Tao Tong MD, Caiyan Mo MD, Hongyu Liu MD, Yao Wang MD, Dan Liang MD, Ying Guo MD, Jian Xu MD, Liyong Zhong MD
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引用次数: 0
Abstract
Objective
Sellar germ cell tumors (GCTs) commonly cause growth hormone deficiency (GHD) and impaired growth in children. A subset of patients maintains near-normal growth despite GHD, a phenomenon termed growth without growth hormone (GWGH), with unclear mechanisms. This study aimed to characterize the clinical features and predictors of GWGH in pediatric sellar GCTs.
Methods
Patients with sellar GCTs and GHD presenting to our hospital between July 2021 and December 2024, with hypogonadotropic hypogonadism or prepubertal status, were included. Patients with annual growth ≥5 cm were classified as GWGH, and a 1:2 age- and sex-matched non-GWGH group served as controls. Clinical characteristics, pituitary dysfunction, hormone replacement therapy, hypothalamic syndrome manifestations, and fasting insulin levels were compared. Logistic regression identified independent predictors of GWGH.
Results
Among 130 patients, 15 (11.5%) exhibited GWGH. GWGH patients had more obesity, larger tumors, greater hypothalamic involvement, and more hypothalamic syndrome components. Pituitary dysfunction and hormone replacement therapy did not differ significantly between groups. Fasting insulin was significantly higher in the GWGH group than in controls (22.58 ± 8.76 vs 7.41 ± 4.38 μIU/mL, P < .001). Multivariate logistic regression identified fasting insulin as an independent predictor of GWGH (odds ratio [OR], 1.61; 95% CI, 1.14-2.25; P = .006).
Conclusion
GWGH occurs in 11.5% of children with sellar GCTs and GHD and is associated with hypothalamic involvement, obesity, and hyperinsulinemia. Elevated fasting insulin may partly explain GWGH, but prospective studies are needed to clarify the underlying mechanisms.
目的：鞍生殖细胞瘤（gct）是儿童生长激素缺乏（GHD）和生长障碍的常见病因。尽管有GHD，但仍有一部分患者保持接近正常的生长，这种现象称为无生长激素生长（GWGH），机制尚不清楚。本研究旨在探讨小儿鞍区gct中GWGH的临床特征和预测因素。方法：纳入2021年7月至2024年12月在我院就诊的伴有促性腺功能减退或青春期前状态的鞍型gct和GHD患者。年生长≥5cm的患者被归类为GWGH， 1:2年龄和性别匹配的非GWGH组作为对照。比较临床特征、垂体功能障碍、激素替代治疗、下丘脑综合征表现和空腹胰岛素水平。Logistic回归确定了GWGH的独立预测因子。结果：130例患者中有15例（11.5%）出现GWGH。GWGH患者有更多的肥胖、更大的肿瘤、更大的下丘脑受累，以及更多的下丘脑综合征成分。垂体功能障碍和激素替代治疗组间无显著差异。GWGH组空腹胰岛素显著高于对照组（22.58±8.76 vs 7.41±4.38 μIU/mL, p < 0.001）。多因素logistic回归发现空腹胰岛素是GWGH的独立预测因子（OR = 1.61, 95% CI 1.14-2.25, p = 0.006）。结论：GWGH发生在11.5%的鞍区gct和GHD患儿中，并与下丘脑受累、肥胖和高胰岛素血症相关。空腹胰岛素升高可能部分解释了GWGH，但需要前瞻性研究来阐明潜在的机制。
期刊介绍：
Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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