Düzce Üniversitesi Tıp Fakültesi çocuk endokrinoloji kliniğinde takip edilen büyüme hormonu nörosekretuvar bozukluğu ve biyoinaktif büyüme hormonu tanılı hastaların başvuru bulguları ve büyüme hormonu tedavisine yanıtları
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Tarih
2016
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Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada Düzce Üniversitesi Tıp Fakültesi Hastanesi, Çocuk Endokrinoloji Polikliniğine boy kısalığı şikayetiyle başvuran hastalardan, izole büyüme hormonu eksikliği olmayıp, Büyüme Hormonu Nörosekretuvar Bozukluğu(BHNB) ve Biyoinaktif Büyüme Hormonu(BBH) tanısı alan hastaların, büyüme hormonu(BH) tedavisine verdikleri yanıtları ve hangi faktörlerden etkilendiğini araştırmayı amaçladık. Gereç ve Yöntem: Hastanemiz Çocuk Endokrinoloji polikliniğine boy kısalığı şikayetiyle başvuran, BHNB tanısı alan 24 hasta ve BBH tanısı alan 41 hasta olmak üzere toplam 65 hasta retrospektif olarak incelendi. Hasta seçiminde hipotiroidi dışında büyüme ve gelişmesini etkileyecek kronik hastalığının olmamasına dikkat edildi. Hastaların cinsiyetleri, doğum tartısı, doğum haftası, tedavi öncesi yaşları, ebeveyn boyları, fizik muayene bulguları, laboratuvar bulguları, radyolojik değerlendirmeleri incelenerek, tedaviye yanıtları ne yönde etkiledikleri araştırıldı. İstatistik analizler SPSS v.21 paket programı ile yapıldı ve anlamlılık düzeyi p<0.05 olarak dikkate alındı. Bulgular: 65 hastanın 36' sı erkek ve 29' u kız olmak üzere erkek/kız oranı 1,2 olarak saptandı. Hastalar ortalama olarak 2,16 yıl tedavi aldı. Boy SDS, BH tedavisi ile hem puberte dönemindeki olgularda hem de prepuberte dönemindeki olgularda anlamlı artış gösterdi. Tedavi alırken 1.yıldaki yıllık büyüme hızının tedavi öncesi yıllık büyüme hızına göre belirgin olarak arttığı gözlendi. Hastaların tanısına göre 1.yıldaki ortalama büyüme hızları arasında anlamlı bir fark görülmedi. Tedavi alırken 1.yıldaki yıllık büyüme hızı ile VKİ arasında anlamlı düzeyde bir ilişki saptanmadı. Tedavi bitiminde ölçülen kemik yaşı (KY) ortanca değeri, tedavi başlangıcında ölçülen değerinden anlamlı düzeyde daha yüksek bulundu. Tedavi öncesi puberte evresinin BH tedavisi sonrası arttığı gözlendi. Tedavi öncesi IGF-1 ve IGFBP-3 düzeyleri düşük bulundu. BH uyarı testlerine maksimum yanıt BHNB tanılı hastalarda ortalama olarak 17,2±8 ng/ml, BBH tanılı hastalarda 16±5,8 ng/ml idi. BHNB tanılı hastalarda uyku testine ortalama yanıt 6,6±2,4 ng/ml idi. BBH tanılı hastalarda iii ise uyku testine ortalama yanıt 17,6±7,9 ng/ml bulundu. BBH tanılı hastalarda jenerasyon testi sonrası ortalama IGF-1 düzeyi 373,1±202,3 ng/ml, ortalama IGFBP-3 düzeyi 4,6±1,1 ng/ml idi. Jenerasyon testi öncesine göre test sonundaki IGF-1 düzeyinde %149±106,1 artış bulunurken, IGFBP-3 düzeyinin ise jenerasyon testi sonrası %47±41,1 arttığı saptandı. Tedavi başlangıcında ölçülen IGF-1 ve IGFBP-3 değeri, jenerasyon testi sonrası ölçülen IGF-1 ve IGFBP-3 değerinden anlamlı olarak daha düşük bulundu. Tedavi alırken 1.yıldaki yıllık büyüme hızı ile farmakolojik uyarıya maksimum yanıt, jenerasyon testi sonrası IGF-1 artışı ve IGFBP-3 artışı arasında anlamlı düzeyde bir ilişki saptanmadı. Sonuç: Olgularımızın tedavi başarısının değerlendirilmesinde bakılan kriterlere göre tedavi sonrası 1.yıl boy SDS artışı >0,3 olanların sayısı %67,7 (n=44), >0,5 olanların sayısı %47,7 (n=31) bulundu. Hastalarımızın yıllık boy uzama değişimi 3 cm üzerinde olanların sayısı %62,7 (n=37) olarak bulundu. Bunun yanında hastaların tedavi öncesi boy SDS' leri ile 1.yıl, 2.yıl, 3.yıl boy SDS' leri arasındaki fark incelendiğinde istatiksel olarak anlamlı bir artışın olması da tedavimizin başarılı olduğunu göstermektedir.
Objectives: In this study, we aimed to investigate the response to growth hormone (GH) treatment and the factors that affect the short stature of the patients who applied to the Pediatric Endocrinology Clinic in Duzce University Faculty of Medicine with diagnosis of growth hormone neurosecretory dysfunction and bioinactive growth hormone. Material and Methods: Totally 65 patients, 24 patients diagnosed as growth hormone neurosecretory dysfunction and 41 patients diagnosed as bioinactive growth hormone, who admitted to Duzce University Medical School pediatric endocrinology clinic with short stature were investigated retrospectively. In the selection criteria, we accepted the patients who had not any chronic diseases affecting the growth and development, except hypothyroidism. Sex, birth weight, birth height, parental height, pretreatment ages, physical examination findings, laboratory findings, radiological assessments of the patients were examined and their affects in response to treatment were investigated. Statistical analysis were performed by the SPSS v.21 programme package and the level of p < 0.05 were considered significant statistically. Results: There were totally 65 patients consisted of 36 males, 29 females whose male/female ratio was 1,2. Patients received GH treatment for meanly 2,16 years. Height SDS showed a significant increase during the growth hormone therapy in both prepubertal and pubertal cases. We found a significant increase in growth velocity during the first year of GH treatment compared to pretreatment. There was no significant difference between the growth velocities during the first year of GH treatment of the patients with growth hormone neurosecretory dysfunction and bioinactive growth hormone. There was no correlation between the growth velocity during the first year of GH treatment and BMI. We found a significant increase in the median bone age after the GH treatment compared to the pretreatment bone age. The pubertal stage was increased after the treatment. Serum IGF-1 and IGFBP-3 levels were higher after the treatment. The mean maximum GH response to stimulation tests was 17,2±8 ng/ml in the patients with growth hormone neurosecretory dysfunction while it was 16±5,8 ng/ml in the patients with bioinactive growth hormone. The v mean nighttime GH response was 6,6±2,4 ng/ml in the patients with growth hormone neurosecretory dysfunction while it was 17,6±7,9 ng/ml in the patients with bioinactive growth hormone. After generation test mean serum IGF-1 level was 373,1±202,3 ng/ml and serum IGFBP-3 level was 4,6±1,1 ng/ml in the patients with bioinactive growth hormone. After generation test there was 149%±106,1 increase in mean serum IGF-1 level and 47%±41,1 increase in IGFBP-3 level. The mean serum IGF-1 and IGFBP-3 levels were significantly increased after the generation test. There was no correlation between the growth velocity during the first year of GH treatment and maximum GH response to stimulation tests and serum IGF-1 and IGFBP-3 levels increase after the generation test. Conclusion: The success of GH treatment in our patients was determined by some criteria. According to these criteria, after 1 year GH therapy the patients with height SDS increase of more than 0,3 was 67,7% (n=44) and 0,5 was 47,7% (n=31). The patients with a first-year height velocity increment of more than 3cm/yr was 62,7% (n=37). Besides, we found a significant increase statistically when we compared the pretreatment height SDS with 1st, 2nd and 3rd year height SDS values that showed a successful GH therapy.
Objectives: In this study, we aimed to investigate the response to growth hormone (GH) treatment and the factors that affect the short stature of the patients who applied to the Pediatric Endocrinology Clinic in Duzce University Faculty of Medicine with diagnosis of growth hormone neurosecretory dysfunction and bioinactive growth hormone. Material and Methods: Totally 65 patients, 24 patients diagnosed as growth hormone neurosecretory dysfunction and 41 patients diagnosed as bioinactive growth hormone, who admitted to Duzce University Medical School pediatric endocrinology clinic with short stature were investigated retrospectively. In the selection criteria, we accepted the patients who had not any chronic diseases affecting the growth and development, except hypothyroidism. Sex, birth weight, birth height, parental height, pretreatment ages, physical examination findings, laboratory findings, radiological assessments of the patients were examined and their affects in response to treatment were investigated. Statistical analysis were performed by the SPSS v.21 programme package and the level of p < 0.05 were considered significant statistically. Results: There were totally 65 patients consisted of 36 males, 29 females whose male/female ratio was 1,2. Patients received GH treatment for meanly 2,16 years. Height SDS showed a significant increase during the growth hormone therapy in both prepubertal and pubertal cases. We found a significant increase in growth velocity during the first year of GH treatment compared to pretreatment. There was no significant difference between the growth velocities during the first year of GH treatment of the patients with growth hormone neurosecretory dysfunction and bioinactive growth hormone. There was no correlation between the growth velocity during the first year of GH treatment and BMI. We found a significant increase in the median bone age after the GH treatment compared to the pretreatment bone age. The pubertal stage was increased after the treatment. Serum IGF-1 and IGFBP-3 levels were higher after the treatment. The mean maximum GH response to stimulation tests was 17,2±8 ng/ml in the patients with growth hormone neurosecretory dysfunction while it was 16±5,8 ng/ml in the patients with bioinactive growth hormone. The v mean nighttime GH response was 6,6±2,4 ng/ml in the patients with growth hormone neurosecretory dysfunction while it was 17,6±7,9 ng/ml in the patients with bioinactive growth hormone. After generation test mean serum IGF-1 level was 373,1±202,3 ng/ml and serum IGFBP-3 level was 4,6±1,1 ng/ml in the patients with bioinactive growth hormone. After generation test there was 149%±106,1 increase in mean serum IGF-1 level and 47%±41,1 increase in IGFBP-3 level. The mean serum IGF-1 and IGFBP-3 levels were significantly increased after the generation test. There was no correlation between the growth velocity during the first year of GH treatment and maximum GH response to stimulation tests and serum IGF-1 and IGFBP-3 levels increase after the generation test. Conclusion: The success of GH treatment in our patients was determined by some criteria. According to these criteria, after 1 year GH therapy the patients with height SDS increase of more than 0,3 was 67,7% (n=44) and 0,5 was 47,7% (n=31). The patients with a first-year height velocity increment of more than 3cm/yr was 62,7% (n=37). Besides, we found a significant increase statistically when we compared the pretreatment height SDS with 1st, 2nd and 3rd year height SDS values that showed a successful GH therapy.
Açıklama
YÖK Tez No: 447365
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases, Boy, Body height, Büyüme, Growth, Büyüme hormonu, Growth hormone, Cücelik, Dwarfism, Cücelik-hipofizer, Dwarfism-pituitary, Nörosekretuar sistemler, Neurosecretory systems, Tedavi, Treatment, Biyoinaktif büyüme hormonu, boy kısalığı, büyüme hormonu nörosekretuvar bozukluğu, büyüme hormonu tedavisi, Bioinactive growth hormone, growth hormone neurosecretory dysfunction, growth hormone treatment, short stature
