ÇOCUKLARDA BÜYÜME HORMONU TEDAVİSİ: TEK MERKEZ DENEYİMİ

Amaç: Büyüme hormonu (BH) eksikliği boy kısalığının en sık endokrinolojik nedenidir. Bu çalışmanın amacı idiyopatik büyüme hormonu eksikliği (İBHE) tanısı alan çocukların klinik özellikleri ve tedaviye cevaplarının değerlendirilmesidir. Gereç ve Yöntemler: Olguların dosyaları retrospektif olarak değerlendirildi. Olguların tanı anındaki takvim yaşı (TY), antropometrik verileri, puberte evresi, hedef boyu, serum insülin benzeri büyüme faktörü-1, serum serbest T4 ve TSH düzeyi, kemik yaşı (KY), öngörülen final boyu, BH uyarı test sonuçları, hipofiz görüntüleme bulguları, tedavi sırasındaki IGF1 düzeyi, yıllık uzama hızı kaydedildi. Bulgular: Çalışmaya 83 olgu dahil edildi. Olguların tanı alma yaşları prepubertal grupta 8.56±2.47 yıl, pubertal grupta 11.87±1.86 yıldı. Prepubertal olgularda boy SDS ve ağırlık SDS pubertal olgulara göre daha düşüktü (p<0.001). Tedavinin ilk yılında yıllık uzama hızı (YUH) en yüksek değerde saptandı ve ilerleyen yıllarda progresif olarak azaldı. Tedavi öncesi ve tedavinin birinci yılındaki YUH karşılaştırıldığında hem pubertal hem de prepubertal olgularda arada istatistiksel olarak anlamlı bir farklılık saptandı (Wilcoxon test; p<0.001). Olguların IGF1 değerleri ile tedavinin birinci yılındaki YUH arasında anlamlı bir ilişki mevcuttu (Friedman testi; p<0.001). Pubertal olgularda erkek cinsiyette son boy SDS ortanca değeri, kız cinsiyete göre daha düşük saptanırken (p=0.045), her iki cinsiyet için başvuru boy SDS’si yüksek olgularda son boy SDS’nin daha yüksek olduğu saptandı (p=0.022). Sonuç: Bu çalışmada İBHE tanısı ile tedavi edilen olguların demografik ve klinik bulguları literatür ile uyumludur. Prepubertal olgularda başvuru boy ve ağırlık SDS’sinin daha düşük ve TY-KY farkının daha belirgin olduğu izlendi. Pubertal olgularda başvuru boy SDS ve kız cinsiyetin daha iyi bir son boy SDS ile ilişkili olduğu, hem pubertal hem prepubertal olgularda birinci yıldaki YUH ile IGF1 düzeyleri ve ilk yıl YUH ile son boy SDS arasında pozitif korelasyon olduğu saptandı.

Anahtar Kelimeler:

Çocuk, büyüme hormonu eksikliği, tedavi yanıtı

Growth Hormone Treatment in Children: Single Center Experience

Objective: Growth hormone (GH) deficiency is the most common endocrinological cause of short stature. The aim of this study is to evaluate the clinical features and treatment response of children diagnosed with idiopathic growth hormone deficiency (IGHE). Material and Methods: The files of the patients were evaluated retrospectively. Chronological age (CA), anthropometric data, pubertal stage, target height, serum insulin-like growth factor-1 (IGF1), serum free T4 and TSH levels, bone age (BA), predicted final height, GH stimulation test results, pituitary imaging results, IGF1 levels and growth velocity (GV) were recorded. Results: 83 patients were included. Chronological age was 8.56±2.47 in the prepubertal group and 11.87±1.86 in the pubertal group (p<0.001). Height SDS and weight SDS were lower in prepubertal cases (p<0.001). Growth velocity was highest in the first year of treatment and progressively decreased. A statistically significant difference was found in both groups when GV before treatment and at the first year of treatment was compared (Wilcoxon test; p<0.001). There was a significant correlation between IGF1 values of the cases and GV in the first year (Friedman test; p<0.001). While the median final height SDS value was found to be lower in boys compared to girls in pubertal cases (p=0.045), final height SDS was found to be higher in cases with high height SDS at admission for both genders (p=0.022). Conclusions: The demographic and clinical findings of the cases are consistent with the literature. The height and weight SDS at admission was lower and the difference between CA-BA was more pronounced in prepubertal cases. In pubertal cases, height SDS at admission and female gender were associated with a better final height SDS. There was a positive correlation between GV and IGF1 levels in the first year of treatment, and between GV and final height SDS in both pubertal and prepubertal cases.

Keywords:

Child, growth hormone deficiency, response to treatment,

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