BACKGROUND AND OBJECTIVE: Both adult- and childhood-onset @entity2338 adults are prone to @entity2331 . Studies of GH replacement have, for the most part, demonstrated increases in @entity79 ( @entity79 ). Previous studies have, however, used GH doses in excess of those currently used in low-dose titration regimens aimed at normalizing the serum @entity442 level. Furthermore, the effect of GH on the lumbar spine that has been irradiated during treatment of @entity5 is unknown. @entity1 : Thirty-two adult @entity1 with childhood-onset @entity2338 were subdivided according to whether or not they had received spinal irradiation in childhood. The cohort in whom the spine had not been irradiated was comprised of 17 @entity1 (seven male, 10 female), median age 29.8 years (range 20.6--40.8), the median age at primary pathological diagnosis being 9 years (range 4--16). The cohort who received spinal irradiation was composed of 15 @entity1 (seven male, eight female), median age 22.9 years (range 16.5--40.3), with a median age at craniospinal irradiation of 9 years (range 2--16). MEASUREMENTS: At baseline, @entity79 was assessed at the lumbar spine and femoral neck by DXA, and at the ultradistal and distal radius by SXA. The @entity1 were then commenced on GH replacement, titrating the dose at 4--6-weekly intervals to normalize the serum @entity442 level. @entity79 scans were reassessed following at least 1 year of GH replacement therapy. The mean duration of GH therapy was 1.68 plus minus 0.52 years. RESULTS: @entity79 was significantly reduced, compared to the reference data, at all four sites measured in both the spinally irradiated and unirradiated groups. No significant difference was observed between the subgroups with respect to lumbar spine @entity79 (P = 0.64). In the cohort who did not receive spinal irradiation, an increase in @entity79 of 3.5% above baseline was observed at the lumbar spine (P = 0.018), 13/17 @entity1 showing a positive increment in lumbar spine @entity79 . No significant changes in @entity79 were observed at any other site within this cohort, or at any site in the @entity1 who received spinal irradiation. A significantly greater change in lumbar spine @entity79 was observed in the unirradiated spine cohort compared with the spinally irradiated cohort (P = 0.018). No differences in response were demonstrated at the other sites studied between the two subgroups. CONCLUSIONS: We have demonstrated an increase in lumbar spine @entity79 with long-term (mean 1.78 +/- 0.55 years) GH therapy in adults with childhood-onset @entity2338 , who have not received spinal irradiation, when GH was administered by a titration regimen aimed at normalizing the serum @entity442 level. No improvements were observed at the femoral neck, ultradistal or distal radius. @entity1 who had received spinal irradiation during childhood did not present with a reduction in spinal @entity79 in excess of that observed in the nonirradiated cohort. The spinally irradiated group were, however, resistant to the osteo-anabolic effects of GH, which we propose reflects the capacity of radiation-induced damage to suppress the skeletal response.

Spinal irradiation impairs the osteo-anabolic effects of low-dose GH replacement in adults with childhood-onset XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'PATIENTS'] @entity2338 :: ('MESH:D004393', 'Disease') :: ['GH-deficient', 'GH deficiency'] @entity5 :: ('MESH:D009369', 'Disease') :: ['childhood cancer'] @entity442 :: ('3479', 'Gene') :: ['IGF-I'] @entity79 :: ('MESH:D001847', 'Disease') :: ['bone mineral density', 'BMD'] @entity2331 :: ('MESH:D001851', 'Disease') :: ['osteopenia']
@entity2338 :: (MESH:D004393,Disease) :: ['GH deficiency']
