title: [Pathological daytime sleepiness in an 11-year old girl receiving growth hormone treatment previously cured from craniopharyngioma].
abstract: An 11-year old girl with multihormonal pituitary deficiency previously cured from craniopharyngioma was admitted to the endocrinology Department because of pathological daytime sleepiness. At the age of 7 she had undergone brain tumor surgery with adjuvant radiotherapy (complete dose of 5400 cGy). She had been given replacement therapy of thyroid hormone, cortisol and adiuretin. At the age of 10 years she had started growth hormone (rGH) treatment. After a period of four months of rGH replacement therapy the girl's mother had observed symptoms of excessive daytime sleepiness with a tendency to escalation. MRI of the brain had been performed; no progression has been shown. After 10 months from the start of rGH replacement therapy was referred to the endocrinology department. On the basis of laboratory findings electrolyte and hormonal abnormalities were excluded. On physical examination, the girl manifested massive tonsillar hypertrophy. It was disclosed that she developed obstructive sleep apnea with the drop of oxygen saturation to 60%. The patient was qualified to adenotonsillectomy. There was a spectacular postoperative improvement observed with no future episodes of night apnea and daytime sleepiness. In our opinion, the rGH treatment in our patient induced hypertrophy of the tonsils and adenoid, which led to obstructive sleep apnea syndrome with compensatory daytime sleepiness.
  
  
  CONCLUSIONS
  Obstructive sleep apnea syndrome with compensatory daytime sleepiness may occur in children on rGH replacement therapy. During rGH therapy children should be regularly examined by a laryngologist.
authors.affiliation: Klinika Pediatrii, Onkologii i Endokrynologii Gdanskiego Uniwersytetu Medyczego.
authors.forename: Maria
authors.initials: M
authors.lastname: Korpal-Szczyrska
authors.forename: Dorota
authors.initials: D
authors.lastname: Birkholz
authors.forename: Maja
authors.initials: M
authors.lastname: Okońska
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Pawłowicz
authors.forename: Józef
authors.initials: J
authors.lastname: Szczyrski
mesh_terms: D002648:Child; D003397:Craniopharyngioma / Q000150:complications* / Q000628:therapy; D003937:Diagnosis, Differential; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000009:adverse effects*; D006801:Humans; D006965:Hyperplasia / Q000139:chemically induced; D008279:Magnetic Resonance Imaging; D014066:Palatine Tonsil / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000150:complications* / Q000628:therapy; D020181:Sleep Apnea, Obstructive / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D019382:Human Growth Hormone