Retrospective assessment of isolated growth hormone deficiency patients receiving growth hormone therapy

The Introduction and Purpose of the Study: In this study, patients diagnosed with isolated growth hormone deficiency (isolated GHD) who applied to our Dicle University Faculty of Medicine Department of Child Health and Diseases, Department of Pediatric Endocrinology Department due to short stature were evaluated. It was aimed to determine the effectiveness of growth hormone (GH) treatment by retrospectively examining the application findings and responses to treatment, the effectiveness of BiH treatment, complications, compliance of the patients, the pre- and posttreatment findings in patients treated with GH. Materials and Methods: The files of patients who received regular GH therapy followed up due to GHD were examined retrospectively. 190 patients without any chronic disease affecting growth, diagnosed with isolated GHD, were evaluated. In the selection of patients, care was taken to have received treatment for at least 1 year and to have no chronic disease that would affect growth and development. Patients' gender, pre-treatment chronologic ages (CA), physical examination findings before and after treatment, laboratory findings, bone ages (BA)obtained by radiological evaluation, target adult height and predicted adult height (PAH) were investigated and how they affect treatment responses. Findings: Of the 190 cases included in our study, 121 (63.7%) were boys and 69 (36.3%) were girls. All 190 cases received treatment for at least one year, 126 cases for at least two years, 42 cases for at least three years. The mean duration of treatment was 2.17 years, and the longest duration was 7 years. The target adult height standard deviation score (SDS) of 76 patients whose target length was calculated was an average of -1.38. Cranial pathology was detected in 36 (22%) of 164 cases with imaging information available. The most common pathological finding was pituitary hypoplasia in 10 patients (6.1%), while in the second place, 9 patients (5.5%) had pars intermedia cysts. During treatment, side effects developed in 16 patients (8.4%): These included hypothyroidism in 9 patients, impaired fasting glucose in 4 patients, joint pain in 2 patients, and high transaminases in 1 patient. The lowest response to the L-dopa test is 0.05 ng / ml, the highest response is 9.87 ng / ml, the average response is 3.99 ng / ml, the lowest response to the glucagon test is 0.32 ng / ml, the highest response is 9, 98 ng / ml, mean response 5.07 ng / ml, lowest response to clonidine test 0.05 ng / ml, highest response 9.8 ng / ml, mean response 5.87 ng / ml. It was found that the patients who had finished treatment were evaluated according to their puberty status, and that the patients who started prepubertal GH treatment had higher gains than pubertal cases. Annual elongation rate was 3,91 cm before treatment, 9,13 cm in the first year, 7,76 cm in the 2nd year and 7,01 cm in the third year. The highest elongation rate was determined in the first year and it was observed that it decreased in the following years. It was determined that the CA/ BA ratio and the CA-BA difference decreased during the treatment compared to years. A weak positive correlation was found between the pre-treatment PAH SDS values and post-treatment height SDS values. Namely, patients with low PAH SDS value were shown to have a better GH treatment response. Patients with low maximum responses in GH stimulus tests were found to have higher height in the 1st and 2nd years. Results: The best response to growth hormone therapy is received in the first year of treatment, and the growth rate and height gain gradually decrease in the following years. Treatment that is started early and given regularly in growth hormone deficiency is important for the individual to reach adult dye in accordance with his genetic height potential. Keywords: Growth hormone deficiency, growth hormone therapy, isolated growth hormone deficiency, short stature