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Eur J Endocrinol. 2016 May;174(5):669-79. doi: 10.1530/EJE-15-1203. Epub 2016 Feb 17.

Development of additional pituitary hormone deficiencies in pediatric patients originally diagnosed with isolated growth hormone deficiency due to organic causes.

Author information

1
Lilly Research LaboratoriesErl Wood Manor, Windlesham, Surrey, UK cjc@lilly.com.
2
University of GiessenGiessen, Germany.
3
University of Montreal and CHU Ste-JustineMontreal, Quebec, Canada.
4
Lilly Research LaboratoriesIndianapolis, Indiana, USA.
5
Sydney Children's HospitalRandwick, New South Wales, Australia.
6
Department of PediatricsErasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
7
Gordon Cutler Consultancy LLCDeltaville, Virginia, USA.
8
Department of PediatricsOregon Health and Science University, Portland, Oregon, USA.

Abstract

OBJECTIVE:

To determine characteristics of children initially diagnosed with isolated growth hormone deficiency (IGHD) of organic aetiology, who later developed multiple pituitary hormone deficiencies (MPHD).

DESIGN:

Data were analysed for 716 growth hormone-treated children with organic IGHD, who were growth hormone-naïve at baseline in the multinational, observational Genetics and Neuroendocrinology of Short Stature International Study.

METHODS:

Development of MPHD was ascertained from investigator-provided diagnoses, adverse events and concomitant medications. Analyses were performed for all patients and separately for those who developed MPHD within 4.5 years or had >3.5 years follow-up and continued to have IGHD (4-year cohort).

RESULTS:

MPHD developed in 71/716 (9.9%) children overall, and in 60/290 (20.7%) in the 4-year cohort. The most frequent additional deficiencies were thyroid-stimulating hormone (47 patients) and gonadotropins (23 patients). Compared with those who remained with IGHD, children who developed MPHD had more severe GHD at study entry, significantly lower baseline insulin-like growth factor1, peak stimulated growth hormone, and more frequent diagnosis of intracranial tumour or mutation of gene(s) controlling hypothalamic-pituitary development and/or function. Multivariate logistic regression analyses identified female gender, longer follow-up, higher baseline age and lower peak stimulated growth hormone as predictors of MPHD development.

CONCLUSIONS:

MPHD is more likely to develop in patients with severe organic IGHD, especially those with history of intracranial tumour or mutation of gene(s) controlling hypothalamic-pituitary development and/or function. Older baseline age, female gender and longer follow-up duration were also associated with higher incidence of MPHD. Long-term monitoring of pituitary function is recommended, irrespective of the aetiology of GHD.

PMID:
26888628
DOI:
10.1530/EJE-15-1203
[Indexed for MEDLINE]

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