Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Clin Endocrinol Metab. 2022 Jun 16;107(7):2047-2056. doi: 10.1210/clinem/dgac139.
The trends in hormone indices of children with attention deficit hyperactivity disorder (ADHD) who received long-term medication treatment remains controversial.
This prospective study aimed to examine the changes in the growth hormone and thyroid hormone systems among children with ADHD undergoing various medication treatments.
In total, 118 children who were diagnosed with ADHD and were drug-naive were observed naturalistically over 12 months. Of them, 22 did not receive any medication, while 39, 40, and 17 were treated with low doses of short-acting methylphenidate (MPH) (14 ± 6.7 mg/day), osmotic-release oral system (OROS) long-acting MPH (32 ± 9.6 mg/day), and atomoxetine (29.2 ± 9.7 mg/day), respectively. Blood samples were obtained at both the baseline and the endpoint (month 12) to measure serum levels of insulin-like growth factor 1 (IGF-1), IGF binding protein 3 (IGFBP-3), prolactin, thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and free T4.
Trends for IGF-1, IGFBP-3, prolactin, TSH, T3, T4, and free T4 levels were similar among the 4 groups. Changes in serum levels of IGF-1 were positively correlated with changes in height and weight of all the children with ADHD. However, patients who received MPH treatment had less body weight gain than the nonmedicated group. The ratio of MPH doses to body weight was inversely correlated with the increment in height.
There were no changes in thyroid or growth hormones associated with the low doses of ADHD medications used in this study within 1 year's duration. Nonetheless, patients' growth and the appropriateness of drug dosage should be closely monitored.
接受长期药物治疗的注意缺陷多动障碍（ADHD）儿童的激素指标趋势仍存在争议。
本前瞻性研究旨在观察接受各种药物治疗的 ADHD 儿童生长激素和甲状腺激素系统的变化。
共有 118 名初诊为 ADHD 且未接受药物治疗的儿童接受了为期 12 个月的自然观察。其中 22 名未接受任何药物治疗，39 名、40 名和 17 名分别接受低剂量短效哌甲酯（MPH）（14±6.7mg/天）、渗透型控释口服系统（OROS）长效 MPH（32±9.6mg/天）和托莫西汀（29.2±9.7mg/天）治疗。在基线和终点（第 12 个月）采集血样，以测量血清胰岛素样生长因子 1（IGF-1）、IGF 结合蛋白 3（IGFBP-3）、催乳素、促甲状腺激素（TSH）、三碘甲状腺原氨酸（T3）、甲状腺素（T4）和游离 T4 水平。
4 组间 IGF-1、IGFBP-3、催乳素、TSH、T3、T4 和游离 T4 水平的趋势相似。所有 ADHD 儿童的 IGF-1 血清水平变化与身高和体重变化呈正相关。然而，接受 MPH 治疗的患者体重增加少于未用药组。MPH 剂量与体重的比值与身高的增量呈反比。
在 1 年内，本研究中使用的低剂量 ADHD 药物未引起甲状腺或生长激素的变化。尽管如此，仍应密切监测患者的生长和药物剂量的适当性。
