Deterioration of growth hormone (GH) response and anterior pituitary function in young adults with childhood-onset GH deficiency and ectopic posterior pituitary: a two-year prospective follow-up study.
BACKGROUND
The current criteria for definition of partial GHD in young adults are still a subject of debate.


OBJECTIVE
The objective of the study was to reinvestigate anterior pituitary function in young adults with congenital childhood-onset GHD associated with structural hypothalamic-pituitary abnormalities and normal GH response at the time of first reassessment of GH secretion.


METHODS
This was a prospective explorative study conducted in a university research hospital.


METHODS
Thirteen subjects with a mean age of 17.2 +/- 0.7 yr and a peak GH after insulin tolerance test (ITT) higher than 5 microg/liter were recruited from a cohort of 42 patients with childhood-onset GHD and ectopic posterior pituitary at magnetic resonance imaging. GH secretion after ITT and GHRH plus arginine, IGF-I concentration, and body mass index, waist circumference, blood pressure, total cholesterol, and fibrinogen were evaluated at baseline and at 2-yr follow-up.


RESULTS
At mean age of 19.2 +/- 0.7 yr, the mean peak GH response decreased significantly after ITT (P = 0.00001) and GHRH plus arginine (P = 0.0001). GH peak values after ITT and GHRH plus arginine were less than 5 and 9 microg/liter in 10 and eight patients, respectively. Additional pituitary defects were documented in eight patients. Significant changes were found in the values of IGF-I sd score (P = 0.0026), waist circumference (P = 0.00001), serum total cholesterol (P = 0.00001), and serum fibrinogen (P = 0.0004).


CONCLUSIONS
The results of this study underline the importance of further reassessment of pituitary function in young adults with GHD of childhood-onset and poststimulation GH responses suggestive of partial GHD.
AssociateDepartment of Pediatrics Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, University of Genova, Largo Gerolamo Gaslini, 5, 16147 Genova, Italy. mohamadmaghnie@ospedale-gaslini.ge.it.
Natascia
N
di Iorgi
Andrea
A
Secco
Flavia
F
Napoli
Carmine
C
Tinelli
Annalisa
A
Calcagno
Nadia
N
Fratangeli
Linda
L
Ambrosini
Andrea
A
Rossi
Renata
R
Lorini
Mohamad
M
Maghnie
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002828:Choristoma / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D013007:Growth Hormone-Releasing Hormone / Q000097:blood; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000097:blood / Q000172:deficiency*; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010900:Pituitary Diseases / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology*; D010903:Pituitary Gland, Anterior / Q000378:metabolism / Q000473:pathology; D011446:Prospective Studies
D019382:Human Growth Hormone; D013007:Growth Hormone-Releasing Hormone