Korpal-Szczyrska Maria, Birkholz Dorota, Okońska Maja, Pawłowicz Małgorzata, Szczyrski Józef
Klinika Pediatrii, Onkologii i Endokrynologii Gdanskiego Uniwersytetu Medyczego.
Pediatr Endocrinol Diabetes Metab. 2012;18(4):158-62.
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.
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.
一名11岁患有多种激素垂体功能减退的女孩，曾因颅咽管瘤治愈，因病理性日间嗜睡入住内分泌科。7岁时她接受了脑肿瘤手术及辅助放疗（总剂量5400厘戈瑞）。她接受了甲状腺激素、皮质醇和抗利尿激素替代治疗。10岁时开始生长激素（rGH）治疗。在rGH替代治疗四个月后，女孩的母亲观察到日间嗜睡症状且有加重趋势。已进行脑部MRI检查；未显示病情进展。在rGH替代治疗开始10个月后转诊至内分泌科。根据实验室检查结果排除了电解质和激素异常。体格检查时，女孩表现为扁桃体大量肥大。经检查发现她出现阻塞性睡眠呼吸暂停，血氧饱和度降至60%。该患者符合腺样体扁桃体切除术条件。术后观察到明显改善，未再出现夜间呼吸暂停和日间嗜睡情况。我们认为，我们的患者接受rGH治疗导致扁桃体和腺样体肥大，进而引发阻塞性睡眠呼吸暂停综合征并伴有代偿性日间嗜睡。
接受rGH替代治疗的儿童可能会出现阻塞性睡眠呼吸暂停综合征并伴有代偿性日间嗜睡。在rGH治疗期间，儿童应定期由耳鼻喉科医生进行检查。
