Isolated growth hormone deficiency

Last updated
Isolated growth hormone deficiency
Other namesIsolated congenital growth hormone deficiency, Familial isolated growth hormone deficiency. [1]
Somatotropine.GIF
Growth hormone
Specialty Endocrinology

Isolated growth hormone deficiency (IGHD) is a rare congenital disorder characterized by growth hormone deficiency and postnatal growth failure. [2] [3] It is divided into four subtypes that vary in terms of cause and clinical presentation. [2] [3] They include IGHD IA (autosomal recessive, absent GH), IGHD IB (autosomal recessive, diminished GH), IGHD II (autosomal dominant, diminished GH), and IGHD III (X-linked, diminished GH). [2] [3]

Contents

Signs and symptoms

Babies diagnosed with type IA are shorter than average at birth, which is a clear sign of growth failure. [4]

Short stature is a characteristic of type IB, yet this development failure is usually not as severe as in type IA. People with type IB typically exhibit growth failure in their early to mid-childhood years. [4]

Individuals suffering with isolated growth hormone deficiency type II exhibit variable degrees of short height and extremely low growth hormone levels. These people typically exhibit growth failure in their early to mid-childhood years. [4]

Similar to type II isolated growth hormone deficiency, type III is characterized by extremely low growth hormone levels and variable degrees of short height in the affected individuals. Type III growth failure typically manifests in early to mid-childhood. Individuals who have type III may also be more susceptible to infections and have a compromised immune system. [4]

Causes

While the majority of isolated growth hormone deficiency cases are sporadic and assumed to be caused by hypothalamic or pituitary injuries in utero, during or after birth, anatomic abnormalities are discovered in just 12% of such patients who undergo magnetic resonance imaging (MRI). [5]

Many children with isolated growth hormone deficiency are known as having idiopathic growth hormone deficiency or idiopathic isolated growth hormone deficiency since in most cases, there is no known etiology for the condition. [6]

Genetics

Genes encoding growth hormone (GH1) or the growth-hormone-releasing hormone receptor (GHRHR) have been linked to the pathogenesis of isolated growth hormone insufficiency. However, there have not yet been any reports of GHRH mutations. Rarely, heterozygous mutations in SOX3 or HESX13 might cause an isolated growth hormone deficit. [7]

Diagnosis

The diagnosis of growth hormone deficiency is a multi-step procedure that involves pituitary MRI, biochemical testing (growth hormone stimulation tests and measurement of IGF-1/IGFBP3), clinical and auxological examination, and genetic test results. [8]

Classification

Four different forms of familial isolated growth hormone deficiency have been identified: X-linked recessive (type III), autosomal dominant (type II), and autosomal recessive (type IA and IB). [7]

Related Research Articles

<span class="mw-page-title-main">Growth hormone</span> Peptide hormone, that stimulates growth

Growth hormone (GH) or somatotropin, also known as human growth hormone in its human form, is a peptide hormone that stimulates growth, cell reproduction, and cell regeneration in humans and other animals. It is thus important in human development. GH also stimulates production of Insulin-like growth factor 1 (IGF-1) and increases the concentration of glucose and free fatty acids. It is a type of mitogen which is specific only to the receptors on certain types of cells. GH is a 191-amino acid, single-chain polypeptide that is synthesized, stored and secreted by somatotropic cells within the lateral wings of the anterior pituitary gland.

<span class="mw-page-title-main">Gigantism</span> Human growth disorder

Gigantism, also known as giantism, is a condition characterized by excessive growth and height significantly above average. In humans, this condition is caused by over-production of growth hormone in childhood.

<span class="mw-page-title-main">Growth hormone deficiency</span> Medical condition

Growth hormone deficiency (GHD), or human growth hormone deficiency, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also present low blood sugar or a small penis size. In adults there may be decreased muscle mass, high cholesterol levels, or poor bone density.

Growth hormone therapy refers to the use of growth hormone (GH) as a prescription medication—it is one form of hormone therapy. Growth hormone is a peptide hormone secreted by the pituitary gland that stimulates growth and cell reproduction. In the past, growth hormone was extracted from human pituitary glands. Growth hormone is now produced by recombinant DNA technology and is prescribed for a variety of reasons. GH therapy has been a focus of social and ethical controversies for 50 years.

<span class="mw-page-title-main">Insulin-like growth factor 1</span> Protein-coding gene in the species Homo sapiens

Insulin-like growth factor 1 (IGF-1), also called somatomedin C, is a hormone similar in molecular structure to insulin which plays an important role in childhood growth, and has anabolic effects in adults.

Congenital adrenal hyperplasia due to 17α-hydroxylase deficiency is an uncommon form of congenital adrenal hyperplasia (CAH) resulting from a mutation in the gene CYP17A1, which produces the enzyme 17α-hydroxylase. It causes decreased synthesis of cortisol and sex hormones, with resulting increase in mineralocorticoid production. Thus, common symptoms include mild cortisol deficiency, ambiguous genitalia in men or amenorrhea at puberty in women, and hypokalemic hypertension. However, partial (incomplete) deficiency often has inconsistent symptoms between patients, and affected women may be asymptomatic except for infertility.

<span class="mw-page-title-main">Hypopituitarism</span> Medical condition

Hypopituitarism is the decreased (hypo) secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain. If there is decreased secretion of one specific pituitary hormone, the condition is known as selective hypopituitarism. If there is decreased secretion of most or all pituitary hormones, the term panhypopituitarism is used.

<span class="mw-page-title-main">Pituitary adenoma</span> Human disease

Pituitary adenomas are tumors that occur in the pituitary gland. Most pituitary tumors are benign, approximately 35% are invasive and just 0.1% to 0.2% are carcinomas. Pituitary adenomas represent from 10% to 25% of all intracranial neoplasms and the estimated prevalence rate in the general population is approximately 17%.

Kallmann syndrome (KS) is a genetic disorder that prevents a person from starting or fully completing puberty. Kallmann syndrome is a form of a group of conditions termed hypogonadotropic hypogonadism. To distinguish it from other forms of hypogonadotropic hypogonadism, Kallmann syndrome has the additional symptom of a total lack of sense of smell (anosmia) or a reduced sense of smell. If left untreated, people will have poorly defined secondary sexual characteristics, show signs of hypogonadism, almost invariably are infertile and are at increased risk of developing osteoporosis. A range of other physical symptoms affecting the face, hands and skeletal system can also occur.

<span class="mw-page-title-main">Adrenocorticotropic hormone deficiency</span> Medical condition

Adrenocorticotropic hormone deficiency is a rare disorder characterized by secondary adrenal insufficiency with minimal or no cortisol production and normal pituitary hormone secretion apart from ACTH. ACTH deficiency may be congenital or acquired, and its symptoms are clinically similar to those of glucocorticoid deficiency. Symptoms consist of weight loss, diminished appetite, muscle weakness, nausea, vomiting, and hypotension. Low blood sugar and hyponatremia are possible; however, blood potassium levels typically remain normal because affected patients are deficient in glucocorticoids rather than mineralocorticoids because of their intact renin-angiotensin-aldosterone system. ACTH may be undetectable in blood tests, and cortisol is abnormally low. Glucocorticoid replacement therapy is required. With the exception of stressful situations, some patients with mild or nearly asymptomatic disease may not require glucocorticoid replacement therapy. As of 2008 about two hundred cases have been described in the literature.

<span class="mw-page-title-main">Laron syndrome</span> Medical condition

Laron syndrome (LS), also known as growth hormone insensitivity or growth hormone receptor deficiency (GHRD), is an autosomal recessive disorder characterized by a lack of insulin-like growth factor 1 production in response to growth hormone. It is usually caused by inherited growth hormone receptor (GHR) mutations.

<span class="mw-page-title-main">HESX1</span> Protein-coding gene in the species Homo sapiens

Homeobox expressed in ES cells 1, also known as homeobox protein ANF, is a homeobox protein that in humans is encoded by the HESX1 gene.

<span class="mw-page-title-main">Growth-hormone-releasing hormone receptor</span> Receptor protein that binds with somatcrinin

The growth-hormone-releasing hormone receptor (GHRHR) is a G-protein-coupled receptor that binds growth hormone-releasing hormone. The GHRHR activates a Gs protein that causes a cascade of cAMP via adenylate cyclase. GHRHR is distinct from the growth hormone secretagogue receptor, where growth hormone releasing peptides act to release growth hormone.

CJC-1295, also known as DAC:GRF, is a synthetic analogue of growth hormone-releasing hormone (GHRH) and a growth hormone secretagogue (GHS) which was developed by ConjuChem Biotechnologies. It is a modified form of GHRH (1-29) with improved pharmacokinetics, especially in regard to half-life.

<span class="mw-page-title-main">Autoimmune polyendocrine syndrome type 1</span> Autoimmune condition causing dysfunction of endocrine glands

Autoimmune polyendocrine syndrome type 1 (APS-1), is a subtype of autoimmune polyendocrine syndrome. It causes the dysfunction of multiple endocrine glands due to autoimmunity. It is a genetic disorder, inherited in autosomal recessive fashion due to a defect in the AIRE gene , which is located on chromosome 21 and normally confers immune tolerance.

<span class="mw-page-title-main">Isolated 17,20-lyase deficiency</span> Medical condition

Isolated 17,20-lyase deficiency (ILD), also called isolated 17,20-desmolase deficiency, is a rare endocrine and autosomal recessive genetic disorder which is characterized by a complete or partial loss of 17,20-lyase activity and, in turn, impaired production of the androgen and estrogen sex steroids. The condition manifests itself as pseudohermaphroditism in males, in whom it is considered to be a form of intersex, and, in both sexes, as a reduced or absent puberty/lack of development of secondary sexual characteristics, resulting in a somewhat childlike appearance in adulthood.

Gonadotropin-releasing hormone (GnRH) insensitivity also known as Isolated gonadotropin-releasing hormone (GnRH)deficiency (IGD) is a rare autosomal recessive genetic and endocrine syndrome which is characterized by inactivating mutations of the gonadotropin-releasing hormone receptor (GnRHR) and thus an insensitivity of the receptor to gonadotropin-releasing hormone (GnRH), resulting in a partial or complete loss of the ability of the gonads to synthesize the sex hormones. The condition manifests itself as isolated hypogonadotropic hypogonadism (IHH), presenting with symptoms such as delayed, reduced, or absent puberty, low or complete lack of libido, and infertility, and is the predominant cause of IHH when it does not present alongside anosmia.

Hypogonadotropic hypogonadism (HH), is due to problems with either the hypothalamus or pituitary gland affecting the hypothalamic-pituitary-gonadal axis. Hypothalamic disorders result from a deficiency in the release of gonadotropic releasing hormone (GnRH), while pituitary gland disorders are due to a deficiency in the release of gonadotropins from the anterior pituitary. GnRH is the central regulator in reproductive function and sexual development via the HPG axis. GnRH is released by GnRH neurons, which are hypothalamic neuroendocrine cells, into the hypophyseal portal system acting on gonadotrophs in the anterior pituitary. The release of gonadotropins, LH and FSH, act on the gonads for the development and maintenance of proper adult reproductive physiology. LH acts on Leydig cells in the male testes and theca cells in the female. FSH acts on Sertoli cells in the male and follicular cells in the female. Combined this causes the secretion of gonadal sex steroids and the initiation of folliculogenesis and spermatogenesis. The production of sex steroids forms a negative feedback loop acting on both the anterior pituitary and hypothalamus causing a pulsatile secretion of GnRH. GnRH neurons lack sex steroid receptors and mediators such as kisspeptin stimulate GnRH neurons for pulsatile secretion of GnRH.

<span class="mw-page-title-main">Kowarski syndrome</span> Medical condition

Kowarski syndrome describes cases of growth failure, despite the presence of normal or slightly high blood growth hormone by radioimmunoassay (RIA-GH) and low serum IGF1, and who exhibit a significant increase in growth rate following recombinant GH therapy.

<span class="mw-page-title-main">Hypothalamic–pituitary–somatotropic axis</span>

The hypothalamic–pituitary–somatotropic axis, or hypothalamic–pituitary–somatic axis, also known as the hypothalamic–pituitary–growth axis, is a hypothalamic–pituitary axis which includes the secretion of growth hormone from the somatotropes of the pituitary gland into the circulation and the subsequent stimulation of insulin-like growth factor 1 production by GH in tissues such as, namely, the liver. Other hypothalamic–pituitary hormones such as growth hormone-releasing hormone, growth hormone-inhibiting hormone, and ghrelin (GHS) are involved in the control of GH secretion from the pituitary gland. The HPS axis is involved in postnatal human growth. Individuals with growth hormone deficiency or Laron syndrome show symptoms like short stature, dwarfism and obesity, but are also protected from some forms of cancer. Conversely, acromegaly and gigantism are conditions of GH and IGF-1 excess usually due to a pituitary tumor, and are characterized by overgrowth and tall stature.

References

  1. "Monarch Initiative". Monarch Initiative. Retrieved 2024-03-11.
  2. 1 2 3 Ora Hirsch Pescovitz; Erica A. Eugster, eds. (2004). Pediatric Endocrinology: Mechanisms, Manifestations, and Management. Lippincott Williams & Wilkins. pp. 129–. ISBN   978-0-7817-4059-3. OCLC   1055331544.
  3. 1 2 3 Jurado, Pérez; Argente, J. (1994). "Molecular Basis of Familial Growth Hormone Deficiency". Hormone Research. 42 (4–5): 189–197. doi:10.1159/000184192. eISSN   1423-0046. ISSN   0301-0163. PMID   7868072.
  4. 1 2 3 4 "Isolated growth hormone deficiency: MedlinePlus Genetics". MedlinePlus. 2012-02-01. Retrieved 2024-03-11.
  5. Cacciari, E; Zucchini, S; Carla, G; Pirazzoli, P; Cicognani, A; Mandini, M; Busacca, M; Trevisan, C (1990-11-01). "Endocrine function and morphological findings in patients with disorders of the hypothalamo-pituitary area: a study with magnetic resonance". Archives of Disease in Childhood. BMJ. 65 (11): 1199–1202. doi:10.1136/adc.65.11.1199. ISSN   0003-9888. PMC   1792591 . PMID   2248527.
  6. Hernández, Libia M.; Lee, Phillip D. K.; Camacho-Hübner, Cecilia (2007-11-08). "Isolated growth hormone deficiency". Pituitary. 10 (4): 351–357. doi:10.1007/s11102-007-0073-3. ISSN   1386-341X. PMID   17965963. S2CID   21108630.
  7. 1 2 Alatzoglou, Kyriaki S.; Dattani, Mehul T. (2010-09-17). "Genetic causes and treatment of isolated growth hormone deficiency—an update". Nature Reviews Endocrinology. Springer Science and Business Media LLC. 6 (10): 562–576. doi:10.1038/nrendo.2010.147. ISSN   1759-5029. PMID   20852587. S2CID   21806017.
  8. Alatzoglou, Kyriaki S.; Webb, Emma Alice; Le Tissier, Paul; Dattani, Mehul T (2014-06-01). "Isolated Growth Hormone Deficiency (GHD) in Childhood and Adolescence: Recent Advances". Endocrine Reviews. 35 (3): 376–432. doi:10.1210/er.2013-1067. ISSN   0163-769X. PMID   24450934.

Further reading