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__NOTOC__ | __NOTOC__ | ||
{{Growth hormone deficiency}} | {{Growth hormone deficiency}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{MAD}} | ||
==Overview== | ==Overview== | ||
The hallmark of growth hormone deficiency is [[growth failure]]. The most common symptoms of GHD in infants are delayed [[Bone age]], perinatal [[asphyxia]], [[hypoglycemia]], and [[jaundice]]. Symptoms in adults include increased [[Body mass|lean body mass]], [[fractures]] of the [[lumbar spine]], and [[osteopenia]]. | |||
The hallmark of | |||
==History and Symptoms== | ==History and Symptoms== | ||
* | Common symptoms of growth hormone deficiency include: | ||
* | ==== Neonatal symptoms ==== | ||
* Growth failure can occur during the first months of life but may not be obvious until 6 to 12 months of age.<ref name="pmid1519958">{{cite journal| author=Wit JM, van Unen H| title=Growth of infants with neonatal growth hormone deficiency. | journal=Arch Dis Child | year= 1992 | volume= 67 | issue= 7 | pages= 920-4 | pmid=1519958 | doi= | pmc=1793852 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1519958 }}</ref> | |||
=== | * [[Bone age]] and height age are significantly delayed when compared to children without deficiency.<ref name="pmid11739421">{{cite journal| author=Pena-Almazan S, Buchlis J, Miller S, Shine B, MacGillivray M| title=Linear growth characteristics of congenitally GH-deficient infants from birth to one year of age. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 12 | pages= 5691-4 | pmid=11739421 | doi=10.1210/jcem.86.12.8068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11739421 }}</ref> | ||
* Higher frequency of perinatal [[asphyxia]] | |||
*[ | * Neonatal morbidity may include [[hypoglycemia]] and prolonged [[jaundice]] especially if combined with adrenocorticotropic hormone deficiency. | ||
* [[Cryptorchidism]] and hypoplasia of the scrotum may occur. | |||
*[ | |||
=== | ==== Childhood symptoms ==== | ||
* The single most important clinical manifestation of GHD is growth failure. | |||
*[ | * [[Growth failure]] may not be obvious until 6-12 months age. | ||
===Less | * Children present with doll-like [[fat]] distribution pattern, immature face with an underdeveloped [[nasal bridge]]. | ||
* The voice is infantile, and hair growth is sparse and thin. | |||
*[ | * [[Developmental milestones]] may be delayed due to [[Muscle weakness|muscle weakness.]] | ||
*[ | '''Adult symptoms''' | ||
*[ | * Patients with childhood-onset GH deficiency have extra severe clinical manifestations than folks who develop it during adulthood.<ref name="pmid11600527">{{cite journal| author=Koranyi J, Svensson J, Götherström G, Sunnerhagen KS, Bengtsson B, Johannsson G| title=Baseline characteristics and the effects of five years of GH replacement therapy in adults with GH deficiency of childhood or adulthood onset: a comparative, prospective study. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 10 | pages= 4693-9 | pmid=11600527 | doi=10.1210/jcem.86.10.7896 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11600527 }}</ref> | ||
* Lean body mass is elevated in adults who're deficient in GH and no longer replaced in comparison with those who have normal GH secretion.<ref name="pmid2245969">{{cite journal| author=Cuneo RC, Salomon F, Wiles CM, Sönksen PH| title=Skeletal muscle performance in adults with growth hormone deficiency. | journal=Horm Res | year= 1990 | volume= 33 Suppl 4 | issue= | pages= 55-60 | pmid=2245969 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2245969 }}</ref> | |||
* Fractures of the [[lumbar spine]] are higher than normal folks with a high incidence of [[osteopenia]]. | |||
* The degree of [[osteopenia]] appears to correlate directly with the degree of GH deficiency.<ref name="pmid10372687">{{cite journal| author=Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G et al.| title=Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism. | journal=J Clin Endocrinol Metab | year= 1999 | volume= 84 | issue= 6 | pages= 1919-24 | pmid=10372687 | doi=10.1210/jcem.84.6.5742 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10372687 }}</ref> | |||
* Less active than normal people of the same age<ref name="pmid2816361">{{cite journal| author=McGauley GA| title=Quality of life assessment before and after growth hormone treatment in adults with growth hormone deficiency. | journal=Acta Paediatr Scand Suppl | year= 1989 | volume= 356 | issue= | pages= 70-2; discussion 73-4 | pmid=2816361 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2816361 }}</ref> | |||
'''Cardiovascular risk factors'''<ref name="pmid26300280">{{cite journal| author=Giovannini L, Tirabassi G, Muscogiuri G, Di Somma C, Colao A, Balercia G| title=Impact of adult growth hormone deficiency on metabolic profile and cardiovascular risk [Review]. | journal=Endocr J | year= 2015 | volume= 62 | issue= 12 | pages= 1037-48 | pmid=26300280 | doi=10.1507/endocrj.EJ15-0337 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26300280 }}</ref> | |||
* [[Dyslipidemia]]<ref name="pmid10566630">{{cite journal| author=Bengtsson BA, Abs R, Bennmarker H, Monson JP, Feldt-Rasmussen U, Hernberg-Stahl E et al.| title=The effects of treatment and the individual responsiveness to growth hormone (GH) replacement therapy in 665 GH-deficient adults. KIMS Study Group and the KIMS International Board. | journal=J Clin Endocrinol Metab | year= 1999 | volume= 84 | issue= 11 | pages= 3929-35 | pmid=10566630 | doi=10.1210/jcem.84.11.6088 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10566630 }}</ref> | |||
* Increased [[Inflammation|inflammatory markers]]<ref name="pmid11739438">{{cite journal| author=Sesmilo G, Miller KK, Hayden D, Klibanski A| title=Inflammatory cardiovascular risk markers in women with hypopituitarism. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 12 | pages= 5774-81 | pmid=11739438 | doi=10.1210/jcem.86.12.8087 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11739438 }}</ref> | |||
* Increase in [[Biochemistry|biochemical]] markers of [[endothelial dysfunction]]<ref name="pmid11549653">{{cite journal| author=Elhadd TA, Abdu TA, Oxtoby J, Kennedy G, McLaren M, Neary R et al.| title=Biochemical and biophysical markers of endothelial dysfunction in adults with hypopituitarism and severe GH deficiency. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 9 | pages= 4223-32 | pmid=11549653 | doi=10.1210/jcem.86.9.7813 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11549653 }}</ref> | |||
==References== | ==References== | ||
Latest revision as of 21:01, 25 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
The hallmark of growth hormone deficiency is growth failure. The most common symptoms of GHD in infants are delayed Bone age, perinatal asphyxia, hypoglycemia, and jaundice. Symptoms in adults include increased lean body mass, fractures of the lumbar spine, and osteopenia.
History and Symptoms
Common symptoms of growth hormone deficiency include:
Neonatal symptoms
- Growth failure can occur during the first months of life but may not be obvious until 6 to 12 months of age.[1]
- Bone age and height age are significantly delayed when compared to children without deficiency.[2]
- Higher frequency of perinatal asphyxia
- Neonatal morbidity may include hypoglycemia and prolonged jaundice especially if combined with adrenocorticotropic hormone deficiency.
- Cryptorchidism and hypoplasia of the scrotum may occur.
Childhood symptoms
- The single most important clinical manifestation of GHD is growth failure.
- Growth failure may not be obvious until 6-12 months age.
- Children present with doll-like fat distribution pattern, immature face with an underdeveloped nasal bridge.
- The voice is infantile, and hair growth is sparse and thin.
- Developmental milestones may be delayed due to muscle weakness.
Adult symptoms
- Patients with childhood-onset GH deficiency have extra severe clinical manifestations than folks who develop it during adulthood.[3]
- Lean body mass is elevated in adults who're deficient in GH and no longer replaced in comparison with those who have normal GH secretion.[4]
- Fractures of the lumbar spine are higher than normal folks with a high incidence of osteopenia.
- The degree of osteopenia appears to correlate directly with the degree of GH deficiency.[5]
- Less active than normal people of the same age[6]
Cardiovascular risk factors[7]
- Dyslipidemia[8]
- Increased inflammatory markers[9]
- Increase in biochemical markers of endothelial dysfunction[10]
References
- ↑ Wit JM, van Unen H (1992). "Growth of infants with neonatal growth hormone deficiency". Arch Dis Child. 67 (7): 920–4. PMC 1793852. PMID 1519958.
- ↑ Pena-Almazan S, Buchlis J, Miller S, Shine B, MacGillivray M (2001). "Linear growth characteristics of congenitally GH-deficient infants from birth to one year of age". J Clin Endocrinol Metab. 86 (12): 5691–4. doi:10.1210/jcem.86.12.8068. PMID 11739421.
- ↑ Koranyi J, Svensson J, Götherström G, Sunnerhagen KS, Bengtsson B, Johannsson G (2001). "Baseline characteristics and the effects of five years of GH replacement therapy in adults with GH deficiency of childhood or adulthood onset: a comparative, prospective study". J Clin Endocrinol Metab. 86 (10): 4693–9. doi:10.1210/jcem.86.10.7896. PMID 11600527.
- ↑ Cuneo RC, Salomon F, Wiles CM, Sönksen PH (1990). "Skeletal muscle performance in adults with growth hormone deficiency". Horm Res. 33 Suppl 4: 55–60. PMID 2245969.
- ↑ Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G; et al. (1999). "Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism". J Clin Endocrinol Metab. 84 (6): 1919–24. doi:10.1210/jcem.84.6.5742. PMID 10372687.
- ↑ McGauley GA (1989). "Quality of life assessment before and after growth hormone treatment in adults with growth hormone deficiency". Acta Paediatr Scand Suppl. 356: 70–2, discussion 73-4. PMID 2816361.
- ↑ Giovannini L, Tirabassi G, Muscogiuri G, Di Somma C, Colao A, Balercia G (2015). "Impact of adult growth hormone deficiency on metabolic profile and cardiovascular risk [Review]". Endocr J. 62 (12): 1037–48. doi:10.1507/endocrj.EJ15-0337. PMID 26300280.
- ↑ Bengtsson BA, Abs R, Bennmarker H, Monson JP, Feldt-Rasmussen U, Hernberg-Stahl E; et al. (1999). "The effects of treatment and the individual responsiveness to growth hormone (GH) replacement therapy in 665 GH-deficient adults. KIMS Study Group and the KIMS International Board". J Clin Endocrinol Metab. 84 (11): 3929–35. doi:10.1210/jcem.84.11.6088. PMID 10566630.
- ↑ Sesmilo G, Miller KK, Hayden D, Klibanski A (2001). "Inflammatory cardiovascular risk markers in women with hypopituitarism". J Clin Endocrinol Metab. 86 (12): 5774–81. doi:10.1210/jcem.86.12.8087. PMID 11739438.
- ↑ Elhadd TA, Abdu TA, Oxtoby J, Kennedy G, McLaren M, Neary R; et al. (2001). "Biochemical and biophysical markers of endothelial dysfunction in adults with hypopituitarism and severe GH deficiency". J Clin Endocrinol Metab. 86 (9): 4223–32. doi:10.1210/jcem.86.9.7813. PMID 11549653.