??????? Growth Hormone Deficiency,GHD

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???????Growth Hormone Deficiency,GHD
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???(dwarfism)?????(Short stature)

• ??(definition)
• ????????????????????????????-2SD??3???

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??????????????
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Etiology of dwarfism

• ??????????
• ??????
• ????????????
• ???????,???????
• ????????
• ????????????????
• ?????GHD?Hypothyrodism?Sexual
  precocity?Cushing Disease

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Synthesis, secretion and action of GH

• ???????????
• 191 amino acid ,22KD(80),20KD
• ????17q22-24,5 ????,4???
• ???50hGH??GHBP??
• GH?????
• GHRH(44 amino acid)?GHIH(somatostatin)??
• Insulin-like growth factor-1(IGF-1)?IGF-BP3
• Act for growth and metabolism

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Growth hormone deficiency(GHD)

• Etiology
• idiopathic or primarily ??????????
• ??,?GH??????
• Congenital GHD
• GH-1 gene(Single GHD)
• Pit-I????????(combined pituitary hormal
  def.)
• Laron???GH receptor def.
• Pygmy IGF receptor def.
• disorders of GH neurosecretion (GHND)

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• Organic(acquire)
• ?????????????
• ????????????
• ????
• ????,????
• ???-??????
• Transient
• ????????
• ?????????
• ?????????

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• Clinic manifestation
• Growth retardation2?????,????lt4cm/y, ????-2SD
  ??31
• ???????????
• ?????????????????
• ????
• ??????,??????
• ?????????????????????????
• ????????????

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GHD?? CA11.5y HA 4.0y BA 3.0y
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Laboratory diagnosis

• GH provocative test
• L-dopa10mg/kg p.o
• Clonidine4ug/kg p.o
• Arginine0.5g/kg iv
• Insulin0.05-0.1U/kg iv
• ?????30?60?90min???GH
• ??????????GH peak
• lt10?g/L?GHD

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• IGF-I?IGFBP3??
• 24hGH?????GHND??
• GHRH????
• ????????????GHD
• ???????(????)
• ?????ACTH??????????? ??????????

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• Imaging examination
• ??????????
• ????????????????
• ??????MRI???????
• ????
• ??????????Turners

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Diagnosis Procedure of GHD

• ??lt-2SD
• ?????
  ????
• ???????
  ???????(??)
• ???(??)
  ????
• ???????? GH????
  ?????
• ?Turner??? GH?? GH??
• 
  IGF-1?? GH???
• ??
  ?? GHRH????
• ????????? IGF??? GH?? GH??
• 
  ???GHD ???GHD

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• Diagnosis of GHD
• ??????????????-2SD
• ??????lt4cm/y
• ????????????,????
• ?????????????
• ????????2???
• ????GH????,GH???lt10µg/L
• ??MRI????????

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• Treatment of hGH
• ??0.1u/kg/d,??1hr????
• ??????????
• ?? 3???????
• ??????????,????12-16cm,??????,?8-9cm
• GHRH, GHRP, sex hormone

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GHD??GH??1??,??????,????
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. Side effect of GH treatment

• ???????????
• ????? (T4) ??
• ?????????
• ???????????
• ????????????????

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Note of GHD treatment

• GHD???????
• ???????????????
• ?????GHD???????
• ????????????
• ??????????????????