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9 "Growth hormone deficiency"
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Review Article
Adrenal gland
Diagnosis and Treatment of Hypopituitarism
Seong Yeon Kim
Endocrinol Metab. 2015;30(4):443-455.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.443
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  • 48 Web of Science
  • 58 Crossref
AbstractAbstract PDFPubReader   

Hypopituitarism is a chronic endocrine illness that caused by varied etiologies. Clinical manifestations of hypopituitarism are variable, often insidious in onset and dependent on the degree and severity of hormone deficiency. However, it is associated with increased mortality and morbidity. Therefore, early diagnosis and prompt treatment is necessary. Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. Knowledge of the use and limitations of these stimulation tests is mandatory for proper interpretation. It is necessary for physicians to inform their patients that they may require lifetime treatment. Hormone replacement therapy should be individualized according to the specific needs of each patient, taking into account possible interactions. Long-term endocrinological follow-up of hypopituitary patients is important to monitor hormonal replacement regimes and avoid under- or overtreatment.

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Case Report
A Case of Turner's Syndrome with Transient Hypopituitarism.
Ji Sun Nam, Min Ho Cho, Jung Min Roh, Hai Jin Kim, Ji Eun Yoon, Han Young Jung, Jong Suk Park, Eun Seok Kang, Chul Woo Ahn, Bong Soo Cha, Eun Jig Lee, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee
J Korean Endocr Soc. 2007;22(4):266-271.   Published online August 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.4.266
  • 1,685 View
  • 18 Download
AbstractAbstract PDF
Turner's syndrome is characterized by short stature and gonadal dysgenesis, and it is often associated with various systemic manifestations, such as cardiovascular, renal, thyroidal, gastrointestinal, and musculoskeletal disorders. Though very rare, it can also be accompanied by hypopituitarism. It is important to give a meticulous medical attention to short females with gonadal dysgenesis so that neither disease is neglected or gets delayed diagnosis. In this case, Turner's syndrome and hypopituitarism were diagnosed almost simultaneously, but hypopiuitarism was transient, and the normal pituitary function was recovered spontaneously without any treatment. Initial sella MRI showed mild congenital hypoplastic hypopituitarism, and combined pituitary function test was compatible with hypopituitarism, but after 5 years, though growth hormone deficiency was still present, otherwise normal pituitary function was noted without any change in MRI. Herein, we are reporting a case of Turner's syndrome with transient idiopathic hypopituitarism with the review of literature.
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Original Articles
The Changes in Atherosclerotic Markers and Adiopocytokines after Treatment with Growth Hormone for the Patients with Hypopituitarism and Growth Hormone Deficiency.
Hyun Won Shin, In Kyung Jeong, Goo Yeong Cho, Cheul Young Choi, Jong Yeop Kim, Yeong Je Chae, Min Ho Cho, Byung Wan Lee, Seong Jin Lee, Chul Young Park, Eun Gyoung Hong, Hyeon Kyu Kim, Doo Man Kim, Jae Myung Yu, Sung Hee Ihm, Moon Ki Choi, Hyung Joon Yoo, Sung Woo Park
J Korean Endocr Soc. 2006;21(6):515-525.   Published online December 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.6.515
  • 1,835 View
  • 22 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
It is known that patients with hypopituitarism have a high mortality rate due to the presence of atherosclerosis, cardiovascular diseases and stroke. The aim of this study was the effect of growth hormone (GH) on the atherosclerotic markers and the adipocytokine levels. METHOD: The study was conducted on 13 adult patients with hypopituitarism and growth hormone deficiency (GHD), and they had been stabilized after receiving hormone replacement therapy for other insufficient pituitary hormones, other than GH, for more than one year. Before treatment with GH, we compared the lipid metabolism, glucose metabolism, cardiovascular risk factors and adipocytokine levels, including adiponectin, leptin, TNF-alpha and IL-6, between the GHD patients and 13 healthy adults who were of a similar age and gender distribution. Patients with GHD were treated with 1 U/day of GH for 6 months. We measured insulin-like growth factor-I (IGF-I), blood pressure, body composition, lipid metabolism, glucose metabolism and hs-CRP, cardiac function, adiponectin, leptin, TNF-alpha and IL-6 levels, flow mediated vasodilation (FMD) and nitroglycerin mediated vasodilation (NMD) before and after GH treatment. RESULTS: The patients with hypopituitarism and GHD showed significantly higher levels of total cholesterol (P = 0.002), low-density lipoprotein cholesterol (LDL-C) (P = 0.036), hs-CRP (P = 0.0087) and leptin (P < 0.001) than did the normal healthy adults. However, there was no difference between the normal adults and the patients with GHD for the systolic and diastolic BP, the levels of apoA, apoB, fasting blood glucose(FBG) and HOMA-IR. In the subjects with GHD after treatment with GH, the level of fat mass (P = 0.0017), total cholesterol (P = 0.004), LDL-C (P = 0.001), leptin (P = 0.013), TNF-alpha (P < 0.001) and hs-CRP (P = 0.0001) were significantly reduced, while lean body mass (P = 0.0161), FFA (P = 0.049) and FMD (P = 0.0051) showed a significant increase. However, there was no significant difference in the level of the systolic and diastolic BP, LDL-C, apoA, apoB, LP (a), HOMA-IR, ejection fraction, left ventricular posterior wall, E/A ratio, intraventricular septum, NMD, intima-media thickness, adiponectin, IL-6, FBG and fasting insulin before and after GH treatment. CONCLUSION: The subjects with GHD were vulnerable to cardiovascular disease. GH therapy for 6 months had a positive effect on their various cardiovascular risk factors.

Citations

Citations to this article as recorded by  
  • Molecular Biology of Atherosclerosis
    In-Kyung Jeong
    Endocrinology and Metabolism.2010; 25(3): 166.     CrossRef
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The Relationship of Ghrelin and Leptin with the Biochemical Markers for Adult Growth Hormone Deficiency.
Chan Hee Jung, Eun Jung Rhee, Se Yeon Kim, Ki Won Oh, Won Young Lee, Sun Woo Kim
J Korean Endocr Soc. 2006;21(3):213-221.   Published online June 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.3.213
  • 2,635 View
  • 18 Download
AbstractAbstract PDF
BACKGROUND
In spite of the increasing information that has recently been accumulated on the involvement of ghrelin and leptin in energy balance control, the relationship between ghrelin or leptin and the growth hormone (GH)-Insulin like growth factor-1 (IGF-1) axis in the pathological condition characterized by growth hormone deficiency (GHD) has been poorly clarified. Therefore, we performed this study to evaluate the correlation of the plasma levels of ghrelin and leptin with the anthropometric and biochemical markers in GHD adults and also in healthy adults. METHODS: For the 60 male adults (GHD, n = 12; healthy control, n = 48; average age, 54 years), we investigated the correlations between the serum leptin and ghrelin levels with the anthropometric and biochemical factors in the two groups, as divided by their GH status. The diagnosis of GHD was made on the basis of a peak response for serum GH of less than 5 micro/L to a GH provocative test (L-dopa test). All the subjects underwent assessment of waist circumference, BMI and percentage body fat for their body composition. The plasma ghrelin, leptin, insulin, GH and IGF-1 were measured. RESULTS: The groups were well-matched for their age, BMI, waist circumference and percentage of body fat. The ghrelin and leptin levels were not significantly different between the two groups. There was no correlation between the peak GH level or the area under the curve of growth hormone (GHAUC) and the ghrelin concentrations in the GHD subjects. Plasma leptin correlated positively with the percentage of body fat, the total cholesterol and the LDL-cholesterol, but it had no correlation with the peak GH or GHAUC in the GHD subjects. CONCLUSIONS: It is possible that the ghrelin concentrations appeared normal in the GHD subjects. Further studies are needed to clarify these controversies about the relation of ghrelin and leptin with the GH and IGF-1 levels.
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Korean Adult Growth Hormone Deficiency Treatment Registry.
Sung Woon Kim, Seong Yeon Kim, Su Youn Nam, Yoon Sok Chung, Jae Hoon Chung, In Kyung Jung, Jong Ryeal Hahm, Minho Shong, Dong Sun Kim, Seong Keun Lee, Sung Dae Moon, Hyun Koo Yoon, Doo Man Kim, Sang Woo Kim, Hye Kyung Park
J Korean Endocr Soc. 2002;17(1):43-47.   Published online February 1, 2002
  • 1,807 View
  • 21 Download
AbstractAbstract PDF
BACKGROUND
Adult growth hormone (GH) deficiency is related with decreased lean body mass, increased body fat, and poor quality of life. In western countries, adult GH deficiency treatment registriesy provide a database of the effects and safety of GH deficiency treatment. The Korean Adult Growth Hormone Study Group of the Korean Society of Endocrinology register adult GH deficiency since 1996. METHEODS: Subjects were aged over 15 years, had organic hypothalamo-pituitary disease, and GH deficiency as documented by GH stimulation test or serum insulin-like growth factor-I (IGF-I) level. The underlying etiology for GH deficiency, serum IGF-I level, starting and maintenance dose, and adult GH deficiency assessment (AGHDA) score were investigated. RESULTS: From January 1996 to May 2001. 115 patients were enrolled. Mean age was 43.7 13.8 years and 60% were female. Thirteen medical institutions were involved in the registry. The most common underlying diseases were Sheehan's syndrome and pituitary adenomas. GH starting dose was from 0.4 to 1.0 units. Maintenance dose was between 0.5 and 1.2 units. Serum IGF-I levels were increased after GH treatment (0-week, 93.7 69.7 ng/mL; 2-weeks, 184.9 89.0 ng/mL; 6-weeks, 188.4 94.8 ng/mL; 10-weeks, 207.6 111.1 ng/mL; 6 months, 281.9 95.5 ng/mL). AGHDA scores slightly improved from 10.25 6.70 to 8.58 5.47 after 6 months of GH deficiency treatment. CONCLUSION: The GH Treatment Registry will be beneficial in monitoring the effects of GH deficiency treatment on Korean adult GH deficient subjects
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Serum Leptin Levels during Growth Hormone Treatment in Children with Growth Hormone Deficiency.
Jin Hee Oh, Byung Churl Lee
J Korean Endocr Soc. 2000;15(4-5):493-501.   Published online January 1, 2001
  • 967 View
  • 18 Download
AbstractAbstract PDF
BACKGROUND
Leptin the ob gene product is secreted by adipocytes and binds to specific receptors in the central nervous system regulating energe intake and expenditure. Correlation between fat mass and leptin level is well established. However, data on the hormonal regulation of the leptin in human are scarce. Growth hormone (GH) has lypolytic action and patients with growth hormone deficiency (GHD) have showed higher leptin levels than expected for the obesity We investigated the changes in serum leptin levels and body mass index in children with GHD during GH therapy. METHODS: Thirty children with GHD participated. All subjects were 5~13 years old and in prepubertal stage. The causes of GHD were idiopathic in 15 and organic in 15 children. Patients received GH 0.6.7 IU/kg/week subcutaneously, in 67 divided doses and investigated at baseline and after 6 and 12 months of GH treatment. Serum leptin levels were determined with a human leptin and IGF-1 radioimmunoassay (Linco Research and Nichols Institute, USA). RESULTS: The height velocity was increased significantly after 12 months of GH treatment. Serum leptin concentrations were significantly reduced after 6 and 12 months of treatment but revealed no significant differences in the sex and the causes of GHD. Body mass indices were significantly reduced after treatment. Serum leptin levels positively correlated with body mass index at baseline and after 6 and 12 months of GH treatment. The serum IGF-1 level were increased significantly after GH treatment and did not significantly correlated with leptin levels at baseline and after treatment. CONCLUSION: This study demonstrated that serum leptin and body mass index were decreased with significant positive correlation during GH treatment in children with GHD.
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Case Reports
A Case of Type Ia Glycogen Storage Disease.
Young II Choi, Young In Choi, Jee Won Park, Yoon Sok Chung, Hyon Ju Kim
J Korean Endocr Soc. 1999;14(4):786-792.   Published online January 1, 2001
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AbstractAbstract PDF
Glycogen storage diseases are inherited disorders of carbohydrate metabolism caused by a deficiency of enzymes that are involved in degradation of glycogen in the liver. The accumulation of glycogen occurs in the liver and other organs. Type Ia is the most common form and clinically may manifest of glycogen storage disease itself rather than growth hormone deficiency. But in this case the patient showed exceptional extreme growth retardation. Growth hormone stimulation test with clonidine and L-dopa revealed that the patient had growth hormone deficiency. Therefore, we report of a case of glycogen storage disease type Ia with the presence of GH deficiency with review of literature. A 16-year-old male was admitted for the evaluation of hepatomegaly and extreme short stature. The height was 113.5cm, less than third percentile of same age group, and compatible with fiftieth percentile of height of 6 years of age. After laboratory work up including liver biopsy, he was diagnosed with type I glycogen storage disease. The patient was presented with metabolic acidosis, hyperuricemia, and hypoglycemia. Hypoglycemia was managed with frequent feeding with high starch diet and intravenous glucose infusion. Metabolic acidosis was treated with sodium bicarbonate. Secondary hyperuricemia was treated with allopurinol. The patient is being followed at out-patient clinic with clinical improvement after of GH administration.
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A Case of X-linked Agammaglobulinemia with Delayed Growth.
Mi Jin Kim, Ho Young Kim, Mi Deok Lee, Hong Seung Kim, Young Goo Shin, Choon Hee Chung, Kye Chul Shin
J Korean Endocr Soc. 1999;14(1):153-159.   Published online January 1, 2001
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In 1980, the clinical syndrome of X-linked agammaglobulinemia and isolated growth hormone defieiency (XLA/IGHD) was first described by Fleisher. We report here 25-year old man with isolated growth hormone deficiency and X-linked agammaglobulinemia. His height was below the third percentile. He had recurrent sinopulmonary infection, lacked circulating B lympocytes and had deficient growth hormone.
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Original Article
Clinical Effects of E. cole Derived Authentic REcombinant Human Growth Hormone(DA-3002) in Children with Growth Hormone Deficiency.
Se Won Yang, Byung Chul Lee, Chul Woo Ko, Duk Hee Kim, Han Wook Yoo, Woo Young Chung
J Korean Endocr Soc. 1998;13(4):526-535.   Published online January 1, 2001
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BACKGROUND
Recently authentic human growth hormone(hGH) has produced in the E coli K-12, W3110 by recombinant DNA tecbnology in Korea In this paper, the clinical efficacy and immunogenicity of this GH was shdied in 38 children with growth hormone deficiency during therapy of 1 year. METHODS: The subjects of this study were aged 4.9-13.9 years, diagnosed by failure of plasma GH to respond to insulin-induced hypoglycemia, arginine and/or L-dopa loading and height below -2 standard deviation of mean for their chronological age. Each patient received GH 0.5-0.7IU/kg/week subcutaneously in 6-7 divided doses. During treatment, vital signs, height, body weight and bone age were checked every 3 months. Complete blood count, urinalysis, blood chemistry and thyroid hormone were checked before and every 6 months. The measurement of serum IGF-1 level and antibody against hGH were performed before and every 6 months during therapy of I year. RESULT: The height velocities significantly increased from 3.3 +/- 1.5cm/year to 10.1 +/- 2.5 and 9.0 +/- 1.8cm/year at 6 and 12 months of therapy, respectively. The height standard deviation score for chronological age were significantly improved from -2.141.50 to -1.74 +/- 1.43 and -1.54 +/- 1.38 at 6 and 12 months of therapy with increasing ratio of bone age to chronological age from 0.72 +/- 0.15 at pretreatment to 0.76 +/- 0.15 at 6 month, 0.79 +/- 0.16 at 12 month of therapy. The plasma IGF-1 level significantly increased during treatment. One of 36 patients(2.8%) showed positive antibody against hGH after 1 year of treatment. During therapy of 1 year, unwanted and remarkable clinical side effect were not observed in all subjects. CONCLUSION: These results indicate that this E. coli derived authentic recombinant growth hormone is very effective in stimulating linear growth in children with growth hormone deficiency.
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Endocrinol Metab : Endocrinology and Metabolism