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Pituitary function in children with hydrocephalus before and after the first shunting operation
T Löppönen1, A L Saukkonen, W Serlo
1Department of Pediatrics, University of Oulu, Finland.
Insights
Children with shunted hydrocephalus show altered growth hormone (GH) secretion. Lower intracranial pressure (ICP) after shunting may contribute to reduced GH and slower growth.
Area of Science:
- Pediatric Endocrinology
- Neurosurgery
- Growth Hormone Physiology
Background:
- Children with shunted hydrocephalus often exhibit impaired linear growth and pubertal development.
- A significant subset presents with diminished growth hormone (GH) response and reduced pituitary volume.
- The underlying mechanisms, potentially involving unphysiological intracranial pressure (ICP), remain unclear.
Purpose of the Study:
- To investigate the impact of elevated ICP on pituitary function in children with hydrocephalus.
- To explore the relationship between ICP and GH secretion in this patient population.
Main Methods:
- Evaluation of pituitary function in 21 children (4 months to 15 years) before and after their initial shunting procedure.
- Assessment included clinical examination, bone age determination, and a combined pituitary stimulation test for GH, gonadotropins, cortisol, thyrotropin, and prolactin.
Main Results:
- Significantly higher GH concentrations were observed 10 and 15 minutes pre-operation compared to post-operation.
- Basal levels of insulin-like growth factor-I (IGF-I) tended to be higher pre-operation.
- Significantly higher levels of IGF-I binding protein-3 (IGFBP-3) were found pre-operation.
Conclusions:
- Elevated GH response and IGFBP-3 levels pre-shunting suggest a link between ICP and pituitary function.
- Reduced GH secretion and retarded linear growth in shunted hydrocephalus may result from decreased ICP or lack of physiological pressure variations post-shunting.
Objective:
Children with shunted hydrocephalus experience slow linear growth in prepuberty, accelerated pubertal maturation and a reduced final height. A substantial proportion of these patients have a poor growth hormone (GH) response to stimulation and reduced pituitary volume. The basic mechanisms behind these phenomena are still unknown, but one can hypothesize that an unphysiological intracranial pressure (ICP) may be involved. This study was undertaken to investigate the effect of increased ICP on pituitary function.
Design:
Twenty-one children (nine males) aged 4 months to 15 years were evaluated for pituitary function before and after their first shunting operation.
Methods:
A clinical examination was performed, bone age was determined and a combined pituitary stimulation test was performed to evaluate GH, luteinizing hormone, follicle-stimulating hormone, cortisol, thyrotropin and prolactin secretion.
Results:
GH concentrations were significantly higher 10 and 15 min before the operation (P=0.04 and P=0.03 respectively) than after it. The basal levels of insulin-like growth factor-I (IGF-I) tended to be higher before the operation than afterwards and those of its binding protein-3 (IGFBP-3) were significantly so (P<0.01).
Conclusions:
The higher GH response to GH releasing hormone and circulating IGFBP-3 levels in children with hydrocephalus before compared with after their first shunting operation raise the possibility that the reduced GH secretion and retarded linear growth observed in children with shunted hydrocephalus may be a consequence of decreased ICP and/or the lack of physiological pressure variations.