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Catch-Up Growth in Patients with Congenital or Acquired Growth Hormone Deficiency After GH Replacement: Clinical Features and Hypothalamic–Pituitary Imaging

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Handbook of Growth and Growth Monitoring in Health and Disease

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Abstract

Hypothalamic and pituitary disorders usually impair statural growth. These disorders may be either congenital or acquired with differences in clinical presentation. Growth failure is mainly related to growth hormone deficiency (GHD) that can be accompanied by other pituitary hormone deficiencies. The onset of clinical features may be insidious and unnoticed for years or decades. Therefore, it is important to periodically assess auxologic data such as height, growth velocity, bone maturation and evaluate hormonal levels related to hypothalamic–pituitary axis in these patients. Magnetic resonance imaging (MRI) greatly improved the study of central nervous system (CNS) disorders including the hypothalamic–pituitary region. Currently, it is an essential tool in the definition of the etiology of GHD. It can detect tumors that may require surgical intervention, and also provide insights into other causes of GHD. Catch up growth of congenital disorders is essentially dependent on hormone replacement. Even with an initial diagnosis of IGHD, attention should be given to the risk of the development of multiple pituitary hormone deficiencies. In addition to the hormonal deficiencies due to the acquired disorder themselves; their treatment (surgery, irradiation, chemotherapy) often leads to combined pituitary deficits. Growth responsiveness to rhGH has safety aspects of treatment which deserve additional discussion.

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Abbreviations

ACTH:

Adrenocortical-stimulating hormone

Afp:

Alpha-fetoprotein

BMI:

Body mass index

CNS:

Central nervous system

CPP:

Central precocious puberty

CT:

Computed tomography

DI:

Diabetes insipidus

EPP:

Ectopic posterior pituitary

GH1 :

Growth hormone 1 gene

GHRHR :

Growth hormone-releasing hormone receptor gene

GLI2 :

GLI-KRUPPEL family member gene 2

GH:

Growth hormone

GHBP:

Growth hormone binding protein

GHD:

Growth hormone deficiency

GHRH:

growth hormone-releasing hormone

HESX1 :

Homeobox embryonic stem cell 1 gene

hCG:

Human chorionic gonadotropin

IGF-1:

Insulin-like growth factor 1

IGFBP-3:

Insulin-like growth factor binding protein 3

IGHD:

Isolated growth hormone deficiency

LCH:

Langerhans cell histiocytosis

LHX4 :

Lim Homeobox 4 gene

MPHD:

Multiple pituitary hormone deficiency

MRI:

Magnetic resonance imaging

OTX2 :

Orthodenticle, drosophila, homolog of, 2 gene

Pit1 :

Pou Domain, Class1, Transcription factor 1, POU1F1 gene

PROP1 :

Prophet of pit 1 gene

rhGH:

Recombinant human growth hormone

SDS:

Standard deviation score

SOD:

Septo-optic dysplasia

SOX2 :

SRY-BOX 2 gene

SOX3 :

SRY-BOX 3 gene

T4:

Levothyroxine

TBI:

Traumatic brain injury

TSH:

Thyroid-stimulating hormone

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Authors and Affiliations

  1. Division of Endocrinology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil

    Luciani R. Carvalho, Ivo J.P. Arnhold, Berenice Bilharinho Mendonca, Everlayny Fiorot Costalonga & Aline Pedrosa Otto

  2. Division of Radiology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil

    Claudia da Costa Leite, Leandro Tavares Lucato & Mirella Maccarini Peruchi

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  1. Luciani R. Carvalho
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  2. Ivo J.P. Arnhold
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  3. Berenice Bilharinho Mendonca
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Correspondence to Luciani R. Carvalho .

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  1. Dept. Nutrition & Dietetics, King's College, Stamford St. 150, London, SE1 9NH, United Kingdom

    Victor R. Preedy

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Carvalho, L.R. et al. (2012). Catch-Up Growth in Patients with Congenital or Acquired Growth Hormone Deficiency After GH Replacement: Clinical Features and Hypothalamic–Pituitary Imaging. In: Preedy, V. (eds) Handbook of Growth and Growth Monitoring in Health and Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1795-9_57

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