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Acromegalic features in growth hormone (GH)-deficient patients after long-term GH therapy.
Clin Endocrinol (Oxf). 2003 Dec; 59(6):788-92.CE

Abstract

BACKGROUND

Craniofacial, hand, foot and somatic growth depend on normal GH secretion. Acromegalic features have been described in children with GH insensitivity after IGF-I treatment. We observed patients with acromegalic features such as increase of foot size, nose and jaw enlargement among our cases with GH deficiency, treated with standard recombinant (rh)GH doses. The aim of our study was to analyse the possible factors involved in the development of acromegalic features in these patients.

PATIENTS

We evaluated 21 patients, 17 with combined pituitary hormone deficiency and four with isolated GH deficiency treated with rhGH (0.05-0.15 U/kg/day, sc, at night) for 2-12 years who achieved final height. IGF-I and IGFBP-3 were measured before and every 6 months during therapy and bone age was evaluated yearly. At the end of therapy, patients' hand and foot sizes and height were measured and plotted on nomograms for hand according to height and age, and foot size according to height. Lateral radiographs of the face were performed to obtain the linear measurement of the lower jaw length.

RESULTS

Foot size was greater than 97th percentile in 8/21 patients and lower jaw length was greater than +2SD in 4/21 patients. Patients were classified in two groups: group 1 (with foot size greater than 97th percentile and/or lower jaw length greater than +2SD) consisted of 11 patients (six females); nine had combined pituitary hormone deficiency (six associated to hypogonadotrophic hypogonadism) and three had isolated GH deficiency; group 2 (with foot size smaller than 97th percentile and lower jaw length less than +2SD) consisted of 10 patients (seven boys); nine had combined pituitary hormone deficiency (six associated to hypogonadotrophic hypogonadism) and one with isolated GH deficiency. During treatment, IGF-I levels ranged from < or = 3 to +2SD and IGFBP-3 levels ranged from -3 to +2SD, in both groups. We observed no statistically significant differences between the two groups regarding chronological age, bone age, height at the beginning and at the end of therapy, pubertal development, duration of rhGH treatment and IGF-I and IGFBP-3 levels (P > 0.05). Foot size percentile exceeded final height percentile in 11/21 patients (seven girls).

CONCLUSION

Long-term rhGH treatment with standard doses might be associated with acromegalic features (increased foot size and lower jaw measurements) in patients with GH deficiency who achieved final height, especially in girls. Neither the clinical nor the hormonal parameters, IGF-I and IGFBP-3 levels, were useful to predict the development of these features. Further studies are necessary to analyse the frequency of this side-effect and how to prevent it.

Authors+Show Affiliations

Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormonios e Genetica Molecular LIM/42, Disciplina de Endocrinologia, HCFMUSP, São Paulo, Brazil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14974923

Citation

Carvalho, Luciani R., et al. "Acromegalic Features in Growth Hormone (GH)-deficient Patients After Long-term GH Therapy." Clinical Endocrinology, vol. 59, no. 6, 2003, pp. 788-92.
Carvalho LR, de Faria ME, Osorio MG, et al. Acromegalic features in growth hormone (GH)-deficient patients after long-term GH therapy. Clin Endocrinol (Oxf). 2003;59(6):788-92.
Carvalho, L. R., de Faria, M. E., Osorio, M. G., Estefan, V., Jorge, A. A., Arnhold, I. J., & Mendonca, B. B. (2003). Acromegalic features in growth hormone (GH)-deficient patients after long-term GH therapy. Clinical Endocrinology, 59(6), 788-92.
Carvalho LR, et al. Acromegalic Features in Growth Hormone (GH)-deficient Patients After Long-term GH Therapy. Clin Endocrinol (Oxf). 2003;59(6):788-92. PubMed PMID: 14974923.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acromegalic features in growth hormone (GH)-deficient patients after long-term GH therapy. AU - Carvalho,Luciani R, AU - de Faria,Maria Estela Justamante, AU - Osorio,Maria Geralda Farah, AU - Estefan,Vivian, AU - Jorge,Alexander Augusto Lima, AU - Arnhold,Ivo Jorge Prado, AU - Mendonca,Berenice Bilharinho, PY - 2004/2/21/pubmed PY - 2004/3/26/medline PY - 2004/2/21/entrez SP - 788 EP - 92 JF - Clinical endocrinology JO - Clin Endocrinol (Oxf) VL - 59 IS - 6 N2 - BACKGROUND: Craniofacial, hand, foot and somatic growth depend on normal GH secretion. Acromegalic features have been described in children with GH insensitivity after IGF-I treatment. We observed patients with acromegalic features such as increase of foot size, nose and jaw enlargement among our cases with GH deficiency, treated with standard recombinant (rh)GH doses. The aim of our study was to analyse the possible factors involved in the development of acromegalic features in these patients. PATIENTS: We evaluated 21 patients, 17 with combined pituitary hormone deficiency and four with isolated GH deficiency treated with rhGH (0.05-0.15 U/kg/day, sc, at night) for 2-12 years who achieved final height. IGF-I and IGFBP-3 were measured before and every 6 months during therapy and bone age was evaluated yearly. At the end of therapy, patients' hand and foot sizes and height were measured and plotted on nomograms for hand according to height and age, and foot size according to height. Lateral radiographs of the face were performed to obtain the linear measurement of the lower jaw length. RESULTS: Foot size was greater than 97th percentile in 8/21 patients and lower jaw length was greater than +2SD in 4/21 patients. Patients were classified in two groups: group 1 (with foot size greater than 97th percentile and/or lower jaw length greater than +2SD) consisted of 11 patients (six females); nine had combined pituitary hormone deficiency (six associated to hypogonadotrophic hypogonadism) and three had isolated GH deficiency; group 2 (with foot size smaller than 97th percentile and lower jaw length less than +2SD) consisted of 10 patients (seven boys); nine had combined pituitary hormone deficiency (six associated to hypogonadotrophic hypogonadism) and one with isolated GH deficiency. During treatment, IGF-I levels ranged from < or = 3 to +2SD and IGFBP-3 levels ranged from -3 to +2SD, in both groups. We observed no statistically significant differences between the two groups regarding chronological age, bone age, height at the beginning and at the end of therapy, pubertal development, duration of rhGH treatment and IGF-I and IGFBP-3 levels (P > 0.05). Foot size percentile exceeded final height percentile in 11/21 patients (seven girls). CONCLUSION: Long-term rhGH treatment with standard doses might be associated with acromegalic features (increased foot size and lower jaw measurements) in patients with GH deficiency who achieved final height, especially in girls. Neither the clinical nor the hormonal parameters, IGF-I and IGFBP-3 levels, were useful to predict the development of these features. Further studies are necessary to analyse the frequency of this side-effect and how to prevent it. SN - 0300-0664 UR - https://www.unboundmedicine.com/medline/citation/14974923/Acromegalic_features_in_growth_hormone__GH__deficient_patients_after_long_term_GH_therapy_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0300-0664&amp;date=2003&amp;volume=59&amp;issue=6&amp;spage=788 DB - PRIME DP - Unbound Medicine ER -