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Comparative Study
. 2009 May 6:9:29.
doi: 10.1186/1471-2431-9-29.

Diagnosis of growth hormone (GH) deficiency: comparison of pituitary stalk interruption syndrome and transient GH deficiency

Murielle Louvel  1 , Mariana Marcu, Christine Trivin, Jean-Claude Souberbielle, Raja Brauner
Affiliations
Comparative Study

Diagnosis of growth hormone (GH) deficiency: comparison of pituitary stalk interruption syndrome and transient GH deficiency

Murielle Louvel et al. BMC Pediatr. .

Abstract

Background: Most patients with childhood non-organic growth hormone (GH) deficiency (GHD) produce a normal GH peak as young adults. Our objectives were to better define this transient GHD and evaluate the factors influencing the growth response of patients with pituitary stalk interruption syndrome (PSIS).

Methods: We studied 72 prepubertal patients with a GH peak < 6.7 ng/ml after 2 stimulation tests, treated with 0.2 mg GH/kg/w for at least 3 years. Group 1 (n = 53, 4.7 +/- 4.0 years) had PSIS and Group 2 (n = 19, 9.2 +/- 3.0 years) had transient GHD and normal pituitary.

Results: At diagnosis, 64% of Group 1 and one Group 2 were < 5 years old. The growth rate of 59% Group 1 and two Group 2 patients was < or = -2 SDS. The GH peak of 64% Group 1 patients and no Group 2 patients was < 3 ng/ml. The plasma insulin-like growth factor-1 of all Group 1 and all but one Group 2 patients was < or = -2 z scores.During the first year of GH treatment, the growth rate was > or = 2 SDS in 81% Group 1 and 37% Group 2 patients. In Group 1, it was negatively correlated with the GH peak before treatment (P < 0.03), and with the difference between the target and adult heights (P < 0.01).The height gain SDSs between diagnosis and adult height were 1.7 +/- 1.2 in Group 1 (n = 30) and 1.08 +/- 0.8 in Group 2 (n = 12, P = 0.05).

Conclusion: The factors of the growth response to GH treatment should be analysed separately for each population: with and without PSIS or other markers.

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Figures

Figure 1
Figure 1
Characteristics at diagnosis.
Figure 2
Figure 2
Growth rates before and during the first three years of GH treatment.
Figure 3
Figure 3
Annual changes in height during the first three years of GH treatment.
See this image and copyright information in PMC

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