Catch-Up Growth in Patients with Congenital or Acquired Growth Hormone Deficiency After GH Replacement: Clinical Features and Hypothalamic–Pituitary Imaging

  • Luciani R. Carvalho
  • Ivo J.P. Arnhold
  • Berenice Bilharinho Mendonca
  • Everlayny Fiorot Costalonga
  • Aline Pedrosa Otto
  • Claudia da Costa Leite
  • Leandro Tavares Lucato
  • Mirella Maccarini Peruchi
Chapter

Abstract

Hypothalamic and pituitary disorders usually impair statural growth. These disorders may be either congenital or acquired with differences in clinical presentation. Growth failure is mainly related to growth hormone deficiency (GHD) that can be accompanied by other pituitary hormone deficiencies. The onset of clinical features may be insidious and unnoticed for years or decades. Therefore, it is important to periodically assess auxologic data such as height, growth velocity, bone maturation and evaluate hormonal levels related to hypothalamic–pituitary axis in these patients. Magnetic resonance imaging (MRI) greatly improved the study of central nervous system (CNS) disorders including the hypothalamic–pituitary region. Currently, it is an essential tool in the definition of the etiology of GHD. It can detect tumors that may require surgical intervention, and also provide insights into other causes of GHD. Catch up growth of congenital disorders is essentially dependent on hormone replacement. Even with an initial diagnosis of IGHD, attention should be given to the risk of the development of multiple pituitary hormone deficiencies. In addition to the hormonal deficiencies due to the acquired disorder themselves; their treatment (surgery, irradiation, chemotherapy) often leads to combined pituitary deficits. Growth responsiveness to rhGH has safety aspects of treatment which deserve additional discussion.

Keywords

Obesity Adenoma Tuberculosis Meningioma Hydrocephalus 

Abbreviations

ACTH

Adrenocortical-stimulating hormone

Afp

Alpha-fetoprotein

BMI

Body mass index

CNS

Central nervous system

CPP

Central precocious puberty

CT

Computed tomography

DI

Diabetes insipidus

EPP

Ectopic posterior pituitary

GH1

Growth hormone 1 gene

GHRHR

Growth hormone-releasing hormone receptor gene

GLI2

GLI-KRUPPEL family member gene 2

GH

Growth hormone

GHBP

Growth hormone binding protein

GHD

Growth hormone deficiency

GHRH

growth hormone-releasing hormone

HESX1

Homeobox embryonic stem cell 1 gene

hCG

Human chorionic gonadotropin

IGF-1

Insulin-like growth factor 1

IGFBP-3

Insulin-like growth factor binding protein 3

IGHD

Isolated growth hormone deficiency

LCH

Langerhans cell histiocytosis

LHX4

Lim Homeobox 4 gene

MPHD

Multiple pituitary hormone deficiency

MRI

Magnetic resonance imaging

OTX2

Orthodenticle, drosophila, homolog of, 2 gene

Pit1

Pou Domain, Class1, Transcription factor 1, POU1F1 gene

PROP1

Prophet of pit 1 gene

rhGH

Recombinant human growth hormone

SDS

Standard deviation score

SOD

Septo-optic dysplasia

SOX2

SRY-BOX 2 gene

SOX3

SRY-BOX 3 gene

T4

Levothyroxine

TBI

Traumatic brain injury

TSH

Thyroid-stimulating hormone

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Luciani R. Carvalho
    • 1
  • Ivo J.P. Arnhold
    • 1
  • Berenice Bilharinho Mendonca
    • 1
  • Everlayny Fiorot Costalonga
    • 1
  • Aline Pedrosa Otto
    • 1
  • Claudia da Costa Leite
    • 2
  • Leandro Tavares Lucato
    • 2
  • Mirella Maccarini Peruchi
    • 2
  1. 1.Division of EndocrinologyHospital das Clinicas, University of São Paulo Medical SchoolSão PauloBrazil
  2. 2.Division of RadiologyHospital das Clinicas, University of São Paulo Medical SchoolSão PauloBrazil

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