High risk of adrenal insufficiency in adults previously treated for idiopathic childhood onset human growth hormone HGH deficiency.
Lange M - J Clin Endocrinol Metab - 01-DEC-2003; 88(12): 5784-9
From NIH/NLM MEDLINE
NLM Citation ID:
14671169 (PubMed)
Full Source Title:
Journal of Clinical Endocrinology and Metabolism
Publication Type:
Journal Article
Language:
English
Author Affiliation:
Department of Endocrinology, Rigshospitalet, DK-2100 Copenhagen, Denmark. mlange@rh.dk
Authors:
Lange M; Feldt-Rasmussen U; Svendsen OL; Kastrup KW; Juul A; Müller J
Abstract:
The aim was to reevaluate a group of adults treated for idiopathic childhood onset HGH deficiency (GHD) after 18 yr without GH treatment. Twenty-six (11 females) patients participated. All but two had isolated GHD. Childhood diagnosis was established by insulin tolerance test (ITT). The patients were retested with an ITT to evaluate adult HGH status. In five patients, an arginine and a synacthen test were performed instead of an ITT. Eleven of 25 patients had a subnormal cortisol response to ITT or synacthen. Ten patients had a GH peak less than 3.0 microg/liter (0.5. +/- 0.5 microg/liter), whereas 16 patients displayed a normal GH response (12.3 +/- 10.6 microg/liter) after ITT. IGF-I values were decreased in the patients with a pathological retest as well as in patients with a normal GH response compared with controls (P < 0.005). In 26 idiopathic childhood onset GHD patients, 44% of the patients had developed adrenal insufficiency; 38.5% had persistent GHD in adulthood, using the same test in both childhood and adulthood. Patients having a normal HGH test had decreased IGF-I levels, compared with controls, indicating impaired function of a seemingly normal HGH axis. It is imperative that pituitary axes other than the HGH axis are tested at regular intervals, even in the absence of GHD in adulthood.
Major Subjects:
- Adrenal Insufficiency / diagnosis / * etiology
- Human Growth Hormone / blood / * deficiency
Additional Subjects:
- Adult
- Cosyntropin
- Cross-Sectional Studies
- Female
- Humans
- Hydrocortisone / blood
- Insulin / diagnostic use
- Insulin-Like Growth Factor I / metabolism
- Male
- Metabolism, Inborn Errors / complications
- Research Support, Non-U.S. Gov't
- Risk Assessment
Chemical Compound Name:
11061-68-0(Insulin); 12629-01-5(Human Growth Hormone); 16960-16-0(Cosyntropin); 50-23-7(Hydrocortisone); 53468-06-7(adrenocorticotropin zinc); 67763-96-6(Insulin-Like Growth Factor I)