ABSTRACT
UNLABELLED: An 11-year old girl with multihormonal pituitary deficiency previously cured from craniopharyngioma was admitted to the endocrinology Department because of pathological daytime sleepiness. At the age of 7 she had undergone brain tumor surgery with adjuvant radiotherapy (complete dose of 5400 cGy). She had been given replacement therapy of thyroid hormone, cortisol and adiuretin. At the age of 10 years she had started growth hormone (rGH) treatment. After a period of four months of rGH replacement therapy the girl's mother had observed symptoms of excessive daytime sleepiness with a tendency to escalation. MRI of the brain had been performed; no progression has been shown. After 10 months from the start of rGH replacement therapy was referred to the endocrinology department. On the basis of laboratory findings electrolyte and hormonal abnormalities were excluded. On physical examination, the girl manifested massive tonsillar hypertrophy. It was disclosed that she developed obstructive sleep apnea with the drop of oxygen saturation to 60%. The patient was qualified to adenotonsillectomy. There was a spectacular postoperative improvement observed with no future episodes of night apnea and daytime sleepiness. In our opinion, the rGH treatment in our patient induced hypertrophy of the tonsils and adenoid, which led to obstructive sleep apnea syndrome with compensatory daytime sleepiness. CONCLUSIONS: Obstructive sleep apnea syndrome with compensatory daytime sleepiness may occur in children on rGH replacement therapy. During rGH therapy children should be regularly examined by a laryngologist.
Subject(s)
Craniopharyngioma/complications , Disorders of Excessive Somnolence/chemically induced , Human Growth Hormone/adverse effects , Palatine Tonsil/pathology , Pituitary Neoplasms/complications , Sleep Apnea, Obstructive/chemically induced , Child , Craniopharyngioma/therapy , Diagnosis, Differential , Disorders of Excessive Somnolence/diagnosis , Female , Hormone Replacement Therapy , Humans , Hyperplasia/chemically induced , Magnetic Resonance Imaging , Pituitary Neoplasms/therapy , Sleep Apnea, Obstructive/diagnosisABSTRACT
INTRODUCTION: Craniopharyngioma (CP) is a tumor, which damages pituitary function because of its localization. Panhypopituitarism (PHP) and excessive weight gain with lipid dysfunction are frequently observed. The growth hormone therapy (rGH) profits in the increase of growth rate and also may have metabolic effects like body weight reduction. AIM OF THE STUDY: The evaluation of benefits from rGH therapy in patients cured from CP. MATERIAL AND METHODS: 12 patients (7 boys and 5 girls) treated for CP with surgery; 3 of them also underwent radiotherapy. The mean age at examination time was 11.7 yrs; remission time 2.96 yrs; rGH therapy started on average 3.69 yrs after the surgery. Height (hSDS), weight, BMI were measured after the surgery, before and after 1 yr of rGH treatment. Height velocity (HV) was evaluated before and after 1 yr of rGH therapy. Pituitary GH-function was assessed. In addition, measurements of TSH, ACTH, LH, FSH. Cholesterol, LDL, HDL, triglycerides and HbA1c were estimated before and after one year of rGH therapy. RESULTS: All patients presented PHP. The GH-peak average 1.53 mIU/l; IGF-1 39.37 ng/ml; TSH 0.1 U/l; ACTH 17.48 pg/ml; LH 0.13 U/l; FSH 0.41 mIU/ml. HSDS after oncological treatment (OT) average -1.66 SD and decreased significantly until rGH therapy; weight after OT average 28.45 kg and until rGH therapy increased significantly; BMI after OT average 19.26 and increased significantly until rGH therapy as well. HV was on average 3.34 cm/yr until rGH started. After one year of rGH therapy hSDS and HV increased significantly; they average -1.65SD and 10.21 cm/yr respectively. BMI, HbA1c and LDL decreased significantly. During rGH therapy neither tumor recurrence nor severe side effects were observed. CONCLUSIONS: rGH therapy of patients cured from CP influences profitably not only growth rate, but also BMI reduction and the decrease in cholesterol LDL and HbA1c.
