Büyüme geriliği ile izlenen büyüme hormonu eksikliği, gestasyonel yaşına göre düşük doğum ağırlığı ve idiyopatik boy kısalığı tanılı hastalarda büyüme hormonu tedavisinin büyüme hızı üzerine etkisi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Büyüme geriliği ile izlenen parsiyel büyüme hormonu eksikliği (PBHE), komplet büyüme hormonu eksikliği (KBHE), gestasyonel yaşına göre düşük doğum ağırlığı (SGA) ve idiyopatik boy kısalığı (İBK) tanılı büyüme hormonu (BH) tedavisi alan olguların tedavi başlangıcında ve tedavi süresince antropometrik ölçüm değerlerini, laboratuvar sonuçlarını ve radyolojik görüntüleme bulgularını karşılaştırarak tedavi etkinliğinin araştırılmasıdır. Materyal ve Metot: Bu çalışmada; İnönü Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı, Çocuk Endokrinoloji ve Diyabet Bilim Dalı polikliniğinde Ocak 2002-Şubat 2019 tarihleri arasında başvuran ve boy kısalığı nedeni ile izlenen büyüme hormonu tedavisi alan toplam 202 hastanın 3 yıllık izlemleri retrospektif olarak incelendi. Çalışmaya alınan olguların poliklinik dosya bilgilerinden başvuru şikayeti, şikayetlerinin başlangıç yaşı, başvuru yaşı, özgeçmiş ve soygeçmiş özellikleri, antropometrik ölçüm değerleri (boy SDS, uzama hızı, ÖSB, TY/KY, VKİ SDS), anne ve baba boyları, hedef boyları, hedef boy SDS'leri, fizik muayene bulguları, puberte evreleri, laboratuvar ve radyolojik görüntüleme bulguları kaydedildi. Hastaların üç ay aralıklar ile düzenli olarak yapılan izlem bulguları kaydedildi. Hastalar tanılarına göre PBHE, KBHE, SGA ve İBK olarak gruplandı. Grupların kendi içinde tanı anındaki ve tedavinin 1., 2. ve 3. yıllarındaki boy SDS, ? boy SDS, ? (boy SDS-hedef boy SDS), uzama hızı, ÖSB, TY/KY, VKİ SDS, IGF-1 SDS, IGFBP-3 SDS, BH dozu değerleri karşılaştırıldı. Aynı karşılaştırma gruplar arasında da yapıldı. Bulgular: BH ile tedavi edilen olguların 69'unda (%34,2) PBHE, 43'ünde (%21,3) KBHE, 53'ünde (%26,2) SGA, 37'sinde (%18,3) İBK tespit edildi. Olgulara düşük doz BH ortalama 0,22 mg/kg/hafta (31,03 mcg/kg/gün) olarak uygulandı. PBHE, KBHE ve SGA tanılı hastalarda BH tedavisinin 3. yılında tedavi başlangıcına göre uzama hızı, boy SDS ve ÖSB değerleri anlamlı olarak artış gösterdi (p<0,05). Özellikle BHE olan olgularda bu artışın ikinci yıldan itibaren anlamlı olduğu görüldü. Tedaviye prepubertal veya pubertal dönemde başlanması nihai boyu değiştirmediği gözlendi. İBK grubunda ise düşük doz BH tedavisi ile uzama hızında ve boy SDS değerinde tedavi başlangıcına göre istatistiksel olarak anlamlı olmayan artış tespit edilse de, ÖSB değerlerinde anlamlı artış saptandı. BHE olan hastalarda VKİ SDS değerinin tedavi öncesinde normal aralıkta olduğu ve BH tedavisi ile bu değerin KBHE grubunda değişmediği, PBHE grubunda ise azaldığı saptandı. Tüm gruplarda yıllık büyüme hızı prepubertal dönemde daha fazla olmasına rağmen, tedaviye prepubertal veya pubertal dönemde başlanmasının nihai boyu değiştirmediği görüldü. Tedavi süresince ciddi ve hayatı tehdit edici yan etki gözlenmedi. Sonuç: BH tedavisinin PBHE, KBHE ve SGA tanılı hastalarda boy kısalığının iyileştirilmesi üzerinde etkin ve güvenilir bir tedavi yöntemi olduğu belirlendi. Hastaların erken yaşta tanı almasının daha uzun süre tedavi imkanı sağlayarak boy kazanımında artışa neden olduğu tespit edildi. Anahtar Kelimeler: Büyüme hormonu eksikliği, boy SDS, uzama hızı, öngörülen son boy, vücut kitle indeksi, büyüme hormonu.
Objective: The aim of this study is to investigate the treatment efficacy by comparing anthropometric measurement values, laboratory results and radiological imaging findings at the beginning and duration of treatment with growth hormone of patients partial growth hormone deficiency (PGHD), complete growth hormone deficiency (CGHD), small for gestational age (SGA) and idiopathic short stature (İSS) followed by growth retardation. Material and Method: In this study; the 3 year follow-ups of 202 patients who were admitted to the İnonu University Faculty of Medicine, Department of Pediatrics, Department of Pediatric Endocrinology and Diabetes Department between January 2002 and February 2019 and who were treated for growth hormone were reviewed retrospectively. Application complaints from the polyclinic file information of the cases included in the study, age of onset of the complaints, age of application, CV and family history, anthropometric measurement values (height SDS, height velocity, PAH, Age/ Bone Age, BMI SDS), mother and father height, target height, target height SDS, physical examination findings, puberty stages, laboratory and radiological imaging findings were recorded. Regular follow-up findings of the patients were recorded at three-month intervals. Patients were grouped according to their diagnosis as PGHD, CGHD, SGA and İSS. Height SDS, ? height SDS, ? (height SDS-target height SDS), height velocity, PAH, Age/Bone Age, BMI SDS, IGF-1 SDS, IGFBP-3 SDS, BH dose values were compared at the time of diagnosis and treatment of the groups within themselves groups. The same comparison was made between groups. Results: İn patients treated with GH were detected 69 (34.2%) of the PGHD, 43 (21.3%) of CGHD, 53 (26.2%) of SGA and 37 (18.3%) of ISS. The cases were administered low dose GH average 0.22 mg/kg/week (31.03 mcg/kg/day). İn patients diagnosed with PGHE, CGHD and SGA in the 3rd year of the treatment of GH, the height velocity, height SDS and PAH values increased significantly (p<0.05). Especially in cases with GHD, this increase was found to be significant from the second year onwards. It was observed that starting treatment in prepubertal or pubertal period did not change the final lenght. In the ISS group with low dose BH treatment, although a statistically insignificant increase was observed in the height growth rate and height SDS value with respect to the start of treatment, showed a significant increase in the predicted final height values. It was determined that the BMI SDS value in the patients with GHD was within the normal range before treatment, and with growth hormone therapy this value did not change in the CGHD group and it was decreased in the PGHD group with the treatment of GH. Although the annual growth rate was higher in all groups in the prepubertal period, it was observed that starting treatment in the prepubertal or pubertal period did not change the final length. No serious and life-threatening side effects were observed during the treatment. Conclusion: It was determined that BH treatment is an effective and reliable treatment method for improving short stature in patients with PGHD, CGHD and SGA. It was determined that the diagnosis of the patients at an early age provides longer treatment opportunities and increases the height gain. Keywords: Growth hormone deficiency, height SDS, height velocity, predict adult height, body mass index, growth hormone
Objective: The aim of this study is to investigate the treatment efficacy by comparing anthropometric measurement values, laboratory results and radiological imaging findings at the beginning and duration of treatment with growth hormone of patients partial growth hormone deficiency (PGHD), complete growth hormone deficiency (CGHD), small for gestational age (SGA) and idiopathic short stature (İSS) followed by growth retardation. Material and Method: In this study; the 3 year follow-ups of 202 patients who were admitted to the İnonu University Faculty of Medicine, Department of Pediatrics, Department of Pediatric Endocrinology and Diabetes Department between January 2002 and February 2019 and who were treated for growth hormone were reviewed retrospectively. Application complaints from the polyclinic file information of the cases included in the study, age of onset of the complaints, age of application, CV and family history, anthropometric measurement values (height SDS, height velocity, PAH, Age/ Bone Age, BMI SDS), mother and father height, target height, target height SDS, physical examination findings, puberty stages, laboratory and radiological imaging findings were recorded. Regular follow-up findings of the patients were recorded at three-month intervals. Patients were grouped according to their diagnosis as PGHD, CGHD, SGA and İSS. Height SDS, ? height SDS, ? (height SDS-target height SDS), height velocity, PAH, Age/Bone Age, BMI SDS, IGF-1 SDS, IGFBP-3 SDS, BH dose values were compared at the time of diagnosis and treatment of the groups within themselves groups. The same comparison was made between groups. Results: İn patients treated with GH were detected 69 (34.2%) of the PGHD, 43 (21.3%) of CGHD, 53 (26.2%) of SGA and 37 (18.3%) of ISS. The cases were administered low dose GH average 0.22 mg/kg/week (31.03 mcg/kg/day). İn patients diagnosed with PGHE, CGHD and SGA in the 3rd year of the treatment of GH, the height velocity, height SDS and PAH values increased significantly (p<0.05). Especially in cases with GHD, this increase was found to be significant from the second year onwards. It was observed that starting treatment in prepubertal or pubertal period did not change the final lenght. In the ISS group with low dose BH treatment, although a statistically insignificant increase was observed in the height growth rate and height SDS value with respect to the start of treatment, showed a significant increase in the predicted final height values. It was determined that the BMI SDS value in the patients with GHD was within the normal range before treatment, and with growth hormone therapy this value did not change in the CGHD group and it was decreased in the PGHD group with the treatment of GH. Although the annual growth rate was higher in all groups in the prepubertal period, it was observed that starting treatment in the prepubertal or pubertal period did not change the final length. No serious and life-threatening side effects were observed during the treatment. Conclusion: It was determined that BH treatment is an effective and reliable treatment method for improving short stature in patients with PGHD, CGHD and SGA. It was determined that the diagnosis of the patients at an early age provides longer treatment opportunities and increases the height gain. Keywords: Growth hormone deficiency, height SDS, height velocity, predict adult height, body mass index, growth hormone
Açıklama
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
