Cargando…
Identifying patient-related predictors of permanent growth hormone deficiency
OBJECTIVE: Isolated childhood growth hormone deficiency (GHD) can persist into adulthood, and re-testing at the transition period is needed to determine whether continued growth hormone therapy is indicated. Here, our objective was to identify predictors of permanent GHD. DESIGN: Retrospective singl...
Autores principales: | , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10597646/ https://www.ncbi.nlm.nih.gov/pubmed/37881494 http://dx.doi.org/10.3389/fendo.2023.1270845 |
_version_ | 1785125387660951552 |
---|---|
author | Mericq, Veronica Iñiguez, German Pinto, Graziella Gonzalez-Briceño, Laura G. Samara-Boustani, Dinane Thalassinos, Caroline Flechtner, Isabelle Stoupa, Athanasia Beltrand, Jacques Besançon, Alix Brabant, Séverine Ghazal, Khaldoun Leban, Monique Touraine, Philippe Cavada, Gabriel Polak, Michel Kariyawasam, Dulanjalee |
author_facet | Mericq, Veronica Iñiguez, German Pinto, Graziella Gonzalez-Briceño, Laura G. Samara-Boustani, Dinane Thalassinos, Caroline Flechtner, Isabelle Stoupa, Athanasia Beltrand, Jacques Besançon, Alix Brabant, Séverine Ghazal, Khaldoun Leban, Monique Touraine, Philippe Cavada, Gabriel Polak, Michel Kariyawasam, Dulanjalee |
author_sort | Mericq, Veronica |
collection | PubMed |
description | OBJECTIVE: Isolated childhood growth hormone deficiency (GHD) can persist into adulthood, and re-testing at the transition period is needed to determine whether continued growth hormone therapy is indicated. Here, our objective was to identify predictors of permanent GHD. DESIGN: Retrospective single-centre study of patients with childhood-onset GHD who were re-tested after adult height attainment. METHODS: Auxological, clinical, laboratory, and MRI data throughout follow-up were collected. RESULTS: We included 101 patients. At GH treatment initiation, age was 8.1 ± 0.4 years, height -2.25 ± 0.8, and BMI -0.27 ± 0.1 SDS. The 29 (28.7%) patients with persistent GHD had lower height SDS (-2.57 ± 0.1 vs. -2.11 ± 0.1, p<0.001) and mean GH peaks (8.4 ± 1.0 vs.13.2 ± 0.5 mIU/L, p<0.001) at GHD diagnosis; at adult height, they had lower IGF1 (232 ± 19.9 vs. 331 ± 9.1 ng/mL, p<0.001) and higher BMI SDS (-0.15 ± 0.27 vs. -0.73 ± 0.13, p<0.005). By multivariate analysis, the best predictive model included height and BMI SDS, both GH peaks, and MRI findings at diagnosis. Patients with height at diagnosis <-3 SDS had a 7.7 (95% IC 1.4-43.1, p=0.02) fold higher risk of persistent GHD after adjustment on BMI SDS. An abnormal pituitary region by MRI was the strongest single predictor (7.2 times, 95% CI 2.7-19.8) and after multivariate analysis adjustment for GH peaks and height SDS at diagnosis, the risk increased to 10.6 (1.8 - 61.3) times. CONCLUSIONS: Height <-3 SDS at GHD diagnosis and pituitary MRI abnormalities should lead to a high index of suspicion for persistent GHD. |
format | Online Article Text |
id | pubmed-10597646 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-105976462023-10-25 Identifying patient-related predictors of permanent growth hormone deficiency Mericq, Veronica Iñiguez, German Pinto, Graziella Gonzalez-Briceño, Laura G. Samara-Boustani, Dinane Thalassinos, Caroline Flechtner, Isabelle Stoupa, Athanasia Beltrand, Jacques Besançon, Alix Brabant, Séverine Ghazal, Khaldoun Leban, Monique Touraine, Philippe Cavada, Gabriel Polak, Michel Kariyawasam, Dulanjalee Front Endocrinol (Lausanne) Endocrinology OBJECTIVE: Isolated childhood growth hormone deficiency (GHD) can persist into adulthood, and re-testing at the transition period is needed to determine whether continued growth hormone therapy is indicated. Here, our objective was to identify predictors of permanent GHD. DESIGN: Retrospective single-centre study of patients with childhood-onset GHD who were re-tested after adult height attainment. METHODS: Auxological, clinical, laboratory, and MRI data throughout follow-up were collected. RESULTS: We included 101 patients. At GH treatment initiation, age was 8.1 ± 0.4 years, height -2.25 ± 0.8, and BMI -0.27 ± 0.1 SDS. The 29 (28.7%) patients with persistent GHD had lower height SDS (-2.57 ± 0.1 vs. -2.11 ± 0.1, p<0.001) and mean GH peaks (8.4 ± 1.0 vs.13.2 ± 0.5 mIU/L, p<0.001) at GHD diagnosis; at adult height, they had lower IGF1 (232 ± 19.9 vs. 331 ± 9.1 ng/mL, p<0.001) and higher BMI SDS (-0.15 ± 0.27 vs. -0.73 ± 0.13, p<0.005). By multivariate analysis, the best predictive model included height and BMI SDS, both GH peaks, and MRI findings at diagnosis. Patients with height at diagnosis <-3 SDS had a 7.7 (95% IC 1.4-43.1, p=0.02) fold higher risk of persistent GHD after adjustment on BMI SDS. An abnormal pituitary region by MRI was the strongest single predictor (7.2 times, 95% CI 2.7-19.8) and after multivariate analysis adjustment for GH peaks and height SDS at diagnosis, the risk increased to 10.6 (1.8 - 61.3) times. CONCLUSIONS: Height <-3 SDS at GHD diagnosis and pituitary MRI abnormalities should lead to a high index of suspicion for persistent GHD. Frontiers Media S.A. 2023-10-10 /pmc/articles/PMC10597646/ /pubmed/37881494 http://dx.doi.org/10.3389/fendo.2023.1270845 Text en Copyright © 2023 Mericq, Iñiguez, Pinto, Gonzalez-Briceño, Samara-Boustani, Thalassinos, Flechtner, Stoupa, Beltrand, Besançon, Brabant, Ghazal, Leban, Touraine, Cavada, Polak and Kariyawasam https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Endocrinology Mericq, Veronica Iñiguez, German Pinto, Graziella Gonzalez-Briceño, Laura G. Samara-Boustani, Dinane Thalassinos, Caroline Flechtner, Isabelle Stoupa, Athanasia Beltrand, Jacques Besançon, Alix Brabant, Séverine Ghazal, Khaldoun Leban, Monique Touraine, Philippe Cavada, Gabriel Polak, Michel Kariyawasam, Dulanjalee Identifying patient-related predictors of permanent growth hormone deficiency |
title | Identifying patient-related predictors of permanent growth hormone deficiency |
title_full | Identifying patient-related predictors of permanent growth hormone deficiency |
title_fullStr | Identifying patient-related predictors of permanent growth hormone deficiency |
title_full_unstemmed | Identifying patient-related predictors of permanent growth hormone deficiency |
title_short | Identifying patient-related predictors of permanent growth hormone deficiency |
title_sort | identifying patient-related predictors of permanent growth hormone deficiency |
topic | Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10597646/ https://www.ncbi.nlm.nih.gov/pubmed/37881494 http://dx.doi.org/10.3389/fendo.2023.1270845 |
work_keys_str_mv | AT mericqveronica identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT iniguezgerman identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT pintograziella identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT gonzalezbricenolaurag identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT samaraboustanidinane identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT thalassinoscaroline identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT flechtnerisabelle identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT stoupaathanasia identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT beltrandjacques identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT besanconalix identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT brabantseverine identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT ghazalkhaldoun identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT lebanmonique identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT tourainephilippe identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT cavadagabriel identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT polakmichel identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency AT kariyawasamdulanjalee identifyingpatientrelatedpredictorsofpermanentgrowthhormonedeficiency |