title: Likelihood of persistent GH deficiency into late adolescence: relationship to the presence of an ectopic or normally sited posterior pituitary gland.
abstract: OBJECTIVE
  The presence of an ectopic posterior pituitary gland (EPP) in childhood is associated with isolated GH deficiency (IGHD) and multiple pituitary hormone deficiency. GHD in late adolescence has been defined as a peak GH level <5 microg/l. The aim of this study was to identify the likelihood of persistent GHD in late adolescence in patients with an EPP compared with those with a normally sited posterior pituitary (NPP).
  
  
  METHODS
  In 18 patients with an EPP and 15 patients with an NPP, clinical, biochemical and radiographic data were collected.
  
  
  RESULTS
  In the EPP vs. the NPP group, the change in peak GH levels at the end of growth was less (+0.4[95% confidence interval (CI) - 0.8 to 2.7] vs. +4.1[95%CI + 0.4 to +10.5] microg/l, P-value for ancova = 0.03, after adjustment for age and sex). Using a peak GH level of <5 microg/l as a cut-off for GHD, 66% of EPP subjects compared with 40% of NPP subjects had GHD (P = 0.3). Hundred per cent of EPP subjects had a peak GH level on retesting <10 microg/l, compared with 40% of NPP subjects (P < 0.001).
  
  
  CONCLUSIONS
  It is important to document GH status at the end of growth, even if there is a structural abnormality of the hypothalamic-pituitary axis. The presence of an EPP compared to an NPP increases the likelihood of persistent GHD by 26%. As all EPP patients had a peak GH level of <10 microg/l, the cut-off for persistent GHD in late adolescence may need to be revised.
authors.affiliation: Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK.
authors.forename: P G
authors.initials: PG
authors.lastname: Murray
authors.forename: C
authors.initials: C
authors.lastname: Hague
authors.forename: O
authors.initials: O
authors.lastname: Fafoula
authors.forename: H
authors.initials: H
authors.lastname: Gleeson
authors.forename: L
authors.initials: L
authors.lastname: Patel
authors.forename: I
authors.initials: I
authors.lastname: Banerjee
authors.forename: A L
authors.initials: AL
authors.lastname: Raabe
authors.forename: C M
authors.initials: CM
authors.lastname: Hall
authors.forename: N B
authors.initials: NB
authors.lastname: Wright
authors.forename: R
authors.initials: R
authors.lastname: Amin
authors.forename: P E
authors.initials: PE
authors.lastname: Clayton
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D002648:Child; D002675:Child, Preschool; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007223:Infant; D008297:Male; D010904:Pituitary Gland, Posterior / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011859:Radiography; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone