title: Voice abnormality in adults with congenital and adult-acquired growth hormone deficiency.
abstract: BACKGROUND
  Adult males with congenital, untreated, severe GH deficiency (GHD) due to genetic GHRH receptor deficiency exhibit distinctive, high-pitched, and raspy voice characteristics.
  
  
  OBJECTIVE
  To determine the physical underpinning of this phenomenon, we performed voice recordings, translarynx impedance measurements, spectral analysis, and estimates of spectral complexity [approximate entropy (ApEn)] in four affected men. Results were compared with those obtained in four men with untreated adult-onset GHD and a normal male population.
  
  
  RESULTS
  Congenital GHD subjects had a high-pitched voice with a fundamental frequency typical of normal females (174-266 Hz). Their frequency spectra were characterized by abnormal harmonics, with reversal/interruption of the normal amplitude decay among higher-order harmonics, findings consistent with a creaky quality of the voice. Patients with adult-onset GHD, acquired at ages 31, 38, and 40 yr, had a normal male pitch (fundamental frequency, 117-154 Hz) but pathologically low ApEn values, corresponding to a breathy quality of the voice and suggesting abnormal vocal fold function. A fourth patient who acquired GHD at age 22 yr had a pitch intermediate between male and female, high ApEn, and a spectral pattern similar to the congenital GHD patients.
  
  
  CONCLUSIONS
  This study demonstrates an effect of GH on laryngeal size and vocal fold compliance that results in a high pitch and disordered spectral quality. The time of onset of GHD determines which type of abnormality predominates.
authors.affiliation: North Western Medical Physics, Christie Hospital, Manchester, United Kingdom. chris.moore@physics.cr.man.ac.uk
authors.forename: Christopher
authors.initials: C
authors.lastname: Moore
authors.forename: Stephen
authors.initials: S
authors.lastname: Shalet
authors.forename: Kathiresan
authors.initials: K
authors.lastname: Manickam
authors.forename: Terry
authors.initials: T
authors.lastname: Willard
authors.forename: Hiralal
authors.initials: H
authors.lastname: Maheshwari
authors.forename: Gerhard
authors.initials: G
authors.lastname: Baumann
mesh_terms: D000328:Adult; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011986:Receptors, Somatotropin / Q000172:deficiency / Q000235:genetics*; D014832:Voice Disorders / Q000209:etiology*
chemical_list: D011986:Receptors, Somatotropin; D019382:Human Growth Hormone