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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 is crucial alongside linear growth during GH treatment for these children.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Child Development
Background:
- Children with multiple pituitary-hormone deficiency (MPHD) may exhibit subnormal head circumference.
- Infant linear growth is critically dependent on growth hormone (GH).
Purpose of the Study:
- To compare head circumference in children with hypopituitarism.
- Evaluate effects of L-thyroxine (L-T4) therapy alone versus combined GH and L-T4 therapy.
- Assess impact on head circumference and linear growth.
Main Methods:
- Retrospective study of five infants (2 girls, 3 boys) with MPHD diagnosed before age 2.
- Analyzed auxological parameters during L-T4 therapy alone and with GH.
- Expressed head circumference and length as standard deviation scores (SDS).
Main Results:
- L-T4 therapy alone showed no significant effect on head circumference or linear growth.
- Combined GH and L-T4 therapy led to significant catch-up growth.
- Mean head circumference SDS increased from -2.20 to -0.89.
- Mean length SDS increased from -4.16 to -0.87 after 18 months.
Conclusions:
- Head circumference growth in infancy is dependent on growth hormone, similar to linear growth.
- Monitoring head circumference is as important as monitoring linear growth during GH treatment.
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.