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Progression from isolated growth hormone deficiency to combined pituitary hormone deficiency

Cerbone, M; Dattani, MT; (2017) Progression from isolated growth hormone deficiency to combined pituitary hormone deficiency. Growth Hormone and IGF Research , 37 pp. 19-25. 10.1016/j.ghir.2017.10.005. Green open access

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Abstract

Growth hormone deficiency (GHD) can present at any time of life from the neonatal period to adulthood, as a result of congenital or acquired insults. It can present as an isolated problem (IGHD) or in combination with other pituitary hormone deficiencies (CPHD). Pituitary deficits can evolve at any time from GHD diagnosis. The number, severity and timing of occurrence of additional endocrinopathies are highly variable. The risk of progression from IGHD to CPHD in children varies depending on the etiology (idiopathic vs organic). The highest risk is displayed by children with abnormalities in the Hypothalamo-Pituitary (H-P) region. Heterogeneous data have been reported on the type and timing of onset of additional pituitary hormone deficits, with TSH deficiency being most frequent and Diabetes Insipidus the least frequent additional deficit in the majority, but not all, of the studies. ACTH deficiency may gradually evolve at any time during follow-up in children or adults with childhood onset IGHD, particularly (but not only) in presence of H-P abnormalities and/or TSH deficiency. Hence there is a need in these patients for lifelong monitoring for ACTH deficiency. GH treatment unmasks central hypothyroidism mainly in patients with organic GHD, but all patients starting GH should have their thyroid function monitored closely. Main risk factors for development of CPHD include organic etiology, H-P abnormalities (in particular pituitary stalk abnormalities, empty sella and ectopic posterior pituitary), midline brain (corpus callosum) and optic nerves abnormalities, genetic defects and longer duration of follow-up. The current available evidence supports longstanding recommendations for the need, in all patients diagnosed with IGHD, of a careful and indefinite follow-up for additional pituitary hormone deficiencies.

Type: Article
Title: Progression from isolated growth hormone deficiency to combined pituitary hormone deficiency
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ghir.2017.10.005
Publisher version: http://dx.doi.org/10.1016/j.ghir.2017.10.005
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Cell Biology, Endocrinology & Metabolism, Isolated growth hormone deficiency, Evolution, Combined pituitary hormone deficiency, STALK INTERRUPTION SYNDROME, CENTRAL-NERVOUS-SYSTEM, SEPTO-OPTIC DYSPLASIA, TERM-FOLLOW-UP, GH DEFICIENCY, CONGENITAL HYPOPITUITARISM, CENTRAL HYPOTHYROIDISM, ENDOCRINE-SOCIETY, SINGLE-CENTER, THYROID AXIS
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Genetics and Genomic Medicine Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10054702
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