Craniopharyngioma in children: accelerated growth phenomenon after surgery for somatotropic hormone insufficiency

Thirty-two children with craniopharyngiomas aged 3.6 to 18.9 were examined. The patients were divided into 2 groups. Group 1 consisted of 16 children treated conservatively and group 2 of 16 children subjected to radical surgery. No release of growth hormone in response to clonidine stimulation (no more than 4,5 ng/ml) was observed in both groups; growth hormone release in response to administration of growth hormone releasing factor was reliably (p=0.003) higher in group 1 than in group 2 (7.5 ± 3.9 and 2,5 ± 5.1 ng/ml, respectively). At the same time, growth SDS was closer to the norm in group 2 than in group 1 (-1.27 ± 1.3 and - 2.04 ± 1.4, respectively), and growth rate in 8 out of 12 children in group 2, despite growth hormone insufficiency, was 6-12 cm/year. Comparison of the levels of serum prolactin in both groups showed no reliable differences, and the standard glucose tolerance test showed a high basal and stimulated level of insulin secretion in 8 children in group 2 and in 1 girl in group 1. The total, area under the curve representing insulin secretion (ACins) was 3016.0 ± 4288.8 IU/l - min in group 1 and 5378.8 + 4511.2 IU/ 1 • min in group 2, the correlation between ACins and growth SDS being 0.58 and between ACins and body weight index 0.61. Normal or high growth rate was observed in all the children with hyperinsulinism (ACins over 6000 IU/l • min) and in 2 with normal insulin release after surgery, this permitting a conclusion on the principal role of insulin in growth stimulation in the presence of growth hormone insufficiency in these children.

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