INVESTIGADORES
REY Rodolfo Alberto
congresos y reuniones científicas
Título:
Clinical, biochemical and neuroimaging findings as predictors of growth hormone deficiency (GHD) in children
Autor/es:
CLÉMENT, F.; BRASLAVSKY, D.; KESELMAN, A.; MARTÍNEZ, A.; ROPELATO, M.G.; BALLERINI, M.G.; BERGADÁ, I.; REY, R.; FINKIELSTAIN, G.
Reunión:
Congreso; 9th Joint Meeting of Paediatrics Endocrinology; 2013
Resumen:
Background: Growth hormone stimulation testing (GHST) has been used as
standard investigation in patients with clinical criteria suggestive of GHD.
However, these tests are invasive and may raise safety issues, especially in a
child with co-morbidities. Different studies aimed to identify risk factors for
GHD but most focused on the differential diagnosis between idiopathic short
stature and GHD in apparently healthy children.
Objective and hypotheses: To assess the association between GHD and the
history of surgery or radiation of the sellar or suprasellar region or another
anterior pituitary deficiency associated with specific clinical and imaging
features, by evaluating the response to GHST.
Methods: Case-control study with retrospective clinical chart review of all
patients meeting the criteria for GHST. GHD was diagnosed with GH peaks
below 6 ng/ml (ECLIA) during sequential Arginine-Clonidine tests.
Results: 205 patients were analysed. 14/50 GHD patients had the postulated
risk factors, while these were found in only 1/155 patients without GHD.
There was a strong association between GHD and the existence of at least one
of the postulated risk factors (Fisher?s exact test p< 0.0001): the probability of
having a risk factor was almost 60-fold higher (OR: 59.9, 95% CI 7.6-470.6)
in the GHD group, and the risk of having GHD was approximately 5-fold
higher (RR: 4.93, 95% CI: 3.56-6.81) in patients with one of the postulated
risk factors.
Conclusions: Our findings clearly identified surgery of the sellar or suprasellar
region, cranial radiotherapy and coexistence of congenital multiple pituitary
hormone deficiencies with hypogenitalism in males, neonatal hypoglycaemia
or cholestasis, diabetes insipidus or midline defects as major risk factors for
GHD in paediatric patients meeting the criteria for GHST.