[Growth hormone usage in Prader-Willi syndrome].
Prader-Willi syndrome (PWS), with a prevalence of 60:1.000.000, results from the loss of paternal chromosome 15, being 56% due to deletion, 24% due to uniparental maternal disomy, and 18% from methylation, an epigenetic phenomenon. The clinical picture begins with extreme muscular hypotonia, which makes it difficult to feed the child in the first year. As the hypotonia improves, usually in the first two years, around the 4th year of life, an insatiable appetite leads these children to an extreme obesity, with alveolar hypoventilation which endangers their lives. So, paradoxically, PWS threatens the lives of the patients, through inanition in a first phase and, afterwards, through excessive weight gain. The use of growth hormone (hrGH) in these children has a primary goal to change the body composition and improve the physical activity and the quality of life. On the other hand, many PWS patients are indeed GH deficient, and an improvement in the height SDS occurs with treatment. We have to be careful, however. When starting a PWS treatment with a patient on hrGH, a careful evaluation of sleep apnoea (polysomnography) as well as a careful examination of the airways is extremely mandatory, since the treatment may compromise the respiratory pattern of some patients.
Damiani
Durval
D
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil. durvald@iconet.com.br
D006128:Growth / Q000187:drug effects; D019382:Human Growth Hormone / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*; D006801:Humans; D007006:Hypogonadism / Q000150:complications; D009123:Muscle Hypotonia / Q000150:complications; D011218:Prader-Willi Syndrome / Q000188:drug therapy* / Q000378:metabolism; D012891:Sleep Apnea Syndromes / Q000150:complications
D019382:Human Growth Hormone