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Effects of growth hormone therapy in pediatric patients with growth hormone deficiency and Chiari I malformation: a retrospective study

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Abstract

Purpose

The safety and efficacy of growth hormone replacement therapy (GHRT) on pediatric patients with growth hormone deficiency (GHD) and Chiari I malformation (CIM) are not well investigated within the current body of literature. With no clear indication of the effects of GHRT on CIM disease progression, we sought to determine the effect of GHRT on tonsillar herniation and progression of CIM symptomatology.

Methods

From a previously established database of 465 patients with radiologically confirmed CIM defined as > 5 mm of tonsillar descent on head magnetic resonance imaging (MRI), we identified 20 patients who also had GHD. Using the imaging analysis software package, ANALYZE, the degree of change in tonsillar herniation was documented between initial and final MRI measurements. The radiologic and clinical changes over time were examined via a proportional odds model, Student’s t test, Mann-Whitney test, or a mixed model corresponding to the outcomes measured either on an ordinal scale or on a quantitative scale.

Results

Incidence of GHD in our CIM population was 4.3%. There was no significant effect of GHRT on the degree of tonsillar herniation in patients with GHD and CIM. No patient became symptomatic, developed syringomyelia, or required surgical intervention for CIM.

Conclusion

Based on our findings with a larger sample size, along with recent reports, the incidence of patients with CIM and GHD we reported (0.86–5%) is likely more indicative of the actual incidence of GHD and CIM than the prior findings within the literature (9.1–20%). We also suggest that GHRT does not significantly affect CIM morphology or symptomatology. Therefore, neurosurgeons should have no hesitation clearing these patients for GHRT.

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Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by University of Arkansas College of Medicine: Research Scholar Pilot Grant Awards in Child Health program.

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Authors and Affiliations

  1. Division of Neurosurgery, Arkansas Children’s Hospital, Little Rock, AR, USA

    Harrison Ballard, William Fuell, Reem Elwy & Gregory W. Albert

  2. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Xiang-Yang Lou

  3. Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Gregory W. Albert

Authors
  1. Harrison Ballard
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  2. William Fuell
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  3. Reem Elwy
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  4. Xiang-Yang Lou
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  5. Gregory W. Albert
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Correspondence to Gregory W. Albert.

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Ballard, H., Fuell, W., Elwy, R. et al. Effects of growth hormone therapy in pediatric patients with growth hormone deficiency and Chiari I malformation: a retrospective study. Childs Nerv Syst 36, 835–839 (2020). https://doi.org/10.1007/s00381-019-04370-2

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  • DOI: https://doi.org/10.1007/s00381-019-04370-2

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