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Treatment of hypopituitarism in infancy. Effect on head circumference growth
S Di Maio1, M Salerno, N Gasparini
1Department of Pediatrics, University of Naples Federico II, Italy.
Insights
Growth hormone (GH) therapy significantly improves head circumference and linear growth in infants with multiple pituitary-hormone deficiency (MPHD). Monitoring head circumference alongside linear growth is crucial during GH treatment for these children.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Research
- Hormone Deficiency Studies
Background:
- Children with multiple pituitary-hormone deficiency (MPHD) may exhibit subnormal head circumference.
- Infant linear growth is recognized as being dependent on growth hormone (GH).
Purpose of the Study:
- To compare head circumference in children with hypopituitarism under L-thyroxine (L-T4) therapy alone versus combined therapy with GH.
- To assess the impact of GH therapy on head circumference and linear growth in infants with MPHD.
Main Methods:
- Retrospective study of five infants (2 girls, 3 boys) with MPHD diagnosed before age two.
- Auxological parameters, including head circumference and length (SDS), and weight (weight-for-length percentage) were analyzed.
- Measurements were compared during L-T4 therapy alone and after the addition of GH therapy.
Main Results:
- L-thyroxine (L-T4) therapy alone showed no positive effect on head circumference or linear growth.
- Combined GH and L-T4 therapy resulted in significant catch-up growth.
- Mean head circumference SDS increased from -2.20 to -0.89, and length SDS increased from -4.16 to -0.87 after 18 months of combined therapy.
Conclusions:
- Head circumference growth in infancy is dependent on growth hormone (GH), similar to linear growth.
- Monitoring head circumference is as important as monitoring linear growth during GH treatment for infants with MPHD.
Background:
Head circumference of children with multiple pituitary-hormone deficiency (MPHD) may be subnormal for age. Moreover it is known that linear growth in infancy is growth-hormone (GH) dependent. Therefore, aim of the study has been to compare head circumference measurements in children with hypopituitarism after L-thyroxine (L-T4) therapy alone, before therapy with GH, and after GH was added to the therapy.
Methods:
Five infants (2 girls, 3 boys) with MPHD, diagnosed and treated before the age of 2 years and whose auxological parameters records during L-T4 therapy alone were available, were retrospectively studied. Head circumference and length measurements were expressed as standard deviation score (SDS). Weight measurements were expressed as weight for length ratio percentage.
Results:
Initially treated with L-T4 alone for a mean period of 4, 5 months, there were neither positive effects on head circumference nor on linear growth. A significant catch-up growth was observed only employing GH therapy in addition to L-T4: mean head circumference SDS and length SDS increased respectively from -2.20 to -0.89 SDS and from -4.16 to -0.87 SDS after a mean period of 18 months of combined GH and L-T4 therapy.
Conclusions:
Therefore, head circumference growth, in infancy, is growth hormone dependent as well as linear growth, and during GH treatment, monitoring head circumference growth is important as much as monitoring linear growth.