Benefits Of Growth Hormone Therapy Research Articles

Unveiling the psychiatric dimensions of hypopituitarism: investigating associations, challenges, and treatment strategies.

Dear Editor, Hypopituitarism is a disorder characterized by insufficient hormone production from the pituitary gland,1,2 manifesting as either pan or partial dysfunction.2 Hypopituitarism is considered a rare disorder by National Institute of Health and there is limited information on its occurrence. A study in Spain demonstrated prevalence of 45.5 cases per 100,000 people.2 Hypopituitarism can be caused by pituitary tumours, head injury, infections, radiation therapy, autoimmune conditions, and genetic abnormalities.2 Hypopituitarism occurs when about 75% of the pituitary gland is affected, causing a spectrum of clinical features from mild to severe.2 Sheehan syndrome, resulting from anterior pituitary ischaemia typically after postpartum haemorrhage, occurs in approximately 5/10,000 births in developing countries.3 Hypopituitarism diagnosis may take a decade or longer due to its diverse clinical presentations.3 As of now, the link between psychotic disorders and hypopituitarism is not completely understood.1 While a few case reports have documented a link between pituitary insufficiency and mental health issues, larger-scale studies are limited in number. Hypopituitarism raises depression and anxiety risk, especially in females and those over 18, with females having tenfold higher risk of depression than males.1 Growth hormone deficiency (GHD) is linked to cognitive impairments, and atypical depression.4 In their 1949 report, Sheehan and Summer noted that one-third of total 143 hypopituitarism patients displayed loss of drive and initiative, and disinterest in social connections.5 Acute psychosis as an initial presentation of hypopituitarism has been reported in cases involving Sheehan's syndrome, traumatic brain injury, and glucocorticoid therapy.5 A 37-year-old pregnant woman diagnosed with Sheehan syndrome exhibited neuropsychiatric symptoms, prompting early diagnosis.3 The 2010 study found that growth hormone therapy improved cognitive function and reduced depression severity in traumatic brain injury patients with GHD. However, discontinuation of therapy led to worsened cognitive function and increased psychiatric symptoms, highlighting the potential benefits of growth hormone therapy and the need for more experimental studies to confirm its effects on neurophysiological and psychiatric wellbeing.4 Adults with Childhood Onset Multiple Pituitary Hormone Deficiency have a notably lower quality of life, underscoring the importance of addressing psychosocial and psychosexual challenges in this population.6 A 60-year-old man with macroprolactinoma and hypopituitarism developed acute psychosis due to non-adherence to cabergoline, treatment with hydrocortisone, and thyroxine lead to full recovery within 48 hours.5 A 41-year-old man with osmophobia improved with sertraline transiently. Later, he was diagnosed with partial hypopituitarism with adrenocorticotropic hormone deficiency. Prednisolone supplementation significantly improved his condition.7 ---Continue

Prader-Willi syndrome and growth hormone therapy: exploring the precise management of hypothalamic short stature: A review

Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by various clinical features linked to hypothalamic/pituitary gland abnormalities. Growth hormone deficiency is a prominent feature of PWS that results in poor linear growth and delayed development. This review discusses the evaluation and effects of growth hormone therapy (GHT) in PWS. Heterogeneity in growth hormone secretion patterns based on genotype and the potential for personalized GHT were explored. The benefits of GHT, including improvements in motor and cognitive development, growth, and body composition, are discussed in detail. Safety considerations for GHT initiation and response to GHT in adults with PWS are discussed, along with ongoing debates regarding the efficacy and safety. Although controversies persist, an evolving understanding of the long-term effects and safety of GHT underscores the need for comprehensive research in this field.

Malnutrition Patterns in Children with Chronic Kidney Disease

Malnutrition is frequent in children with chronic kidney disease (CKD). Apart from undernutrition and protein energy wasting (PEW), overnutrition prevalence is rising, resulting in fat mass accumulation. Sedentary behavior and unbalanced diet are the most important causal factors. Both underweight and obesity are linked to adverse outcomes regarding renal function, cardiometabolic risk and mortality rate. Muscle wasting is the cornerstone finding of PEW, preceding fat loss and may lead to fatigue, musculoskeletal decline and frailty. In addition, clinical data emphasize the growing occurrence of muscle mass and strength deficits in patients with fat mass accumulation, attributed to CKD-related wasting processes, reduced physical activity and possibly to obesity-induced inflammatory diseases, leading to sarcopenic obesity. Moreover, children with CKD are susceptible to abdominal obesity, resulting from high body fat distribution into the visceral abdomen compartment. Both sarcopenic and abdominal obesity are associated with increased cardiometabolic risk. This review analyzes the pathogenetic mechanisms, current trends and outcomes of malnutrition patterns in pediatric CKD. Moreover, it underlines the importance of body composition assessment for the nutritional evaluation and summarizes the advantages and limitations of the currently available techniques. Furthermore, it highlights the benefits of growth hormone therapy and physical activity on malnutrition management.

Growth Hormone Therapy in Adults with Prader-Willi Syndrome.

Prader-Willi syndrome (PWS) is characterized by hyperphagia, obesity if food intake is not strictly controlled, abnormal body composition with decreased lean body mass and increased fat mass, decreased basal metabolic rate, short stature, low muscle tone, cognitive disability, and hypogonadism. In addition to improvements in linear growth, the benefits of growth hormone therapy on body composition and motor function in children with PWS are well established. Evidence is now emerging on the benefits of growth hormone therapy in adults with PWS. This review summarizes the current literature on growth hormone status and the use of growth hormone therapy in adults with PWS. The benefits of growth hormone therapy on body composition, muscle strength, exercise capacity, certain measures of sleep-disordered breathing, metabolic parameters, quality of life, and cognition are covered in detail along with potential adverse effects and guidelines for initiating and monitoring therapy.

The pituitary stalk interruption syndrome: Endocrine features and benefits of growth hormone therapy

Introduction Childhood anterior-pituitary insufficiency has many causes (malformative, genetic, traumatic, tumoral…). One particular entity can be clearly identified: pituitary stalk interruption syndrome (PSIS). The aim of our study was to analyse the long-term evolution of patients with PSIS. Patients and methods The records of all the children followed at Dijon University Hospital between 1990 and 2008 who underwent brain magnetic resonance imaging (MRI) and endocrinological evaluation that revealed a growth hormone (GH) deficiency were analysed. We thus selected 14 children diagnosed with PSIS according to the results of MRI. We studied the perinatal characteristics of these patients, then the auxological and the endocrine evolutions, before the initiation of GH therapy and then after 1 and 3 years of treatment and during the last evaluation. Results Fourteen children were diagnosed with PSIS at a mean ± sd age of 3.2 ± 3.5 years, five of whom being diagnosed during the first 2 months of life. Growth, as well as other anterior-pituitary deficiencies, was systematically followed up two to four times a year depending on the clinical context. The results in terms of endocrinology were analysed in all 14 children, and with regard to auxology in the 10 children who received GH therapy for at least 12 months, with a mean of 8.3 ± 4.2 years and at a mean maintenance posology of 0.22 ± 0.02 mg/kg per week. Among the 14 children, 12 had complete GH deficiency while two had a partial deficiency. Nine had multiple anterior pituitary deficiencies, diagnosed at the same time or later in five and four of them respectively. A clinical picture of panhypopituitarism was found in the infants who were diagnosed with PSIS in their first months of life. In the 10 children who were treated for at least 12 months, the height before treatment was −3.1 ± 0.8 standard deviation score (SDS). At the last consultation, the total gain in height was +2.5 ± 0.9 SDS compared to the distance to target height of +2.7 ± 0.6 SDS. The height gain after 1 year of treatment corresponded to 60% of the total gain. Conclusion In children with PSIS, the other anterior pituitary deficiencies are often associated with GH deficiency and sometimes during the first month of life. These functions therefore require to be carefully followed early, periodically and in the long term. Growth in these children responds particularly well to GH therapy, in particular during the first year.

Measuring the benefits of growth hormone therapy in children: a role for preference-based approaches?

Recombinant human growth hormone has revolutionised the management of children with growth hormone deficiency, chronic renal insufficiency, Turner syndrome, Prader-Willi syndrome, small-for-gestational-age status, idiopathic short stature and other growth disorders...

Growth Hormone Therapy for Hypopituitary Adults: Time for Re-appraisal

The advent of the production of large quantities of recombinant growth hormone (GH) has made it possible to have sufficient material to assess its efficacy in adult growth hormone deficiency (GHD). Although some studies have shown that patients who are severely deficient benefit from GH therapy, the spectrum of GHD is broad, and the degree of deficiency at times is very difficult to define. In some cases, benefit is not easily quantified, and some studies have claimed benefits that, although statistically significant, are either not clinically important or are so marginal as to be questionable in terms of cost, difficulty of administration and potential risks. The purpose here is to identify the current problems in the diagnosis of GHD, to discuss the rationale for GH therapy and to assess the potential effects of GHD as well as the benefits of GH therapy in GHD adults. We will include a commentary as to which effects appear more robust than others and which are likely to result in the greatest patient benefit. Finally, some attention will be paid to long-term safety issues that should be monitored to ensure that this medication is safe even for the patients with the greatest need.

Growth Velocity After Growth Hormone (GH) Therapy in Children with Isolated GH Deficiency (IGHD) and Prader-Willi syndrome (PWS) † 397

Short stature, obesity, decreased lean mass, cryptorchidism, and hypogonadism are characteristic features of PWS. The growth pattern in PWS suggest an abnormality in GH secretion or action. Body composition changes in PWS including increased adipose and decreased muscle mass are similar to those children with IGHD. In GH deficiency, GH secretion is negligible and IGF levels are low, leading to decreased linear growth. In exogenous obesity the GH are low but the IGF levels however are normal or high. Contrary to exogenous obesity PWS children have decreased growth velocity, sexual development, muscle mass, and IGF levels. Other investigators and ourselves have shown blunted GH secretion in both obese and non-obese PWS children and the benefits of GH therapy (J of Ped End & Metab. 9,943-400, 1996.). We now compare the growth velocity in 96 PWS children and 6965 children with IGHD from the National Cooperative Growth Study (NCGS) after 4 years of GH therapy. The linear growth was similar in both groups. Although is unlikely that GHD is the only cause of short stature, decreased growth velocity and increased adiposity in PWS children, suggest that GHD is a common feature and significant contributory factor in expression of PWS phenotype. Figure

Ethical Issues in Growth Hormone Therapy

Pediatricians face clinical and ethical dilemmas about therapy to augment growth in short children who do not meet classic criteria for growth hormone (GH) deficiency. Biologic norms of health are unhelpful because of the uncertain relationship between stature, GH secretion, health, and disease. Instead, we suggest that GH therapy be evaluated from the perspective of cultural norms. We compare GH therapy for short normal children with currently accepted therapies for non--life-threatening pediatric conditions such as well-child care, cosmetic therapy, treatment of psychological problems, and invasive outpatient therapy for chronic conditions. Based on this analysis, we argue that the burdens of therapy, the uncertainty about long-term risks and benefits, the unclear therapeutic end point, and the implications for child health policy place routine GH therapy for children without documented deficiency of GH secretion outside current pediatric ethical norms. Such therapy is properly administered within a comprehensive clinical research protocol.