Acquired somatotropic deficiency in adults: diagnosis and treatment

Abstract

Background. Metabolic disorders due to somatotropic insufficiency in adults can cause serious complications such as the development of atherosclerosis, osteopenia and osteoporosis, significant deterioration of the quality in patients’ life. Treatment of growth hormone deficiency in adults improves the quality and prognosis of patients’ life, however, long-term studies of the effectiveness of treatment with recombinant growth hormone drugs in adult patients with somatotropic insufficiency are isolated and relate to a small number of subjects, so their implementation is relevant. at the same time, longterm studies of the efficacy of therapy with recombinant growth hormone preparations in adult patients with growth hormone deficiency are single and concern a small number of surveyed, so their implementation is relevant. The aim is to determine a diagnostic criteria for acquired somatotropic insufficiency (ASI) in adult patients, and to study of the effectiveness and safety of their treatment with recombinant growth hormone (rGH) drugs. Material and methods. A comprehensive examination of 20 patients (13 women and 7 men), who were diagnosed with multiple hormone deficiency of the adenohypophysis with acquired GH deficiency, was carried out. The age of the examined persons ranged from 20 to 63 years, with the duration of the disease from 3 to 25 years. In 10 patients (50%), the manifestations of the disease were found in childhood (in 6 of them the disease developed as a result of removal of a pituitary tumor, in 1 — as a result of rupture of the pituitary gland during childbirth, in 3 — syndrome of an empty Turkish saddle with hypoplasia of the pituitary tissue). Thus,
these patients had organic somatotropic insufficiency resulting from intracranial lesion of the pituitary gland. These patients were treated with rGH in childhood and, upon transition into adulthood, they were retested to confirm the presence of GH deficiency. In the other 10 patients (50%) acquired GH deficiency occurred in adulthood after surgery for removing pituitary tumors. All patients were received stable replacement therapy for adenohypophysis hormone deficiency and at the time of verification of acquired GH deficiency were compensated. Conducted dual-photon osteodensitometry, determination of
anthropometric, hormonal and biochemical parameters. The levels of GH (basal and during the stimulation test with insulin), osteocalcin, insulin-like factor 1 (IGF‑1) and the concentration of IGF-binding protein 3 (IGF-BP‑3) in the blood were determined by radioimmunoassay. Treatment was carried out using rGH drugs at an average daily dose of 0.2 to 0.6 mg/day. The efficacy, tolerance and safety of treatment were assessed after 1, 3, 6, 12 months, and indicators were compared with data before treatment. Results. The diagnosis of GH deficiency was confirmed in patients with low levels of GH (basal and during a stimulation
test with insulin). The IGF‑1 level before treatment was low (the standard deviation was on average –4.36. Treatment was effective in all patients. Skin changes, inflammation, or allergic reactions at the injection site were not observed. No somatic disorders or concomitant diseases were identified during treatment. According to the results of the questionnaire survey, a significant improvement in well-being, decreased signs of anxiety, an increase in activity and physical endurance were noted in all patients. There was a significant dynamics of anthropometric parameters in the course of treatment: body mass, waist, hips were decreased. The central and peripheral skin fold thickness indices decreased by 2.5 times. An increase in linear growth was noted in 4 patients with GH deficiency, detected in childhood, and open bone growth zones. The levels of IGF‑1 and IGF-BP‑3 increased by 3 times after 3, 6, 9 and 12 months of treatment. The blood cholesterol level, elevated before treatment (on average, 7.05±1.30 mmol/L) was decreased in the dynamics of treatment and after 12 months was
3.84±0.90 mmol/L (p<0.05). The blood osteocalcin index increased from 17.60±0.02 ng/mL to 35.30±0.10 ng/mL (p<0.05), reflecting an improvement in the processes of osteosynthesis and was accompanied by improvement in the osteodensitometry parameters during 12 months of treatment. Conclusions. 1. Acquired somatotropic insufficiency in adult patients most often is developed as a result of tumor processes in the hypothalamic-pituitary region, neurosurgical interventions, brain trauma. Monitoring of the somatotropic function of the pituitary gland is a necessary component of diagnostic procedures, requires timely diagnosis and treatment. 2. The levels of IGF‑1 and IGF-BP‑3 in patients significantly (p<0.05) increased during treatment with GH, which makes it possible to use them to assess the effectiveness of such therapy. Treatment of acquired somatotropic insufficiency in adult patients is effective, safe, leads to a significant improvement in metabolic processes and quality of life, however, it mustbe long-term.