Büyüme hormonu eksikliği saptanan çocuk hastalarda, büyüme hormonu tedavisinin retrospektif olarak değerlendirilmesi
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Date
2012
Authors
Salı, Enes
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada, Uludağ Üniversitesi Tıp Fakültesi Pediatrik Endokrinoloji Bilim Dalımız'da büyüme hormonu (BH) eksikliği tanısıyla tedavi alan çocukların lineer büyümeleri, kilo artışı, kemik yaşı ilerleme durumu ve puberte ilerleme hızlarının değerlendirilmesi amaçlandı. Ocak 1995-Aralık 2005 tarihleri arasındaki veriler retrospektif olarak değerlendirildi.Toplam 230 hasta çalışmaya alındı. Hastalar Grup-1; İzole BHE, Grup-2; Turner sendromu ve Grup-3; Diğer olarak ayrıldı.Tanı aşamasında bakılan ortalama maksimum BH yanıtı klonidin stimülasyon testi için 4,58 ng/ml, glukagon stimülasyon testi için ise 6,01 ng/ml bulundu. Ortalama BH dozu 0,215 (0,15- 0,46) mg/kg/hafta olarak belirlendi. BH tedavisi ile her üç grupta da boy SDS anlamlı olarak arttı (p<0,05). Tedavi süresince takvim yaşı ile kemik yaşı arasındaki farkın Grup-1 ve Grup-2 de birinci ve ikinci yıllarda azaldığı görüldü (p<0,05). Kemik yaşındaki ilerleme, TY/KY oranındaki azalma ile teyid edildi. KY daki ilerlemeye karşın öngörülen boy olumsuz etkilenmedi. Klonidin ve glukagon uyarısına maksimum BH yanıtı ile boy uzaması arasındaki ilişki Grup-1 için negatif yönde anlamlı bulundu (P<0,05). Boy uzaması ile BH dozu arasında pozitif yönde, başlangıç takvim yaşı arasında negatif yönde anlamlı bir ilişki saptandı (p<0,05). Serum IGF-1 SDS'leri ile boy uzaması arasında anlamlı ilişki saptanmadı (p=0,120). Boy uzaması ile öngörülen boy arasında; Grup-1 ve Grup-2 için 1. yılda pozitif yönde anlamlı bir ilişki saptandı (p<0,05). Toplam 180 hastanın hipofiz veya kranial MR'ı mevcuttu. Bunların % 78'i normaldi. Toplam 41 hastamız nihai boya ulaştı. Bu hastaların 27 tanesi hedef boylarına ulaştı.
We aimed to investigate the linear growth, weight gain, bone age progression, and pubertal pace of children on growth hormone treatment followed in our Division of Pediatric Endocrinology at Uludag University. The data between January 1995 and December 2005 were analyzed retrospectively.A total of 230 patients were included. The patients were classified as isolated growth hormone deficiency (Group-1), Turner syndrome (Group-2), and others (Group-3). The mean maximum GH response to clonidin and glucagon stimulation tests was 4.58 and 6.01 ng/ml respectively. The mean GH dose was 0.215 (0.15- 0.46) mg/kg/week. Height SDS significantly increased in all three groups (p<0.05). The difference between the chronologic age (CA) and bone age (BA) decreased in Groups-1 and 2 during the first and second years of treatment (p<0.05). The BA acceleration was verified by the decrement in CA/BA ratio. However, predicted height was not negatively influenced despite BA advancement. There was a negative correlation between the response to GH treatment and the maximum GH response to stimulation with clonidin and glucagon (p<0.05). There was a positive correlation between response to treatment and GH dose and a negative correlation between response to treatment and the CA at the beginning of therapy (p<0.05). There was no correlation between the initial serum IGF-1 SDS and response to therapy (p=0,120). There was a positive correlation between the height velocity and the predicted height at the end of the first year of treatment for Groups-1 and 2 (p<0.05). Magnetic resonance imaging of the pituitary gland was available in 180 patients and 78% was normal. Forty one patients reached final height twenty seven of whom could attain their target height.
We aimed to investigate the linear growth, weight gain, bone age progression, and pubertal pace of children on growth hormone treatment followed in our Division of Pediatric Endocrinology at Uludag University. The data between January 1995 and December 2005 were analyzed retrospectively.A total of 230 patients were included. The patients were classified as isolated growth hormone deficiency (Group-1), Turner syndrome (Group-2), and others (Group-3). The mean maximum GH response to clonidin and glucagon stimulation tests was 4.58 and 6.01 ng/ml respectively. The mean GH dose was 0.215 (0.15- 0.46) mg/kg/week. Height SDS significantly increased in all three groups (p<0.05). The difference between the chronologic age (CA) and bone age (BA) decreased in Groups-1 and 2 during the first and second years of treatment (p<0.05). The BA acceleration was verified by the decrement in CA/BA ratio. However, predicted height was not negatively influenced despite BA advancement. There was a negative correlation between the response to GH treatment and the maximum GH response to stimulation with clonidin and glucagon (p<0.05). There was a positive correlation between response to treatment and GH dose and a negative correlation between response to treatment and the CA at the beginning of therapy (p<0.05). There was no correlation between the initial serum IGF-1 SDS and response to therapy (p=0,120). There was a positive correlation between the height velocity and the predicted height at the end of the first year of treatment for Groups-1 and 2 (p<0.05). Magnetic resonance imaging of the pituitary gland was available in 180 patients and 78% was normal. Forty one patients reached final height twenty seven of whom could attain their target height.
Description
Keywords
Büyüme hormonu eksikliği, Büyüme hormonu tedavisi, Turner sendromu, Growth hormone deficiency, Growth hormone treatment, Turner syndrome
Citation
Salı, E. (2012). Büyüme hormonu eksikliği saptanan çocuk hastalarda, büyüme hormonu tedavisinin retrospektif olarak değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.