Analysis of Craniofacial and Extremity Growth in Patients with Growth Hormone Deficiency during Growth Hormone Therapy

Abstract

Background/Aims: There are many controversies regarding side effects on craniofacial and extremity growth due to growth hormone (GH) treatment. Our aim was to estimate GH action on craniofacial development and extremity growth in GH-deficient patients. Methods: Twenty patients with GH deficiency with a chronological age ranging from 4.6 to 24.3 years (bone age from 1.5 to 13 years) were divided in 2 groups: group 1 (n = 6), naive to GH treatment, and group 2 (n = 14), ongoing GH treatment for 2–11 years. GH doses (0.1–0.15 U/kg/day) were adjusted to maintain insulin-like growth factor 1 and insulin-like growth factor binding protein 3 levels within the normal range. Anthropometric measurements, cephalometric analyses and facial photographs to verify profile and harmony were performed annually for at least 3 years. Results: Two patients with a disharmonious profile due to mandibular growth attained harmony, and none of them developed facial disharmony. Increased hand or foot size (>P97) was observed in 2 female patients and in 4 patients (1 female), respectively, both not correlated with GH treatment duration and increased levels of insulin-like growth factor 1. Conclusions: GH treatment with standard doses in GH-deficient patients can improve the facial profile in retrognathic patients and does not lead to facial disharmony although extremity growth, mainly involving the feet, can occur.

Growth hormone positive effects on craniofacial complex in Turner syndrome

“…Considering GH effects, two year therapy is regarded as longterm therapy (Funatsu, Sato, & Mitani, 2006;Cantu, Buschang, & Gonzalez, 1997), since catch-up growth is substantial during the first years of therapy (Litsas, 2013;de Faria et al, 2009). In order to investigate GH effects when catch-up growth is fully expressed, we have decided to include girls who have received GH for at least two years.…”

“…Nevertheless, it was reported that GH tratment mostly influenced posterior cranial base length (Cantu, Buschang, & Gonzalez, 1997;de Faria et al, 2009). Discrepancy in the results may be due to the fact that these studies have Table 1 Linear and angular measurements of study and control group and p value for independent samples t-test (SD-standard deviation, SE-standard error, *-statistically significant).…”

“…These results could be anticipated since GH therapy was proven to influence mandibular (de Faria et al, 2009), as well as mandibular ramus growth (Funatsu, Sato, & Mitani, 2006;Litsas, 2013) by accelerating cartilage growth (Funatsu, Sato, & Mitani, 2006;Kjellberg & Wikland, 2007). Interestingly, in one study ramus height catch-up growth was not detected (Cantu, Buschang, & Gonzalez, 1997).…”

“…Positive effect on the growth of cranial base (van Erum, Mulier, Carels, Verbeke, & de Zegher, 1997;Cantu, Buschang, & Gonzalez, 1997), maxilla (Funatsu, Sato, & Mitani, 2006) and mandible, especially on ramus height (Funatsu, Sato, & Mitani, 2006;van Erum, Mulier, Carels, Verbeke, & de Zegher, 1997;Forsberg, Krekmanova, & Dahllof, 2002;Kjellberg & Wikland, 2007), as well as on facial heights (van Erum, Mulier, Carels, Verbeke, & de Zegher, 1997;Cantu, Buschang, & Gonzalez, 1997;Kjellberg & Wikland, 2007) have been confirmed. Based on previous evidence, it appears that treatment with GH can partially correct facial profile and occlusion (Funatsu, Sato, & Mitani, 2006;Segal, Pescovitz, Schaefer, & DiMeglio, 2004;de Faria et al, 2009). There are also concerns that long-term GH treatment could cause acromegalic features such as increased foot, hand and mandibular measurements (Carvalho et al, 2003).…”

The effects of testosterone on craniosynostotic calvarial cells: a test of the gene/environmental model of craniofacial anomalies

“…Craniofacial growth, development, and anomalies are influenced by hormonal regulation/dysregulation of the sex steroids (18–22), growth hormones (23–28), and thyroid hormones (29, 30). Environment influences endogenous hormone levels, including absorption via exposure from the environment.…”