Growth hormone deficiency history and symptoms: Difference between revisions

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==== Neonatal symptoms  ====
==== Neonatal symptoms  ====
* Growth failure can occur during the first months of life but may not be obvious until 6 to 12 months of age.<ref name="pmid1519958">{{cite journal| author=Wit JM, van Unen H| title=Growth of infants with neonatal growth hormone deficiency. | journal=Arch Dis Child | year= 1992 | volume= 67 | issue= 7 | pages= 920-4 | pmid=1519958 | doi= | pmc=1793852 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1519958  }}</ref>
* Growth failure can occur during the first months of life but may not be obvious until 6 to 12 months of age.<ref name="pmid1519958">{{cite journal| author=Wit JM, van Unen H| title=Growth of infants with neonatal growth hormone deficiency. | journal=Arch Dis Child | year= 1992 | volume= 67 | issue= 7 | pages= 920-4 | pmid=1519958 | doi= | pmc=1793852 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1519958  }}</ref>
* Bone age and height age are delayed but similar to each other.<ref name="pmid11739421">{{cite journal| author=Pena-Almazan S, Buchlis J, Miller S, Shine B, MacGillivray M| title=Linear growth characteristics of congenitally GH-deficient infants from birth to one year of age. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 12 | pages= 5691-4 | pmid=11739421 | doi=10.1210/jcem.86.12.8068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11739421  }}</ref>
* [[Bone age]] and height age are delayed but at the same age of each other.<ref name="pmid11739421">{{cite journal| author=Pena-Almazan S, Buchlis J, Miller S, Shine B, MacGillivray M| title=Linear growth characteristics of congenitally GH-deficient infants from birth to one year of age. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 12 | pages= 5691-4 | pmid=11739421 | doi=10.1210/jcem.86.12.8068 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11739421  }}</ref>
* Higher frequency of perinatal asphyxia
* Higher frequency of perinatal [[asphyxia]]
* Neonatal morbidity may include hypoglycemia and prolonged jaundice especially if combined with adrenocorticotropic hormone deficiency.
* Neonatal morbidity may include [[hypoglycemia]] and prolonged [[jaundice]] especially if combined with adrenocorticotropic hormone deficiency.
* Cryptorchidism and hypoplasia of the scrotum
* [[Cryptorchidism]] and hypoplasia of the scrotum may occur.


==== Childhood symptoms ====
==== Childhood symptoms ====
* The single most important clinical manifestation of GHD is growth failure.
* The single most important clinical manifestation of GHD is growth failure.
* The growth failure may not be manifested until late infancy.
* Growth failure may not be obvious until 6-12 months old.


* Children with acquired GHD present with infantile or doll-like fat distribution pattern, immature face with underdeveloped nasal bridge and frontal bossing. The voice is infantile, and hair growth is sparse and thin.
* Children present with doll-like fat distribution pattern, immature face with under developed nasal bridge. The voice is infantile, and hair growth is sparse and thin.
* Delayed muscular development, so that gross motor milestones such as standing, walking, and jumping may be delayed. 
* [[Developmental milestones]] may be delayed due to [[Muscle weakness|muscle weakness.]] 
'''Adult symptoms'''
'''Adult symptoms'''
* Patients with childhood-onset GH deficiency have more severe clinical manifestations than those who develop it as adults.<ref name="pmid11600527">{{cite journal| author=Koranyi J, Svensson J, Götherström G, Sunnerhagen KS, Bengtsson B, Johannsson G| title=Baseline characteristics and the effects of five years of GH replacement therapy in adults with GH deficiency of childhood or adulthood onset: a comparative, prospective study. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 10 | pages= 4693-9 | pmid=11600527 | doi=10.1210/jcem.86.10.7896 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11600527  }}</ref>
* Patients with childhood-onset GH deficiency have more severe clinical manifestations than those who develop it as adults.<ref name="pmid11600527">{{cite journal| author=Koranyi J, Svensson J, Götherström G, Sunnerhagen KS, Bengtsson B, Johannsson G| title=Baseline characteristics and the effects of five years of GH replacement therapy in adults with GH deficiency of childhood or adulthood onset: a comparative, prospective study. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 10 | pages= 4693-9 | pmid=11600527 | doi=10.1210/jcem.86.10.7896 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11600527  }}</ref>
* Lean body mass is increased in adults who are deficient in GH and not replaced compared with those who have normal GH secretion.<ref name="pmid2245969">{{cite journal| author=Cuneo RC, Salomon F, Wiles CM, Sönksen PH| title=Skeletal muscle performance in adults with growth hormone deficiency. | journal=Horm Res | year= 1990 | volume= 33 Suppl 4 | issue=  | pages= 55-60 | pmid=2245969 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2245969  }}</ref>  
* [[Body mass|Lean body mass]] is increased in adults who are deficient in GH and not replaced compared with those who have normal GH secretion.<ref name="pmid2245969">{{cite journal| author=Cuneo RC, Salomon F, Wiles CM, Sönksen PH| title=Skeletal muscle performance in adults with growth hormone deficiency. | journal=Horm Res | year= 1990 | volume= 33 Suppl 4 | issue=  | pages= 55-60 | pmid=2245969 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2245969  }}</ref>  
* Fractures of the lumbar spine is somewhat lower in patients with adult-onset GH deficiency
* Fractures of the lumbar spine are higher than normal persons with a high incidence of [[Osteopenia|osteopenia.]]
* The degree of osteopenia appears to correlate directly with the degree of GH deficiency.<ref name="pmid10372687">{{cite journal| author=Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G et al.| title=Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism. | journal=J Clin Endocrinol Metab | year= 1999 | volume= 84 | issue= 6 | pages= 1919-24 | pmid=10372687 | doi=10.1210/jcem.84.6.5742 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10372687  }}</ref>
* The degree of [[osteopenia]] appears to correlate directly with the degree of GH deficiency.<ref name="pmid10372687">{{cite journal| author=Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G et al.| title=Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism. | journal=J Clin Endocrinol Metab | year= 1999 | volume= 84 | issue= 6 | pages= 1919-24 | pmid=10372687 | doi=10.1210/jcem.84.6.5742 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10372687  }}</ref>
* Less energetic than normal people of the same age<ref name="pmid2816361">{{cite journal| author=McGauley GA| title=Quality of life assessment before and after growth hormone treatment in adults with growth hormone deficiency. | journal=Acta Paediatr Scand Suppl | year= 1989 | volume= 356 | issue=  | pages= 70-2; discussion 73-4 | pmid=2816361 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2816361  }}</ref>
* Less energetic than normal people of the same age<ref name="pmid2816361">{{cite journal| author=McGauley GA| title=Quality of life assessment before and after growth hormone treatment in adults with growth hormone deficiency. | journal=Acta Paediatr Scand Suppl | year= 1989 | volume= 356 | issue=  | pages= 70-2; discussion 73-4 | pmid=2816361 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2816361  }}</ref>
'''Cardiovascular risk factors''' 
'''Cardiovascular risk factors''' 
* Dyslipidemia<ref name="pmid10566630">{{cite journal| author=Bengtsson BA, Abs R, Bennmarker H, Monson JP, Feldt-Rasmussen U, Hernberg-Stahl E et al.| title=The effects of treatment and the individual responsiveness to growth hormone (GH) replacement therapy in 665 GH-deficient adults. KIMS Study Group and the KIMS International Board. | journal=J Clin Endocrinol Metab | year= 1999 | volume= 84 | issue= 11 | pages= 3929-35 | pmid=10566630 | doi=10.1210/jcem.84.11.6088 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10566630  }}</ref>
* [[Dyslipidemia]]<ref name="pmid10566630">{{cite journal| author=Bengtsson BA, Abs R, Bennmarker H, Monson JP, Feldt-Rasmussen U, Hernberg-Stahl E et al.| title=The effects of treatment and the individual responsiveness to growth hormone (GH) replacement therapy in 665 GH-deficient adults. KIMS Study Group and the KIMS International Board. | journal=J Clin Endocrinol Metab | year= 1999 | volume= 84 | issue= 11 | pages= 3929-35 | pmid=10566630 | doi=10.1210/jcem.84.11.6088 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10566630  }}</ref>
* Increased inflammatory markers<ref name="pmid11739438">{{cite journal| author=Sesmilo G, Miller KK, Hayden D, Klibanski A| title=Inflammatory cardiovascular risk markers in women with hypopituitarism. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 12 | pages= 5774-81 | pmid=11739438 | doi=10.1210/jcem.86.12.8087 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11739438  }}</ref>
* Increased inflammatory markers<ref name="pmid11739438">{{cite journal| author=Sesmilo G, Miller KK, Hayden D, Klibanski A| title=Inflammatory cardiovascular risk markers in women with hypopituitarism. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 12 | pages= 5774-81 | pmid=11739438 | doi=10.1210/jcem.86.12.8087 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11739438  }}</ref>
* Increase in biochemical markers of endothelial dysfunction<ref name="pmid11549653">{{cite journal| author=Elhadd TA, Abdu TA, Oxtoby J, Kennedy G, McLaren M, Neary R et al.| title=Biochemical and biophysical markers of endothelial dysfunction in adults with hypopituitarism and severe GH deficiency. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 9 | pages= 4223-32 | pmid=11549653 | doi=10.1210/jcem.86.9.7813 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11549653  }}</ref>
* Increase in biochemical markers of endothelial dysfunction<ref name="pmid11549653">{{cite journal| author=Elhadd TA, Abdu TA, Oxtoby J, Kennedy G, McLaren M, Neary R et al.| title=Biochemical and biophysical markers of endothelial dysfunction in adults with hypopituitarism and severe GH deficiency. | journal=J Clin Endocrinol Metab | year= 2001 | volume= 86 | issue= 9 | pages= 4223-32 | pmid=11549653 | doi=10.1210/jcem.86.9.7813 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11549653  }}</ref>

Revision as of 23:03, 14 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

History and Symptoms

Common symptoms of growth hormone deficiency include:

Neonatal symptoms

  • Growth failure can occur during the first months of life but may not be obvious until 6 to 12 months of age.[1]
  • Bone age and height age are delayed but at the same age of each other.[2]
  • Higher frequency of perinatal asphyxia
  • Neonatal morbidity may include hypoglycemia and prolonged jaundice especially if combined with adrenocorticotropic hormone deficiency.
  • Cryptorchidism and hypoplasia of the scrotum may occur.

Childhood symptoms

  • The single most important clinical manifestation of GHD is growth failure.
  • Growth failure may not be obvious until 6-12 months old.
  • Children present with doll-like fat distribution pattern, immature face with under developed nasal bridge. The voice is infantile, and hair growth is sparse and thin.
  • Developmental milestones may be delayed due to muscle weakness. 

Adult symptoms

  • Patients with childhood-onset GH deficiency have more severe clinical manifestations than those who develop it as adults.[3]
  • Lean body mass is increased in adults who are deficient in GH and not replaced compared with those who have normal GH secretion.[4]
  • Fractures of the lumbar spine are higher than normal persons with a high incidence of osteopenia.
  • The degree of osteopenia appears to correlate directly with the degree of GH deficiency.[5]
  • Less energetic than normal people of the same age[6]

Cardiovascular risk factors 

  • Dyslipidemia[7]
  • Increased inflammatory markers[8]
  • Increase in biochemical markers of endothelial dysfunction[9]
  • High coronary calcium scores (a marker of subclinical atherosclerosis)[10]

References

  1. Wit JM, van Unen H (1992). "Growth of infants with neonatal growth hormone deficiency". Arch Dis Child. 67 (7): 920–4. PMC 1793852. PMID 1519958.
  2. Pena-Almazan S, Buchlis J, Miller S, Shine B, MacGillivray M (2001). "Linear growth characteristics of congenitally GH-deficient infants from birth to one year of age". J Clin Endocrinol Metab. 86 (12): 5691–4. doi:10.1210/jcem.86.12.8068. PMID 11739421.
  3. Koranyi J, Svensson J, Götherström G, Sunnerhagen KS, Bengtsson B, Johannsson G (2001). "Baseline characteristics and the effects of five years of GH replacement therapy in adults with GH deficiency of childhood or adulthood onset: a comparative, prospective study". J Clin Endocrinol Metab. 86 (10): 4693–9. doi:10.1210/jcem.86.10.7896. PMID 11600527.
  4. Cuneo RC, Salomon F, Wiles CM, Sönksen PH (1990). "Skeletal muscle performance in adults with growth hormone deficiency". Horm Res. 33 Suppl 4: 55–60. PMID 2245969.
  5. Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G; et al. (1999). "Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism". J Clin Endocrinol Metab. 84 (6): 1919–24. doi:10.1210/jcem.84.6.5742. PMID 10372687.
  6. McGauley GA (1989). "Quality of life assessment before and after growth hormone treatment in adults with growth hormone deficiency". Acta Paediatr Scand Suppl. 356: 70–2, discussion 73-4. PMID 2816361.
  7. Bengtsson BA, Abs R, Bennmarker H, Monson JP, Feldt-Rasmussen U, Hernberg-Stahl E; et al. (1999). "The effects of treatment and the individual responsiveness to growth hormone (GH) replacement therapy in 665 GH-deficient adults. KIMS Study Group and the KIMS International Board". J Clin Endocrinol Metab. 84 (11): 3929–35. doi:10.1210/jcem.84.11.6088. PMID 10566630.
  8. Sesmilo G, Miller KK, Hayden D, Klibanski A (2001). "Inflammatory cardiovascular risk markers in women with hypopituitarism". J Clin Endocrinol Metab. 86 (12): 5774–81. doi:10.1210/jcem.86.12.8087. PMID 11739438.
  9. Elhadd TA, Abdu TA, Oxtoby J, Kennedy G, McLaren M, Neary R; et al. (2001). "Biochemical and biophysical markers of endothelial dysfunction in adults with hypopituitarism and severe GH deficiency". J Clin Endocrinol Metab. 86 (9): 4223–32. doi:10.1210/jcem.86.9.7813. PMID 11549653.
  10. Cannavò S, Marini F, Curtò L, Torre ML, de Gregorio C, Salamone I; et al. (2011). "High prevalence of coronary calcifications and increased risk for coronary heart disease in adults with growth hormone deficiency". J Endocrinol Invest. 34 (1): 32–7. doi:10.3275/7076. PMID 20511726.

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