Growth Hormone Replacement Therapy in Patients with Cushing's Disease

Autor: Milan Vrkljan, Tajana Zah, Josip Rešetić, Branka Vizner, Vilma Kosović, Davorka Herman
Jazyk: angličtina
Rok vydání: 2003
Předmět:
Zdroj: Acta clinica Croatica
Volume 42
Issue 4
ISSN: 1333-9451
0353-9466
Popis: 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.
Deset bolesnica s tumorom hipofize i Cushingovom bolešću praćeno je u ovom retrospektivnom istraživanju. Sve bolesnice su operirane i imale su panhipopituitarizam nakon operacije. Kroz 6 mjeseci provođena je standardna hormonska nadomjesna terapija Cortefom, Euthyroxom i gonadnim hormonima. Nakon 6 mjeseci terapije provedene su pretrage i bolesnice su odgovorile na manji upitnik o subjektivnom osjećanju. Pretrage su uključile kolesterol, trigliceride i glukozu u krvi, tjelesnu težinu i tjelesnu visinu, opseg struka, indeks tjelesne mase, puls u mirovanju, sistolički i dijastolički tlak, denzitometriju i prisutnost kostobolje. Objektivni pregled, subjektivno osjećanje i nalazi laboratorijske obrade pokazali su kako nijedna bolesnica nije postigla zadovoljavajući poslijeoperacijski oporavak. U naknadnim pretragama mjerena je bazalna razina hormona rasta i vršna vrijednost dobivena testom ITT, te IGF-I. Nađene su niske vrijednosti u bazalnim uvjetima i u testu. Test TRH pokazao je nedostatan odgovor hormona rasta u svih bolesnica. Nakon analize dobivenih nalaza donesena je odluka o terapiji hormonom rasta uza standardnu nadomjesnu hormonsku terapiju (nadbubrežna žijezda, štitnjača i gonade), što je provedeno kroz slijedećih 6 mjeseci. Testiranje je ponovljeno nakon 6 mjeseci, kada su mjereni isti parametri kao i odmah nakon operacije, tj. kolesterol, trigliceridi, glukoza u krvi, tjelesna težina, tjelesna visina, opseg struka, indeks tjelesne mase, puls u mirovanju, sistolički i dijastolički tlak. Subjektivni upitnik sadržavao je pitanja o kostobolji, a napravljena je i denzitometrija. Analiza je pokazala kako su bolesnice koje su uzimale hormon rasta uza standardnu hormonsku nadomjesnu terapiju prema svim parametrima nakon 6 mjeseci terapije postigle puno bolje rezultate, te da se subjektivno bolje osjećaju. Rezultati su pokazali kako je pozitivan učinak hormona rasta nakon operacije tumora hipofize neosporan, te da se stupanj oporavka koji se postiže nakon uključivanja hormona rasta u terapiju ne može postići standardnom hormonskom nadomjesnom terapijom.
Databáze: OpenAIRE
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