Henry Rohan K, Menon Ram K
Division of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH 43205, USA.
Division of Endocrinology, Department of Pediatrics, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
Case Rep Endocrinol. 2018 Oct 24;2018:4748750. doi: 10.1155/2018/4748750. eCollection 2018.
In a seminal report, a 17-year-old boy with panhypopituitarism had fatty liver (FL) amelioration with growth hormone (GH). By extension, since hepatic insulin resistance (IR) is key to FL and type 2 diabetes mellitus (T2DM), GH then may ameliorate the IR of T2DM. We present a 17-year-old nonobese female with untreated childhood onset growth hormone deficiency (CO-GHD) who developed type 2 diabetes mellitus (T2DM) and steatohepatitis with bridging fibrosis. Based on height z-score of - 3.1 and a history of radiation therapy as treatment for a medulloblastoma at 7 years of age, GHD was quite likely. GH therapy was, however, not initiated at 15 years of age (when growth was concerning) based on full skeletal maturity. After she developed T2DM, GHD was confirmed and GH was initiated. With its initiation, though insulin dose decreased from 2.9 (155 units) to 1.9 units/kg/day ( 100 units), her T2DM was, however, not fully reversed. This illustrates the natural history of untreated CO-GHD and shows that though hepatic IR can be ameliorated by GH, full reversal of T2DM may be prevented with irreversible hepatic changes (fibrosis). Clinicians caring for pediatric patients and otherwise should remember that, even in patients beyond the cessation of linear growth, GH can have a crucial role in both glucose and lipid metabolism.
在一份具有开创性的报告中，一名患有全垂体功能减退症的17岁男孩的脂肪肝（FL）通过生长激素（GH）得到了改善。由此推断，由于肝脏胰岛素抵抗（IR）是FL和2型糖尿病（T2DM）的关键因素，那么GH可能会改善T2DM的IR。我们报告了一名17岁非肥胖女性，她患有未经治疗的儿童期起病的生长激素缺乏症（CO-GHD），并发展为2型糖尿病（T2DM）和伴有桥接纤维化的脂肪性肝炎。根据身高z评分-3.1以及7岁时因髓母细胞瘤接受放射治疗的病史，很可能存在生长激素缺乏症。然而，基于完全骨骼成熟，在15岁（当时生长情况令人担忧）时并未开始GH治疗。在她患上T2DM后，生长激素缺乏症得到确诊并开始使用GH。随着GH的开始使用，尽管胰岛素剂量从2.9（约155单位）降至1.9单位/千克/天（约100单位），但她的T2DM并未完全逆转。这说明了未经治疗的CO-GHD的自然病程，并表明尽管GH可以改善肝脏IR，但由于肝脏不可逆的变化（纤维化），T2DM可能无法完全逆转。照顾儿科患者及其他患者的临床医生应该记住，即使在患者停止线性生长之后，GH在葡萄糖和脂质代谢中仍可发挥关键作用。
