ABSTRACT
BACKGROUND: The possible relationship between the circulating concentrations of T4 and GH sensitivity has not been elucidated. OBJECTIVE: The aim of this study is to evaluate the effect of levothyroxine supplementation on GH sensitivity in prepubertal boys with idiopathic short stature (ISS). METHODS: We selected 28 prepubertal boys with ISS (mean age 8.2±0.5years) and free T4 (Ft4) concentrations between the 3rd and the 25th percentiles (Ft4: 0.8-1.5ng/dl). They were randomly divided into two groups: Group A received thyroid supplementation (1-3µg/kg/day) for 120days, and Group B received placebo for the same period. To evaluate GH sensitivity, an IGF-I generation test (GH: 33µg/kg/day sc for 3days) was performed in both groups: under basal conditions, and after 120days of levothyroxine supplementation (or placebo). RESULTS: After thyroid supplementation, Group A had higher Ft4 concentrations compared with Group B (2.14±0.06 vs 1.48±0.06ng/dl, p=0.01), their growth velocity was significantly higher (2.3±0.1 vs 1.5±0.2cm/4months), and they exhibited a greater increase in IGF-I after GH administration (Group A: 32.5±3.8% vs Group B 17.3±2.6%). CONCLUSION: Supplementation with levothyroxine for 120days promotes an increase in growth velocity, and a greater IGF-I response to short-term GH administration in prepubertal boys with ISS and low-normal thyroid hormone concentrations.
Subject(s)
Growth Disorders/drug therapy , Growth Hormone/therapeutic use , Thyroxine/therapeutic use , Body Height/drug effects , Child , Humans , Insulin-Like Growth Factor I/analysis , Male , Thyroxine/blood , Thyroxine/pharmacology , Treatment OutcomeABSTRACT
The established facts to date relating to Floating-Harbor syndrome (FHS) are its characteristic typical triangular facies with bulbous nose and thin lips, short stature, delayed bone age, and mild mental retardation with delay in expressive speech; its sporadic occurrence without Mendelian inheritance; and its unknown cause. Little is known about the growth hormone-insulin-like growth factor 1 (GH-IGF-1) axis and the effect of GH treatment in children with this syndrome. We report on a 9-year-old girl born small for gestational age (SGA, birth length -2.2 standard deviation score) with persistent short stature who has been treated with GH from 3.5 years onward with a modest growth response. Revision of the case led to the diagnosis of FHS. No abnormalities were found in the sequence or copy number of IGF-1 receptor or in the genomic single-nucleotide polymorphism array. GH treatment led to an increase in serum IGF-1 in the upper normal range, but the growth response was modest, suggesting a defect in IGF-1 signaling. Early recognition of this entity is important, as it enables specific diagnostic tests targeted at other abnormalities associated with FHS.
Subject(s)
Abnormalities, Multiple/drug therapy , Craniofacial Abnormalities/drug therapy , Growth Disorders/drug therapy , Heart Septal Defects, Ventricular/drug therapy , Human Growth Hormone/therapeutic use , Abnormalities, Multiple/genetics , Child , Craniofacial Abnormalities/genetics , Female , Growth Disorders/genetics , Heart Septal Defects, Ventricular/genetics , Humans , Insulin-Like Growth Factor I/physiology , Polymorphism, Single Nucleotide , Receptor, IGF Type 1/geneticsABSTRACT
Early referral is the key to the optimal management of growth failure. Evidence shows that there is no universal consensus for endocrinologists on the handling, tracking and monitoring of growth hormone (GH) treatment. The monitoring of therapy varies due to national prescription guidelines. The aim of this work was to assess the clinical management of short-stature patients who use GH prescribed by pediatric endocrinologists (n = 30) who belong to the Chilean Endocrinology Society (SOCHED). We conducted a questionnaire through an anonymous survey. We observed a large variability of responses to all of the questions. Once the clinician suggests GH treatment, patients usually begin treatment with a strong motivation, and maintenance of this motivation will improve the treatment outcomes. We propose 3-4 months of medical follow-up during which strict physician-patient communication and education is critical.
Subject(s)
Hormone Replacement Therapy , Human Growth Hormone/deficiency , Human Growth Hormone/therapeutic use , Practice Patterns, Physicians' , Adult , Body Height/drug effects , Child , Child Development/drug effects , Chile , Cross-Sectional Studies , Drug Monitoring , Endocrinology , Female , Hormone Replacement Therapy/psychology , Human Growth Hormone/administration & dosage , Human Growth Hormone/adverse effects , Humans , Male , Medication Adherence/psychology , Patient Education as Topic , Pediatrics , Practice Guidelines as Topic , Recombinant Proteins/administration & dosage , Recombinant Proteins/adverse effects , Recombinant Proteins/therapeutic use , Surveys and Questionnaires , WorkforceABSTRACT
We present a case of a 45-year-old gentlemen with invasive Aspergillosis who has no apparent immune deficiencies. Follow up imaging shows improvement after the initiation of therapy. The case is accompanied by a brief discussion over invasive aspergillosis.
