University Children's Hospital, Pediatric Endocrinology, Hoppe-Seyler-Strasse 1, 72076 Tübingen, Germany.
Hasbro Children's Hospital Department of Pediatrics, Providence, RI, United States of America.
Bone. 2021 Jan;142:115771. doi: 10.1016/j.bone.2020.115771. Epub 2020 Nov 24.
Severe growth hormone deficiency causes lean body mass loss in male adolescents and increased fat mass in both sexes. The changes appear after a 6 month GH pause.
The aim was to examine bone density and structure changes in adolescents with severe GHD during a 6-month rhGH treatment interruption.
In total, 113 adolescents (20 females) paused rhGH treatment for 6 months at near-final height, and they were retested with arginine-GHRH challenge and basal IGF-1. Severe GHD was diagnosed in 19 individuals (5 females, GH peak <16 ng/ml and IGF-1 < -1.9 SDS) and excluded in 94 (15 females). Bone density and structure were measured by pQCT of the forearm and DXA of the total body at cessation of rhGH and 6 months later.
In severe adolescent GHD (sGHD) patients, trabecular density (mg/cm) decreased from 214 to 202 (p < 0.01); changes in the adolescents with normal test results (tGHD) were from 221 to 214 (p < 0.05). Cortical density (mg/cm) increased from 1077 to 1099 (p < 0.01) in sGHD patients and from 1060 to 1082 in tGHD patients (p < 0.001). The strength strain index (mm) showed no significant changes in sGHD patients (306 to 307) but changed from 302 to 315 in tGHD patients (p < 0.05). Total bone area (mm) shifted from 145.1 to 145.2 in sGHD patients and from 153 to 156 in tGHD patients. Total body aBMD (g/cm) increased in both groups: from 1.10 to 1.12 in sGHD patients and from 1.11 to 1.14 in tGHD patients (p < 0.01). All bone measurements remained within the reference ranges, and there were no differences between sGHD and tGHD patients.
During a 6-month pause of rhGH treatment, the bone structure and density of adolescents with sGHD did not show changes implying harm. Routine retesting of adolescents, including 6 months without GH, is unlikely to be detrimental to the bone.
严重生长激素缺乏症会导致男性青少年瘦体重减少，两性脂肪量增加。这些变化在 GH 暂停 6 个月后出现。
检查严重生长激素缺乏症青少年在 rhGH 治疗中断 6 个月期间骨密度和结构的变化。
共有 113 名青少年（20 名女性）在接近最终身高时暂停 rhGH 治疗 6 个月，并接受精氨酸-GHRH 挑战和基础 IGF-1 检测。19 名患者（5 名女性，GH 峰值<16ng/ml 和 IGF-1<-1.9 SDS）被诊断为严重生长激素缺乏症（sGHD），94 名患者（15 名女性）被排除在外。rhGH 治疗停止时和 6 个月后，采用前臂 pQCT 和全身 DXA 测量骨密度和结构。
在严重青少年生长激素缺乏症（sGHD）患者中，小梁密度（mg/cm）从 214 降至 202（p<0.01）；正常检测结果（tGHD）的青少年从 221 降至 214（p<0.05）。sGHD 患者的皮质密度（mg/cm）从 1077 增至 1099（p<0.01），tGHD 患者从 1060 增至 1082（p<0.001）。sGHD 患者的骨强度应变指数（mm）无明显变化（306 至 307），而 tGHD 患者则从 302 增至 315（p<0.05）。sGHD 患者的总骨面积（mm）从 145.1 变为 145.2，而 tGHD 患者从 153 变为 156。两组全身 aBMD（g/cm）均增加：sGHD 患者从 1.10 增至 1.12，tGHD 患者从 1.11 增至 1.14（p<0.01）。所有骨测量值仍在参考范围内，sGHD 和 tGHD 患者之间无差异。
在 rhGH 治疗暂停 6 个月期间，sGHD 青少年的骨结构和密度未发生变化，表明无损害。对青少年进行常规复查，包括 6 个月无 GH，不太可能对骨骼造成损害。
