الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This prospective case control study was conducted on ٢٣ patients
with GHD and ١٤ healthy matched children serving as a control group. All
subjects were recruited from Endocrinology clinic, Children’s hospital,
Ain Shams University during the period from December ٢٠١٠ till
February ٢٠١٣. Subjects with history of old or current GH replacement
therapy, with previous or current cardiovascular (CVD), respiratory, renal,
gastro-intestinal or other endocrinal disease as well as malnutrition were
excluded from the study.
All subjects were subjected to anthropometric measurements
(height, height SDS, BMI, BMI SDS and growth velocity with its SDS);
and measurement of heart rate, systolic and diastolic blood pressure at the
start of study. In addition, fasting lipid profile, ghrelin and leptin were
measured in all subjects. Also, detailed cardiologic examination was done
by transthoracic echocardiography to all subjects commenting on cardiac
dimensions, mass and thickness by left ventricular diameters in both
systole and diastole, left ventricular wall and septum thickness in diastole
as well as left ventricular mass. Ejection fraction, fractional shortening and
myocardial performance index assessed the systolic function. Both
Doppler imaging and tissue Doppler imaging assessed diastolic function
by measuring isovolumetric relaxation time, waves of early and late
diastolic filling at both mitral and tricuspid annulus. Also the carotid
intima thickness was measured by carotid sonography. Growth hormone
provocation testing by insulin and clonidine was done only for patients
and only at start of study.GHD patients received GH therapy in a dose of ٠٫٢ mg/kg/dose ٦-
٧ days/week, given subcutaneously at night.
All subjects were followed up for one year then all the previously
mentioned data were re-assessed. Four patients were lost to follow up as
well as ٥ controls.
Results are as follows:
o On comparing baseline auxologic criteria in untreated GHD
patients with the control group it was found that their
height SDS was significantly less. The height SDS
increased significantly after one-year treatment with GH in
the patients yet when compared to controls it was still
statistically less.
o Baseline and after one year follow up systolic blood
pressure was found to be significantly higher in patients
than controls, however there was no change in systolic
blood pressure after GH therapy.
o Diastolic blood pressure was not different at baseline or
after one year of GH therapy between the two groups.
o Heart rate was significantly higher in the patients at start of
study while after one-year GH therapy there was no
statistical difference.
o Cardiac LV dimensions, mass index and thickness showed
no difference between the two groups at baseline as well as
after one year follow up. The LV mass, end diastolic and
systolic volume indices as well as posterior wall and septum thickness increased significantly after one year
therapy with GH in the studied patients.
o The untreated GHD patients when compared to controls
showed significant impairment in diastolic functions. The
diastolic functions did not show any difference after one
year follow up between the two groups, yet they improved
significantly in the patients after one year therapy.
o There was no significant difference in systolic functions
either at baseline or after one-year therapy between the two
groups.
o The carotid intima thickness was comparable between the
two groups at both baseline and after one-year therapy. It
was significantly evident that it decreased after one-year
therapy with GH in the studied cases.
o Blood lipids at start of study did not show significant
difference between cases and controls. After GH therapy
for one year, total cholesterol, triglycerides and the
atherogenesis index significantly decreased while HDL
significantly increased.
o Ghrelin levels were comparable between the two groups at
baseline and after one year follow up. Also the cases did
not show any difference in ghrelin levels with or without
treatment with GH.
o Leptin was comparable between controls and treated and
untreated GHD patients.
o GH levels did not correlate with any of the
echocardiographic or laboratory investigations.o Ghrelin in treated GHD patients correlated negatively
with Em/Am denoting that the higher the ghrelin levels the
better the LV diastolic function.
o Leptin in untreated patients correlated positively with
LVEDd suggesting a possible effect of leptin on cardiac
dimensions and myocardial function in patients with GHD.
o Total cholesterol in untreated GHD patients correlated
positively with E’t/A’t meaning that the higher levels of
cholesterol were associated with impaired LV diastolic
functions.
o Also total cholesterol correlated with indices of impaired
systolic function as shown by negative relation with
myocardial performance index.
o HDL in untreated GHD patients correlated negatively
with Em/Am suggesting that it was higher in patients with
better LV diastolic function.
o LDL in untreated patients correlated negatively with A’t
and positively with E’t/A’t, adding to what was evidenced
with other lipids in relation to LV diastolic impairment.