GROWTH HORMONE THERAPY IN TRACHEOMALACIA

Abstract

Growth hormone may be involved in normal cartilage production. Two patients with GH deficient states were treated with GH. Both patients, one with panhypopituitarism (patient 1) and another with pseudohypoparathyroidism (patient 2) presented with severe tracheomalacia. Both patients required tracheostomy. Patient 1 had his tracheostomy at age 3 years and 9 years later, despite numerous ENT procedures to reduce granulation tissue, could not be extubated due to collapse of the tracheal cartilage. Patient 1 was treated for hypothyroidism and hypoadrenalism. An insulin-glucagon test showed no GH values greater than 2 ng/ml (Hybritech IRMA). At one month of life, patient 2 had a tracheostomy and was diagnosed with pseudohypoparathyroidism with no significant rise in phosphate excretion, cyclic-AMP, or calcium (urinary or serum ionized) after PTH administration. This patient had a low IGF-1 and IBP-3. Patient 1 was treated with GH at a dose of 0.05 mg/kg/dose SC 6X per week; patient 2 at a dose of 0.1 mg/kg/day SC (the higher dose due to resistance to peptide hormones), each for six months. After treatment, the tracheal cartilage had become more firm, allowing extubation in both patients. This experience suggests a role for GH in the development of tracheal cartilage.