Prethodno priopćenje

Growth Hormone Replacement Therapy in Patients with Cushing's Disease

Milan Vrkljan
Tajana Zah
Josip Rešetić
Branka Vizner
Vilma Kosović
Davorka Herman

Sažetak

In this retrospective study, the benefit of growth hormone in replacement therapy was assessed in comparison with standard hormone replacement therapy in patients with panhypopituitarism. The study included ten female patients aged 29-44 (mean age 37.6±8.6) years, who had undergone adenectomy for pituitary tumor and Cushing's disease. After adenectomy, the patients received conventional hormone replacement therapy for panhypopituitarism, consisting of hydrocortisol (Cortef), L-thyroxine (Euthyrox) and ovarian hormones, for 6 months. After 6 months of therapy, both subjective and objective recovery was quite poor, as indicated by the following parameters: cholesterol, triglycerides, blood glucose, body weight, body height, waist circumference, diastolic and systolic blood pressure at rest, and body mass index. The growth hormone basal and peak values as determined by insulin tolerance test (ITT) test, and insulin-like growth factor (IGF-I) were below the normal range. All patients were indicated TRH nonreactive on TRH testing. Then, growth hormone was added to their conventional therapy in a dose of 2 IU/day s.c., and the same parameters were determined after 6 months of therapy. The criteria for the introduction of growth hormone in therapy were as follows: subjectively and objectively inadequate recovery after adenectomy; growth hormone and IGF-I values below the normal range in basal conditions; and inappropriate growth hormone result on ITT test (patients were administered 0.1 IU insulin per kg body weight, where after peak growth hormone level was measured). On TRH testing, patients were administered 200 mg TRH; where-after growth hormone levels were measured. After 6 months of therapy with Cortef, Euthyrox, ovarian hormones and growth hormone, all patients felt much better subjectively (three of them still reported ostealgia, whereas densitometry showed no improvement in only four of ten patients). Objective test results also improved (cholesterol, triglycerides, blood glucose, body weight, body height, waist circumference, diastolic and systolic blood pressure at rest, and body mass index). The mean plasma concentration of total cholesterol decreased from 6.95±1-05 to 4.9±1.8 mmol/L, plasma triglycerides from 4.39±1.61 to 1.94±0.76 mmol/L, plasma glucose from 7.83±3.17 to 5.12±1.22 mmol/L, mean body weight from 80.2±5.2 to 74.7±4.7 kg, mean body mass index from 29.1± 2.1 to 26.8±1.6 kg/m2, waist circumference from 0.827±0.093 to 8.814±0.064 m, pulse from 82.2±7.8 to 71±11.0 per min, systolic blood pressure from 148.5±11.5 to 141±9.0 mm Hg, and diastolic blood pressure from 89±16.0 to 84.5±5.5 mm Hg. Osteoporosis was reduced, ostealgia and podagra disappeared in most patients. It was concluded that the introduction of growth hormone in standard hormone replacement therapy led to a considerably better patient recovery as compared with standard hormone replacement therapy alone.

Ključne riječi

Cushing syndrome - therapy; Somatotropin - therapeutic use; Hormone replacement therapy; Follow up studies

Hrčak ID:

14702

URI

https://hrcak.srce.hr/14702

Datum izdavanja:

1.12.2003.

Podaci na drugim jezicima: hrvatski

Posjeta: 2.370 *