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Likelihood of persistent GH deficiency into late adolescence: relationship to the presence of an ectopic or normally sited posterior pituitary gland
Author(s) -
Murray P.G.,
Hague C.,
Fafoula O.,
Gleeson H.,
Patel L.,
Banerjee I.,
Raabe A.L.,
Hall C.M.,
Wright N.B.,
Amin R.,
Clayton P.E.
Publication year - 2009
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2009.03554.x
Subject(s) - ighd , medicine , endocrinology , confidence interval , abnormality , pituitary disease , pituitary gland , growth hormone deficiency , posterior pituitary , prolactin , growth hormone , bone age , hormone , psychiatry
Summary Objectives The presence of an ectopic posterior pituitary gland (EPP) in childhood is associated with isolated GH deficiency (IGHD) and multiple pituitary hormone deficiency. GHD in late adolescence has been defined as a peak GH level <5 μg/l. The aim of this study was to identify the likelihood of persistent GHD in late adolescence in patients with an EPP compared with those with a normally sited posterior pituitary (NPP). Methods In 18 patients with an EPP and 15 patients with an NPP, clinical, biochemical and radiographic data were collected. Results In the EPP vs. the NPP group, the change in peak GH levels at the end of growth was less (+0·4[95% confidence interval (CI) ‐ 0·8 to 2·7] vs. +4·1[95%CI + 0·4 to +10·5] μg/l, P ‐value for ancova = 0·03, after adjustment for age and sex). Using a peak GH level of <5 μg/l as a cut‐off for GHD, 66% of EPP subjects compared with 40% of NPP subjects had GHD ( P = 0·3). Hundred per cent of EPP subjects had a peak GH level on retesting <10 μg/l, compared with 40% of NPP subjects ( P < 0·001). Conclusion It is important to document GH status at the end of growth, even if there is a structural abnormality of the hypothalamic–pituitary axis. The presence of an EPP compared to an NPP increases the likelihood of persistent GHD by 26%. As all EPP patients had a peak GH level of <10 μg/l, the cut‐off for persistent GHD in late adolescence may need to be revised.