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Kojima N, Koriyama N, Tokito A, et al. Growth hormone deficiency with late-onset hypothalamic hypoadrenocorticism associated with respiratory and renal dysfunction: a case report. BMC Endocr Disord. 2020;20(1):50doi: 10.1186/s12902-020-0536-3.
Kojima, N., Koriyama, N., Tokito, A., Ogiso, K., Kusumoto, K., Kubo, S., & Nishio, Y. (2020). Growth hormone deficiency with late-onset hypothalamic hypoadrenocorticism associated with respiratory and renal dysfunction: a case report. BMC endocrine disorders, 20(1), 50. https://doi.org/10.1186/s12902-020-0536-3
Kojima, Nami, et al. "Growth hormone deficiency with late-onset hypothalamic hypoadrenocorticism associated with respiratory and renal dysfunction: a case report." BMC endocrine disorders vol. 20,1 (2020): 50. doi: https://doi.org/10.1186/s12902-020-0536-3
Kojima N, Koriyama N, Tokito A, Ogiso K, Kusumoto K, Kubo S, Nishio Y. Growth hormone deficiency with late-onset hypothalamic hypoadrenocorticism associated with respiratory and renal dysfunction: a case report. BMC Endocr Disord. 2020 Apr 16;20(1):50. doi: 10.1186/s12902-020-0536-3. PMID: 32299407; PMCID: PMC7160895.
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BMC Endocr Disord. 2020 Apr 16;20(1):50. doi: 10.1186/s12902-020-0536-3.

Growth hormone deficiency with late-onset hypothalamic hypoadrenocorticism associated with respiratory and renal dysfunction: a case report.

BMC endocrine disorders

Nami Kojima, Nobuyuki Koriyama, Akinori Tokito, Kazuma Ogiso, Koshi Kusumoto, Satoshi Kubo, Yoshihiko Nishio

Affiliations

  1. Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center, 8-1 Shiroyama-cho, Kagoshima, 892-0853, Japan.
  2. Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
  3. Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center, 8-1 Shiroyama-cho, Kagoshima, 892-0853, Japan. [email protected].

PMID: 32299407 PMCID: PMC7160895 DOI: 10.1186/s12902-020-0536-3

Abstract

BACKGROUND: The prevalence of childhood-onset growth hormone (GH) deficiency (GHD) is estimated to be approximately 1 in 5000 or more, with the cause unknown in most cases (idiopathic isolated GHD). However, additional disorders of secretion of other pituitary hormones reportedly develop over time, with a frequency of 2-94% (median, 16%). Furthermore, median times to development of other anterior pituitary hormone deficiencies have been reported to be 6.4-9.4 years. On the other hand, adult patients affected by childhood-onset GHD reportedly develop impaired ventilation function due to reduced lung volumes and respiratory pressures, probably due to reductions in respiratory muscle strength. In addition, GH is known to play a role in stimulating the glomerular filtration rate (GFR), and the estimated GFR (eGFR) is decreased in patients with GHD.

CASE PRESENTATION: This case involved a 65-year-old woman. Her short stature had been identified at around 3 years of age, but no effective treatments had been provided. The patient was mostly amenorrheic, and hair loss became apparent in her late 30s. She developed hyperuricemia, dyslipidemia, and hypertension at 45 years of age. In addition, the patient was diagnosed with hypothyroidism at 50 years of age. At 58 years of age, endocrinological examination showed impaired secretion of thyroid-stimulating hormone, luteinizing hormone/follicle-stimulating hormone, and growth hormone, and magnetic resonance imaging showed an empty sella turcica. However, secretion ability of adrenocorticotropic hormone was retained. At 63 years of age, respiratory function tests confirmed a markedly restricted ventilation disorder (vital capacity, 0.54 L; percentage predicted vital capacity, 26.9%). Renal function had also decreased (eGFR, 25.0 mL/min/1.73 m

CONCLUSIONS: The rare case of a 65-year-old woman with childhood-onset GHD with panhypopituitarism, including late-onset secondary hypoadrenocorticism in her 60s, associated with severely impaired respiratory function and renal dysfunction, was reported. In GHD patients with risk factors for progression from isolated GHD to combined pituitary hormone deficiency, such as empty sella turcica, lifelong endocrinological monitoring may be important.

Keywords: Childhood-onset growth hormone deficiency (GHD); Empty Sella turcica; Estimated glomerular filtration rate (eGFR); Growth hormone (GH); Late-onset secondary hypoadrenocorticism; Panhypopituitarism; Restricted ventilation disorder

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