Growth hormone deficiency natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
- If left untreated, may progress to develop
- Common complications of growth hormone deficiency include
- Prognosis is generally good with treatment.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of growth hormone deficiency usually develop in the first days of life and start with symptoms such as perinatal asphyxia, neonatal hypoglycemia, reduced birth length, and prolonged jaundice especially if associated with ACTH deficiency. If left untreated, patients with growth hormone deficiency may progress to develop delayed postnatal growth, delayed bone age, delayed puberty, infantile fat distribution, and infantile voice.
Complications
- Patients less healthy and less energetic than normal people of the same age.
- Fractures of the lumbar spine are somewhat lower in patients with adult-onset GH deficiency.
- The degree of osteopenia appears to correlate directly with the degree of GH deficiency.
- Cardiovascular complications
- Dyslipidemia[7]
- Increased inflammatory markers (ESR)[8]
- Increase in biochemical markers of endothelial dysfunction[9]
- High coronary calcium scores (a marker of subclinical atherosclerosis)[10]
- Mortality
Patients with growth hormone deficiency have a mortality rate twice that of normal subjects, a difference due to an increased number of cardiovascular events.[1]
Prognosis
- Since recombinant DNA–derived growth hormone became available, most children with growth hormone deficiency reach normal adult stature.
- Initiate growth hormone therapy as early as possible and continue therapy through adolescence to ensure the best chance of achieving height potential.
Childhood
- In the first year of treatment, the rate of growth may increase from half as fast as other children are growing to twice as fast.
- Growth typically slows in subsequent years, but usually remains above normal so that over several years a child who had fallen far behind in his height may grow into the normal height range. Excess adipose tissue may be reduced.
Adulthood
- GH treatment can confer a number of measurable benefits to severely GH-deficient adults, such as enhanced energy and strength, and improved bone density. Muscle mass may increase at the expense of adipose tissue.
- Although adults with hypopituitarism have been shown to have a reduced life expectancy, and a cardiovascular mortality rate more than double controls[1], treatment has not been shown to improve mortality even after improved blood lipid levels.
- Although measurements of bone density improve with treatment, rates of fractures have not been shown to improve.
References
- ↑ 1.0 1.1 Prabhakar VK, Shalet SM (2006). "Aetiology, diagnosis, and management of hypopituitarism in adult life". Postgrad Med J. 82 (966): 259–66. doi:10.1136/pgmj.2005.039768. PMC 2585697. PMID 16597813.