Objectives: To identify growth hormone deficiency (GHD) in cases referred for short stature in a multi-national population and evaluate the acceptance, adherence and side effects of GH therapy in these GH deficient cases.
Materials and methods: Retrospective analysis was done on all the cases referred for short stature to Pediatric endocrine facility of our hospital from January 2016 to January 2017. GHD was diagnosed on the basis of a GH response <10 μg/l documented by 2 GH provocation tests (clonidine followed by glucagon) in suspected GHD cases. The patient was started on GH treatment after detailed counseling at initial dose of 25 35 μg/kg/day. Patients were monitored 36 monthly and also evaluated for adherence. The determination of the growth response to GH therapy was considered the most important parameter for response. Regular IGF-1, glucose metabolic parameters, thyroid and adrenal functions monitoring was done.
Results: Out of total 356 cases worked up for short stature, 68 underwent GH stimulation test. 37 were identified as GH deficient. 26 had Isolated GH deficiency and 11 had Multiple Pituitary hormone defects MPHD (most common-Thyroid followed by hypogonadism and adrenal). The age range was 2.9 years to 15.1 years with a mean age of 10.6 years. 27 were males and ten were females. Maximum number of cases were Emiratis-9 followed by Indians-7, Pakistanis-6, Jordan-4, Egypt-3 and the rest were other nationalities. Average peak GH levels post stimulation was 5.6 ng/ml (range 1.29.5 ng/ml). MRI Pituitary was reported as normal in 22, small size for age in 10, Pituitary microadenoma in 3 and as empty sella in two cases. Out of 33 patients (89%) started on GH therapy, 22(66%) were good responders whereas seven responded poorly (21%) and response could not be assessed in 4(12%). Factors affecting response were age, pubertal status and adherence. Reduced insulin sensitivity (6) was the most common side effect followed by hyperlipidemia (2) and blurring of vision (1). 7 patients (24%) unmasked their thyroid and adrenal insufficiency during course of therapy.
Conclusion: Acceptance and adherence of long term GH treatment needs proper motivation and counseling particularly in multi-cultural milieu. Close monitoring and constant support system is vital for success of GH therapy.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology