儿科学英文课件：15 Growth Hormone Deficiency

1、1,Whats the growth hormone ?l,GH (somatotropin or somatropin) A 191-amino acid,single-chain polypeptide,Whats the GH,Synthesized, stored, and secreted by somatotropic cells in the anterior pituitary gland Secrete in a pulsatile manner Secretion of GH is regulated by the GHRH and GHIH of the hypothal

2、amus A number of other affected factors age, sex, diet, exercise, stress, growth hormonereleasing peptides (GHRPs), other hormones,Growth Axis,GHRH,GHIH (hypothalamus) GH(anterior pituitary gland) IGF-1(liver) Bone,WHAT will Happen if GHD,Biological function of GH,Stimulates growth, cell reproductio

3、n and regeneration in humans and other animals Stimulates production of IGF-1 Raises the concentration of glucose and free fatty acids,Mortality/Morbidity of GHD,Neonatal period prolonged jaundice hypoglycemia small penis Childhood short stature central hypothyroidism,Mortality/Morbidity of GHD,Adul

4、thood altered body composition (excess body fat, lower lean body mass) cardiovascular risk factors (dyslipidemia ) decreased bone mineralization decreased exercise tolerance psychosocial problem,Cause ?,Etiology of GHD,Idiopathic Organic causes Brain tumors ( craniopharyngioma) CNS surgery, infectio

5、n, trauma, radiation Anatomical abnormalities (septooptic dysplasia, empty sella syndrome ) Genetic causes (PIT-1,PROP1 gene mutation),Diagnosis of GHD,Criteria 1. Short stature Shorter than P3 (-2SD) of their peers (same age ,gender, race,region ),Diagnosis of GHD,Criteria 2. Growth velocity(GV) (s

6、lower than -2SD of their peers) infancy 3 岁）,Diagnosis of GHD,Criteria 3. Laboratory examination Lower level of IGF-I GH peak level 10 ng/ml(by two GH provocative test ) Provocative stimuli : insulin, arginine, L-dopa, clonidine, glucagon 4. Bone age delay one year or more delay than CA,Medical hist

7、ory,A (age) when started? How long? B(birth) weight & height (IUGR, SGA) delivery ( breech birth，foot presentation,Apgar score) HIE history C(chronic disease) congenital acquired,Medical history,D(drugs) steroids other medical therapy E(environment) nutrition emotion(abuse),Medical history,F (family

8、) family members height (genetics) Parents timing of puberty (CDGP) G(growth) growth velocity growth curve deviation from the standard,Physical examination,Height and weight measurement Proportionality US/LS ratio Pubertal status Tanner staging system General health Phenotype,Laboratory Studies,Imag

9、ing Studies Bone Age(BA delay) Ultrasound(pelvic) MRI (brain),Laboratory Studies,FT4,TSH(Hypothyroidism) Serum electrolytes(renal tubular acidosis) Insulin-like growth factor 1 (IGF-1) IGF-binding protein 3 (IGFBP-3) Karyotype (female:Turner syndrome) GH provocative test Others blood,urine test ESR

10、liver,renal function FSH,LH,T(E2),PRL,Differential Diagnoses,Familial (genetic) short stature Constitutional growth(pubertal) delay Psychosocial short stature Short stature accompanying systemic disease Short stature as part of a genetic syndrome (Turner ,Noonan,Laron syndrome) Short stature related

11、 to a metabolic abnormality achondroplasia,MPS,renal tubular acidosis Other endocrine disease hypothyroidism,Cushing syndrome,panhypopituitarism,Treatment & Management,hGH replacement recombinant human GH(rhGH) SC injected every night long course of treatment (several years) high cost *HRT(hormone r

12、eplacement therapy),Medical effects of rhGH,increase height in children and adolescents Increases calcium retention strengthens and increases the mineralization of bone Increases muscle mass Promotes lipolysis Increases protein synthesis Stimulates the growth of all internal organs excluding the bra

13、in,Adverse Effects of rhGH,Slipped capital epiphyses Scoliosis Hypothyroidism Hyperglycemia Pancreatitis Benign intracranial hypertension (uncommon) Hematuria increment of ALS,AST,Contraindications,Hypersensitivity to preperation Pediatric patients with closed epiphyses Active neoplasia, acute complications of open heart or abdominal surgery, multiple trauma, acute respiratory failure hyperglycemia or diabetes,Follow up,Monitor growth progress Adjust growth hormone dosage Investigation for side effect Assure p