Treatment ◽  
The Impact

Purpose. Growth hormone (GH) treatment is recommended to improve growth and psychosocial problems in short stature children born small for gestational age (SGA). Although GH therapy in these patients has been extensively studied, the impact of therapy according to delays in bone age (BA) is not known well. Objective. To investigate the effects of GH therapy in SGA patients with short stature according to BA delay. Methods. We retrospectively analyzed changes in height SD score (SDS) and BA/chronological age (CA) after 6 and 12 months of GH therapy in patients grouped according to BA delay. We studied 27 SGA children with short stature in the pediatric endocrinology clinic of Kyungpook National University Children’s Hospital. Results. Of the 27 patients, 9 had <2 years of BA delay, while 18 had >2 years of delay. There were no significant differences between the two groups in terms of gestational age and weight at birth, height SDS, IGF-1 SDS, and growth hormone dosage at the beginning of therapy. However, height SDS increased significantly in the group with >2 years of BA delay after 6 months of GH therapy (−2.50 ± 0.61 vs −1.87 ± 0.82; p=0.037) and 12 months (−2.27 ± 0.70 vs −1.63 ± 0.65; p=0.002). When height SDS was compared between with and without GHD, there were no significant differences. Conclusions. Delayed BA (>2 years) may impact the response to GH treatment in SGA children with short stature.

scholarly journals Three years of growth hormone therapy in children born small for gestational age: results from the ANSWER Program

2018 ◽  
Vol 7 (10) ◽  
pp. 1096-1104 ◽  
Author(s):  
Robert Rapaport ◽  
Peter A Lee ◽  
Judith L Ross ◽  
Paul Saenger ◽  
Vlady Ostrow ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Short Stature ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Growth Failure ◽  
Hormone Deficiency ◽  
Birth Size ◽  
Growth Disorders ◽  
Gh Therapy ◽  
The Impact

Growth hormone (GH) is used to treat short stature and growth failure associated with growth disorders. Birth size and GH status variably modulate response to GH therapy. The aim of this study was to determine the effect of birth size on response to GH therapy, and to determine the impact of GH status in patients born small for gestational age (SGA) on response to GH therapy. Data from the prospective, non-interventional American Norditropin Studies: Web-Enabled Research (ANSWER) Program was analyzed for several growth outcomes in response to GH therapy over 3 years. GH-naïve children from the ANSWER Program were included in this analysis: SGA with peak GH ≥10 ng/mL (20 mIU/L), SGA with peak GH <10 ng/mL (20 mIU/L), isolated growth hormone deficiency (IGHD) born SGA, IGHD not born SGA and idiopathic short stature. For patients with IGHD, those who did not meet criteria for SGA at birth showed greater improvements in height SDS and BMI SDS than patients with IGHD who met criteria for SGA at birth. For patients born SGA, response to GH therapy varied with GH status. Therefore, unlike previous guidelines, we recommend that GH status be established in patients born SGA to optimize GH therapy.

PITUITARY-THYROID FUNCTION AFTER TOTAL ADRENALECTOMY IN PATIENTS WITH CUSHING'S DISEASE

1974 ◽  
Vol 76 (4) ◽  
pp. 712-718 ◽  
Author(s):  
Mogens Blichert-Toft ◽  
Lotte Hummer ◽  
Harriet Dige-Petersen
Keyword(s):  
Replacement Therapy ◽  
Thyroid Function ◽  
Cushing’S Disease ◽  
Treated Patient ◽  
Experimental Studies ◽  
Stimulation Test ◽  
Cushing's Disease ◽  
Trh Stimulation ◽  
Total Adrenalectomy ◽  
Urine Levels

ABSTRACT In patients with untreated Cushing's disease decreased thyroid function has been demonstrated by several investigators. An inhibiting effect of glucocorticosteroids on the release of thyrotrophin seems to be the cause. In the treated patient with remission of the disease the pituitary-thyroid function has not been studied in detail. The question is, if the hypofunction proved in the untreated state might persist in the treated patient. This might be anticipated from both clinical and experimental studies. In the present study the pituitary-thyroid function has been determined after total adrenalectomy followed by remission in 14 patients with Cushing's disease. All patients were replaced adequately with cortisone acetate post-operatively as estimated by excretion of cortisol in urine. Levels of serum thyroxine, thyroxine-binding globulin, and serum thyrotrophin were measured. In addition, tracer studies were performed. The 131I-uptake in the thyroid gland and plasma protein-bound radioiodine were determined. After thyrotrophin-stimulation test, the thyroxine reserve and the rise in 131I-uptake in the gland were measured. TRH-stimulation test was performed to determine the TSH-reserve. A normal pituitary-thyroid function and a normal pituitary and thyroid reserve were demonstrated. In the conclusion it can be said that decreased pituitary-thyroid function or reserve has not been found in the Cushing-patient subjected to adrenalectomy followed by remission. Thus, thyroid replacement therapy has not to be considered, when an adequate replacement therapy is planned after total adrenalectomy.

scholarly journals What is the evidence for beneficial effects of growth hormone treatment beyond height in short children born small for gestational age? A review of published literature

2020 ◽  
Vol 33 (1) ◽  
pp. 53-70
Author(s):  
David Dunger ◽  
Feyza Darendeliler ◽  
Nurgun Kandemir ◽  
Mark Harris ◽  
Ali Rabbani ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Cardiovascular Risk ◽  
Bone Strength ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pubertal Development ◽  
Adult Life ◽  
Gh Therapy ◽  
Published Evidence ◽  
Short Children

AbstractBackgroundAn increasing body of evidence supports the view that both an adverse intrauterine milieu and rapid postnatal weight gain in children born small for gestational age (SGA) contribute towards the risk for the development of chronic diseases in adult life.ContentThe aim of this review was to identify and summarize the published evidence on metabolic and cardiovascular risk, as well as risk of impaired cardiac function, intellectual capacity, quality of life, pubertal development and bone strength among children born SGA. The review will then address whether growth hormone (GH) therapy, commonly prescribed to reduce the height deficit in children born SGA who do not catch up in height, increases or decreases these risks over time.SummaryOverall, there are limited data in support of a modest beneficial effect of GH therapy on the adverse metabolic and cardiovascular risk observed in short children born SGA. Evidence to support a positive effect of GH on bone strength and psychosocial outcomes is less convincing.OutlookFurther evaluation into the clinical relevance of any potential long-term benefits of GH therapy on metabolic and cardiovascular endpoints is warranted.

Issues in the Transition From Childhood to Adult Growth Hormone Therapy

PEDIATRICS ◽  
1999 ◽  
Vol 104 (Supplement_5) ◽  
pp. 1004-1010
Author(s):  
David B. Allen
Keyword(s):  
Growth Hormone ◽  
Replacement Therapy ◽  
Blood Lipid ◽  
Hormone Deficiency ◽  
Late Adolescent ◽  
Gh Therapy ◽  
Gh Treatment ◽  
Beneficial Effects ◽  
Gh Replacement ◽  
Adult Growth

The consequences of severe growth hormone deficiency (GHD) in adults and the beneficial effects of GH replacement therapy are clear. However, the majority of children who have a diagnosis of GHD and who are treated with GH do not have permanent GHD and will not require treatment during adulthood. Several issues must be considered in selecting candidates for adult GH treatment and transitioning their care from pediatrics to adult medicine. Counseling about possible lifelong treatment should focus on children with panhypopituitarism and those with severe isolated GHD that is associated with central nervous system abnormalities. When to terminate growth-promoting GH therapy should be guided by balancing the high cost of late-adolescent treatment with the attainment of reasonable statural goals. Retesting for GH secretion is appropriate for all candidates for adult GH therapy; the GH axis can be tested within weeks after the cessation of treatment, but confirming an emerging adult GHD state with body composition, blood lipid, and quality-of-life assessments may require 1 year or more of observation. Selecting patients for lifelong adult GH replacement therapy will present diagnostic, therapeutic, and ethical problems similar to those in treating childhood GHD. The experience and expertise of pediatric endocrinologists in diagnosing and treating GHD should be offered and used in identifying and transitioning appropriate patients to adult GH therapy.

GROWTH HORMONE LEVELS IN NORMOGLYCEMIC AND HYPOGLYCEMIC INFANTS BORN SMALL FOR GESTATIONAL AGE

PEDIATRICS ◽  
1971 ◽  
Vol 48 (2) ◽  
pp. 190-199
Author(s):  
James R. Humbert ◽  
Ronald W. Gotlin
Keyword(s):  
Growth Hormone ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Gh Deficiency ◽  
Newborn Infants ◽  
Significant Rise ◽  
Glucose Levels ◽  
Appropriate For Gestational Age ◽  
A Prospective Study ◽  
Serum Gh

Recent investigations have raised the possibility that growth hormone (GH) influences intra-uterine weight and length. Moreover, the hypoglycemic tendency of small for gestational age (FSGA) infants and their small size could result from GH deficiency. To verify these hypotheses, a prospective study of daily serum GH and glucose levels was conducted in 46 newborn infants, including 18 FSCA infants, 18-full-term, appropriate for gestational age (FAGA), and 10 premature (PR) infants. Two FSGA babies became hypoglycemic. Both manifested normal GH competence as evidenced by normal daily GH levels, adequate GH response to arginine provocation, and satisfactory growth for over 2 years. Eleven of 12 FSGA babies followed from 14 to 26 months showed no evidence of impaired linear growth. The FSGA babies had GH values similar in magnitude and pattern to those of FAGA and PR infants. During the second half of the first postnatal day, a significant rise in serum GH occurred in all infants regardless of their size or gestational age; this rise may be the result of the stimulating effect of early milk feedings. GH deficiency does not appear to contribute to either the small size or hypoglycemic tendency of FSGA newborn infants.

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