Mann Jake, Caruana Dennis, Luo Evelyn, Gottesman Eric, Agrawal Nidhi, Lozeau Daniel, Hessel Justina, Neumann Melissa, Khanijo Sameer, Hasan Zubair, Rizvi Khizer, Gunther Regina, Donovan Daniel, Chan Derek, Lee-Wong Mary, Szema Anthony M
Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, USA.
Orthopedics, Yale University School of Medicine, New Haven, USA.
Cureus. 2022 Aug 12;14(8):e27920. doi: 10.7759/cureus.27920. eCollection 2022 Aug.
Adult growth hormone (GH) deficiency is rare and requires replacement with extrinsic/synthetic injection. GH hypersensitivity has been reported; specifically, atopic patients may develop rashes from somatotropin therapy. Allergic and non-allergic skin reactions to recombinant human GH are uncommon and infrequently reported. We describe a graded-dose challenge with intravenous Norditropin® in a 65-year-old atopic adult woman who developed a severe whole-body rash with Norditropin FlexPro® administration on several occasions but was negative on skin-prick testing to Norditropin® percutaneously and intradermally, but the patch testing was positive for gold and nickel. The patient was registered as a direct admission to the emergency room at a university hospital for a rapid antigen coronavirus disease 2019 (COVID-19) testing after having received two COVID-19 vaccinations and re-testing four months after vaccination. She was then directly admitted to a non-COVID-19 intensive care unit with direct bedside supervision by a registered nurse and a physician board certified in internal medicine, allergy/immunology, and pulmonary diseases. The patient brought a Norditropin® pen which our pharmacy team attached to a compatible syringe for dilutions. A graded dose challenge at a final dosage of 0.1 mL was performed and the patient was monitored for allergic and other adverse drug reactions, which did not occur. At the time of writing this case report, the patient has been maintained on Norditropin FlexPro® 0.1 mL and has not experienced any adverse reactions, including recurrent skin eruptions. The case presented is the first to describe a patient who successfully tolerated a graded dose challenge of an adult patient to GH replacement therapy (as Norditropin®) under supervision in an intensive care unit, whereas prior to reporting of this case, a graded dose challenge to GH replacement therapy had only been successfully performed in a child using another formulation of somatotropin (Humatrope®). Hence, this case lends support that graded dose challenge with somatotropin analogs may be considered for patients with isolated GH deficiency such as in the case presented here.
成人生长激素（GH）缺乏症较为罕见，需要通过外部/合成注射进行替代治疗。已有生长激素超敏反应的报道；具体而言，特应性患者可能因生长激素治疗而出现皮疹。对重组人生长激素的过敏和非过敏皮肤反应并不常见，相关报道也很少。我们描述了一名65岁的特应性成年女性，她多次在使用诺德人体生长激素（Norditropin FlexPro®）后出现严重的全身性皮疹，但经皮和皮内皮肤点刺试验对诺德人体生长激素（Norditropin®）呈阴性，不过斑贴试验对金和镍呈阳性。该患者在接种两剂2019冠状病毒病（COVID - 19）疫苗后，因快速抗原COVID - 19检测而直接入住大学医院急诊室，并在接种疫苗四个月后再次进行检测。随后，她被直接收治入非COVID - 19重症监护病房，由注册护士和具有内科、过敏/免疫学及肺病专业认证的医生进行直接床边监护。患者带来了一支诺德人体生长激素（Norditropin®）笔，我们的药房团队将其连接到一个兼容的注射器上进行稀释。以0.1 mL的最终剂量进行了分级剂量挑战，并对患者进行了过敏和其他药物不良反应监测，未出现不良反应。在撰写本病例报告时，患者一直使用0.1 mL的诺德人体生长激素（Norditropin FlexPro®），未出现任何不良反应，包括皮疹复发。本病例是首例描述一名成年患者在重症监护病房监护下成功耐受生长激素替代治疗（如诺德人体生长激素（Norditropin®））分级剂量挑战的病例，而在本病例报告之前，生长激素替代治疗的分级剂量挑战仅在一名儿童中使用另一种生长激素制剂（优猛茁（Humatrope®））成功进行过。因此，本病例支持对于孤立性生长激素缺乏症患者，如本病例中的患者，可考虑使用生长激素类似物进行分级剂量挑战。
