Study On The Relationship Between The Development Of Pituitary And The Treatment Of Recombinant Human Growth Hormone In Children With Growth Hormone Deficiency

Objective: To investigate the relationship between pituitary development and growth hormone secretion in children with growth hormone deficiency(GHD),and to analyze the efficacy of recombinant human growth hormone(rh GH)in the treatment of children with growth hormone deficiency.In order to improve the survival and quality of life of children.Methods: We randomly selected 40 children with growth hormone deficiency(GHD)who were admitted to Qingdao Women and Children’s Hospital from January 2015 to August 2017.Among them,6 cases[M 2,F 4,age(11.79 ±3.67)years] showed pituitary enlargement(excluding tumors)by pituitary magnetic resonance imaging.There were 18 cases[M 10,F 8,age(7.87 ±2.65)years] of pituitary dysplasia and16 cases [M 8,F 8,age(9.68 ±2.65)years] of normal pituitary size.Growth hormone secretion was measured by intravenous injection of insulin and oral clonidine.The growth hormone secretion status of GHD children under different pituitary development was analyzed.After diagnosis,all children were given hypodermic injection of recombinant human growth hormone at a dose of0.10-0.15 U /(kg.d)before bedtime.Among them,patients with hypothyroidism were treated with levothyroxine tablets for 3 months,and rh GH treatment began after thyroid function returned to normal.The children were followed up once every 3 months,and the changes of Height,weight,second sexual characteristics,the blood and urine routine,liver enzymes,thyroid function,blood glucose,Insulin-like growth factor-1 and insulin-like growth factor binding protein-3 were monitered.Bone age was taken every 6 months.After 1 year of treatment,the height change,annual growth rate(GV),height standard deviation score(Ht SDS),body mass index(BMI)of GHD children with different pituitary development were evaluated,the changes of body mass index standard deviation scores(BMISDS),the difference of bone age(BA),and the adverse reactions were observed.Results:1.There was a significant difference in the peak of GH stimulation test between GHD children with different pituitary development status(F=14.62,P<0.01).The peak value of GH in pituitary enlargement group and pituitary dysplasia group was significantly lower than that in normal pituitary size group.There was no significant difference between pituitary enlargement group andpituitary dysplasia group(P =0.061).There was a significant positive correlation between pituitary height and peak value of GH in non-pituitary enlargement patients with GHD(r=0.67,P< 0.01).In pituitary enlargement group,GHD children were more complicated with hypothyroidism,accounting for 66.7%.2.There was significant difference in GV and ΔHt SDS between GHD children with different pituitary development status after rh GH treatment(F = 20.619,P <0.01,F = 10.537,P < 0.01).The GV,ΔHt SDS of pituitary enlargement group and pituitary dysplasia group was higher than that of normal pituitary size group.There was no significant difference in GV,ΔHt SDS between pituitary enlargement group and pituitary dysplasia group.There was no correlation between pituitary height and GV,ΔHt SDS in the first year of rh GH treatment in non-pituitary enlargement group and pituitary enlargement group.3.In the first year of rh GH treatment,the GV,ΔHt SDS of children with bone age less than 10 years old was significantly faster than that of those with bone age greater than 10 years old.There was a significant correlation between the age of treatment and GV and Δ Ht SDS in children with GHD(r =-0.42,P < 0.01 r =-0.72,P <0.01).4.In the first year of rh GH treatment,the BMI of the pituitary enlargement group and the pituitary dysplasia group decreased significantly,the normal pituitary size group was higher than before treatment,and there was no statistical difference between the three groups.The difference of the ratio of increased value of bone age to increased value of age among the three groups was not statistically significant.The advanced bone age is not observed;after the treatment with rh GH the subclinical hypothyroidism adverse reactions such as redness and swelling of skin at the site of local injection is rare.Conclusion:1.The peak of GH stimulation test in GHD patients with pituitary hyperplasia and pituitary dysplasia was significantly lower than that in GHD patients with normal pituitary size.There was a significant positive correlation between pituitary height and peak value of GH in children with non-pituitary hyperplasia of GHD.2.Rh GH can significantly promote the height of GHD children with different pituitary development,and the therapeutic effect of rh GH on GHD children with pituitary hyperplasia and pituitary dysplasia is better than that in normal pituitary development children.3.The effect of rh GH in GHD children with younger bone age at the beginning of treatment was better than that of older children.