Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- baixa estatura
- velocidade de crescimento deficitária
- baixo para a altura-alvo
- ausência do estirão de crescimento puberal e/ou puberdade tardia
- sintomas de tumor no sistema nervoso central (suprasselar)
- sintomas de outras disfunções hormonais hipofisárias
- aparência facial característica
Outros fatores diagnósticos
- parto instrumental
- comprometimento visual
- características dismórficas associadas
- deficits neurológicos focais
- hiperfagia/obesidade
- temperatura desregulada/distúrbio do sono
- problemas comportamentais
Fatores de risco
- história familiar de DGH
- outras deficiências hormonais hipofisárias
- tumores/cistos do sistema nervoso central (SNC)
- radioterapia
- anomalias na linha média
- doenças infiltrativas do SNC
- complicações perinatais
- trauma do SNC
- distúrbio de sobrecarga de ferro preexistente
- abuso infantil
- infecções do SNC
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- radiografia de punho
- testes da função tireoidiana
- fator de crescimento semelhante à insulina-1 (IGF-1) e proteína 3 de ligação ao IGF (IGFBP3)
- testes da função hipofisária basais
- perfil básico de hematologia e bioquímica
Investigações a serem consideradas
- teste de provocação de hormônio do crescimento (GH)
- ressonância nuclear magnética (RNM) cranioencefálica
- tomografia computadorizada (TC) cranioencefálica/radiografia do crânio
- avaliação hormonal hipofisária completa
- encaminhamento a especialista
- estudos genéticos
- hormônio do crescimento (GH) aleatório
Algoritmo de tratamento
deficiência de hormônio do crescimento (GH) confirmada
Colaboradores
Autores
Hoong-Wei Gan, BMedSci (Hons), BMBS, MSc, PhD, MRCPCH
Consultant Paediatric Endocrinologist
Great Ormond Street Hospital for Children NHS Foundation Trust
London
UK
Declarações
HWG has received educational grants and had travel expenses and hospitality paid for by Ipsen and Novo Nordisk for international meetings. He has received lecture fees from Ipsen. HWG is Deputy Chair of the UK National Paediatric Craniopharyngioma Guideline Development Group and is an author of references cited in this topic.
Harshini Katugampola, BSc, MBBS, MSc, PhD, MRCPCH
Consultant Paediatric Endocrinologist
Great Ormond Street Hospital for Children NHS Foundation Trust
London
UK
Declarações
HK is an author of references cited in this topic.
Agradecimentos
Dr Hoong-Wei Gan and Dr Harshini Katugampola would like to gratefully acknowledge Dr Ameeta Mehta, Professor Mehul T. Dattani, and Dr Kyriaki S. Alatzoglou, previous contributors to this topic.
Declarações
AM is an author of references cited in this topic. MTD received lecture fees from Novo Nordisk, Pfizer, and Ipsen; consultancy fees from Novo Nordisk, Pfizer, Ipsen, and Sandoz; and was a member of a Novo Nordisk advisory board. Novo Nordisk, Pfizer, Ferring, Ipsen, Lilly, Merck, and Serono have made financial contributions to MTD's departmental teaching programme. MTD declared that none of these activities are related to this topic. MTD is an author of references cited in this topic. KSA is an author of references cited in this topic.
Revisores
Martin Savage, MA, MD, FRCP, MRCPCH
Professor of Paediatric Endocrinology (Emeritus)
Department of Endocrinology
William Harvey Research Institute
St Bartholomew's and the Royal London School of Medicine and Dentistry
John Vane Science Centre
London
UK
Declarações
MS has received honoraria and consultancy payments from Ipsen, Pfizer, Novo Nordisk, and Merck Serono.
Paul Saenger, MD, MACE
Professor of Pediatrics
Department of Pediatrics (Endocrinology)
Montefiore Medical Center
Albert Einstein College of Medicine
New York
NY
Declarações
PS declares that he has no competing interests.
Referências
Principais artigos
Mehta A, Dattani MT. Congenital disorders of the hypothalamic-pituitary axis. In: Brook CG, Clayton PE, Brown RS, et al., eds. Clinical pediatric endocrinology. 5th ed. Oxford, United Kingdom: Blackwell Publishing; 2005:62-89.
Hage C, Gan HW, Ibba A, et al. Advances in differential diagnosis and management of growth hormone deficiency in children. Nat Rev Endocrinol. 2021 Oct;17(10):608-24. Resumo
Grimberg A, DiVall SA, Polychronakos C, et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency. Horm Res Paediatr. 2016;86(6):361-97.Texto completo Resumo
Sklar CA, Antal Z, Chemaitilly W, et al. Hypothalamic-pituitary and growth disorders in survivors of childhood cancer: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 Aug 1;103(8):2761-84.Texto completo Resumo
Segal TY, Mehta A, Anazodo A, et al. Role of gonadotropin-releasing hormone and human chorionic gonadotropin stimulation tests in differentiating patients with hypogonadotropic hypogonadism from those with constitutional delay of growth and puberty. J Clin Endocrinol Metab. 2009 Mar;94(3):780-5. Resumo
Dattani M, Preece M. Growth hormone deficiency and related disorders: insights into causation, diagnosis, and treatment. Lancet. 2004 Jun 12;363(9425):1977-87. Resumo
Ho KK, 2007 GH Deficiency Consensus Workshop Participants. Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol. 2007 Dec;157(6):695-700.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Baixa estatura idiopática
- Atraso constitucional no crescimento
- Baixa estatura familiar
Mais Diagnósticos diferenciaisDiretrizes
- Guidelines for management of growth hormone deficiency in adults and patients transitioning from pediatric to adult care
- Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency
Mais DiretrizesFolhetos informativos para os pacientes
Diabetes do tipo 2: devo tomar insulina?
Diabetes do tipo 2: quais tratamentos funcionam?
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal