Harrison Ballard1, William Fuell1, Reem Elwy1, Xiang-Yang Lou2, Gregory W Albert3,4. 1. Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, AR, USA. 2. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA. 3. Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, AR, USA. GAlbert2@uams.edu. 4. Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA. GAlbert2@uams.edu.
Abstract
PURPOSE: The safety and efficacy of growth hormone replacement therapy (GHRT) on pediatric patients with growth hormone deficiency (GHD) and Chiari I malformation (CIM) are not well investigated within the current body of literature. With no clear indication of the effects of GHRT on CIM disease progression, we sought to determine the effect of GHRT on tonsillar herniation and progression of CIM symptomatology. METHODS: From a previously established database of 465 patients with radiologically confirmed CIM defined as > 5 mm of tonsillar descent on head magnetic resonance imaging (MRI), we identified 20 patients who also had GHD. Using the imaging analysis software package, ANALYZE, the degree of change in tonsillar herniation was documented between initial and final MRI measurements. The radiologic and clinical changes over time were examined via a proportional odds model, Student's t test, Mann-Whitney test, or a mixed model corresponding to the outcomes measured either on an ordinal scale or on a quantitative scale. RESULTS: Incidence of GHD in our CIM population was 4.3%. There was no significant effect of GHRT on the degree of tonsillar herniation in patients with GHD and CIM. No patient became symptomatic, developed syringomyelia, or required surgical intervention for CIM. CONCLUSION: Based on our findings with a larger sample size, along with recent reports, the incidence of patients with CIM and GHD we reported (0.86-5%) is likely more indicative of the actual incidence of GHD and CIM than the prior findings within the literature (9.1-20%). We also suggest that GHRT does not significantly affect CIM morphology or symptomatology. Therefore, neurosurgeons should have no hesitation clearing these patients for GHRT.
PURPOSE: The safety and efficacy of growth hormone replacement therapy (GHRT) on pediatric patients with growth hormone deficiency (GHD) and Chiari I malformation (CIM) are not well investigated within the current body of literature. With no clear indication of the effects of GHRT on CIM disease progression, we sought to determine the effect of GHRT on tonsillar herniation and progression of CIM symptomatology. METHODS: From a previously established database of 465 patients with radiologically confirmed CIM defined as > 5 mm of tonsillar descent on head magnetic resonance imaging (MRI), we identified 20 patients who also had GHD. Using the imaging analysis software package, ANALYZE, the degree of change in tonsillar herniation was documented between initial and final MRI measurements. The radiologic and clinical changes over time were examined via a proportional odds model, Student's t test, Mann-Whitney test, or a mixed model corresponding to the outcomes measured either on an ordinal scale or on a quantitative scale. RESULTS: Incidence of GHD in our CIM population was 4.3%. There was no significant effect of GHRT on the degree of tonsillar herniation in patients with GHD and CIM. No patient became symptomatic, developed syringomyelia, or required surgical intervention for CIM. CONCLUSION: Based on our findings with a larger sample size, along with recent reports, the incidence of patients with CIM and GHD we reported (0.86-5%) is likely more indicative of the actual incidence of GHD and CIM than the prior findings within the literature (9.1-20%). We also suggest that GHRT does not significantly affect CIM morphology or symptomatology. Therefore, neurosurgeons should have no hesitation clearing these patients for GHRT.
Authors: Rushaid N A AlJurayyan; Nasir A M AlJurayyan; Hala G Omer; Sharifah D A Alissa; Hessah M N AlOtaibi; Reem A H AlKhalifah; Amir M I Babiker; Sarar Mohamed Journal: Sudan J Paediatr Date: 2017
Authors: Maria Estela Justamante de Faria; Luciani R Carvalho; Shirley M Rossetto; Terezinha Sampaio Amaral; Karina Berger; Ivo Jorge Prado Arnhold; Berenice Bilharinho Mendonca Journal: Horm Res Date: 2009-02-03
Authors: R Shane Tubbs; Michael J Lyerly; Marios Loukas; Mohammadali M Shoja; W Jerry Oakes Journal: Childs Nerv Syst Date: 2007-07-18 Impact factor: 1.475