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Acta Pædiatrica ISSN 0803-5253

REGULAR ARTICLE
Characteristics of ir!s "ith #it$itar% h%#er#!asia a&d se'$a! #recocit%
seco&dar% to #ri(ar% h%#oth%roidis(
)a&-)a& *$
+
, G$i--ei Li .!($sa05/(ai!0co(1
+
, 2e&-2e& *$
2
, )i 2a&
+
+03e#art(e&t of Pediatrics, Pro4i&cia! *os#ita! Affi!iated to Sha&do& U&i4ersit%, 5i&a&, Chi&a
203e#art(e&t of Pediatrics, The Peo#!e6s *os#ita! of La&sha& 3istrict, Li&%i, Chi&a
7e%"ords
Pit$itar% h%#er#!asia, Pri(ar% h%#oth%roidis(, Se'$a! #recocit%
Corres#o&de&ce
G$i--ei Li, -3, 3e#art(e&t of Pediatrics, Pro4i&cia! *os#ita! Affi!iated to Sha&do&
U&i4ersit%, 89::, 5i&shi Road, 5i&a& 25002+, Chi&a0
Te!; <89 +30 3+:+ 9889 =
>a'; <89 53+ 8:09 8:0: = E(ai!; !($sa05/(ai!0co(
Recei4ed
2+ -a% 20+3? re4ised 25 5$!% 20+3? acce#ted 30 Se#te(@er 20+30
3AI;+00++++Ba#a0+2CCC
ADSTRACT
Ai(; To i&4estiate
the differe&t
characteristics of
ir!s "ith #it$itar%
h%#er#!asia
seco&dar% to
#ri(ar%
h%#oth%roidis(
.PP*1, "ith a&d
"itho$t se'$a!
#recocit%0
-ethods; Pit$itar%
h%#er#!asia
seco&dar% to
#ri(ar%
h%#oth%roidis( ir!s
"ere di4ided i&to
t"o ro$#s; ro$#
A, "ith se'$a!
#recocit% .& = 81,
a&d ro$# D,
"itho$t se'$a!
#recocit% .& = +C10
The fo!!o"i&
4a!$es "ere
(eas$red @efore a&d
after 3 (o&ths
!e4oth%ro'i&e thera#%; free triiodoth%ro&i&e
.>T
3
1, free th%ro'i&e .>T
C
1, th%rotro#i& .TS*1,
fo!!ic!e-sti($!ati& hor(o&e .>S*1, !$tei&isi&
hor(o&e .L*1, #ro!acti& .PRL1, estradio! .E
2
1,
testostero&e .T1, #it$itar% heiht, $teri&e
4o!$(e .UE1, o4aria& 4o!$(e .AE1 a&d
fo!!ic$!ar dia(eter .>310
Res$!ts; Th%rotro#i&, >S*, PRL, E
2
, T,
#it$itar% heiht, UE, AE a&d >3 "ere hiher i&
ro$# A tha& ro$# D .a!! # < 00051? >T
3
, >T
C
a&d L* !e4e!s "ere &ot differe&t .a!! # > 000510
I& a!! of the PP* ir!s, #it$itar% heiht "as
corre!ated "ith >T
3
, >T
C
a&d PRL .r = 005C5,
# = 00008, r = 0059:, # = 00009 a&d r =
00999, # = 0000+, res#ecti4e!%10 PRL "as
#ositi4e!% corre!ated "ith UE, >3 a&d >S*
.r = 0058+, # = 00005, r = 00C82, # = 0003+
a&d r = 0099:, # = 0000+, res#ecti4e!%1, a&d
>S* "as #ositi4e!% corre!ated "ith AE
.r = 00522, # = 000+310 These a@&or(a!ities
reressed after thera#%0
Co&c!$sio&; Pit$itar% h%#er#!asia
seco&dar% to #ri(ar% h%#oth%roidis( ir!s
"ith se'$a! #recocit% ha4e i&creased #!as(a
TS*, >S*, PRL, E
2
a&d T !e4e!s, #it$itar%
heiht a&d $teri&e, o4aria& a&d fo!!ic$!ar
siFe0
INTRA3UCTIAN
Se'$a! #recocit% seco&dar% to #ri(ar%
h%#oth%roidis( i& ir!s is characterised @%
@reast de4e!o#(e&t, 4ai&a! @!eed-i&,
a!actorrhoea, a@se&ce of #$@ic hair a&d
de!a%ed @o&e ae a&d is acco(#a&ied @%
($!tic%stic o4aries0 The co(-@i&atio& of
#ri(ar% h%#oth%roidis(, se'$a! #recocit% a&d
($!tic%stic o4aries "as first descri@ed @% Ea&
2%G a&d Gr$(@ach i& +890 .+10 Si&ce the&,
s#oradic cases ha4e @ee& re#orted i& the
!iterat$re .2,310 Patie&ts "ith Ea& 2%G a&d
Gr$(@ach s%&dro(e ca& #rese&t "ith
#it$itar% h%#er-#!asia i& t%#ica! cases .C,510
These c!i&ica! fi&di&s ca& @e re4ersed @% the
ad(i&istratio& of th%roid hor(o&es0 Pri(ar%
h%#oth%roidis( sho$!d @e reco&ised as the
ca$se of the s%&dro(e ear!% to e!i(i&ate
$&&ecessar% s$rer%0 >e" st$dies ha4e
i&4estiated characteristics of #it$itar%
h%#er#!asia a&d se'$a! #recocit% seco&dar% to
#ri(ar%
h%#oth%roid
is( i& a
cohort of
ir!s0
2hether
ir!s "ith
#it$itar%
h%#er#!asia
seco&dar%
to #ri(ar%
h%#oth%roid
is( .PP*1,
"ho ha4e
se'$a!
#recocit%,
dis#!a%
differe&t
char-
acteristics
to those
"ho do &ot
ha4e se'$a!
#recocit% is
$&G&o"&0 Therefore, the
#$r#ose of this st$d% "as to
i&4estiate differe&ces i&
hor(o&a! !e4e!s, #it$itar%
heiht
a&d o&ada! siFe
@et"ee& PP* ir!s
"ith a&d "itho$t
se'$a! #recocit%0
Cha&es i&
hor(o&a! a&d
i(ai& #ara(-eters
@efore a&d after
th%roid hor(o&e
re#!ace(e&t thera#%
"ere a!so e4a!$ated0
SUD5ECTS AN3
-ET*A3S
Study subjects
A retros#ecti4e
st$d% of ir!s "ith
se4ere #ri(ar%
h%#oth%-roidis(
"as #erfor(ed
@et"ee& 2008 a&d
20+2 at the
7e% &otes
The differe&t
characteristics
of ir!s "ith
#it$itar%
h%#er#!asia
seco&dar% to
#ri(ar%
h%#oth%roidis
( .PP*1 "ith
a&d "itho$t
se'$a!
#recocit% are
$&c!ear0
A$r st$d% of
22 ir!s "ith
PP* sho"ed
that the eiht
ir!s "ith
se'$a!
#recocit% had
hiher hor(o&a! !e4e!s, #it$itar% heiht
a&d o&ada! siFe tha& the +C ir!s
"itho$t se'$a! #recocit%0
>$rthe
r
st$dies are &eeded to
e'#!ore the e'act
(ech-a&is(s
associated
"ith PP* a&d
se'$a!
#recocit%0
©20+3 >o$&datio&
Acta Pædiatrica0
P$@!ished @% 5oh&
2i!e% H So&s Ltd
20+C 103, ##0 eC3IeC8 eC3
Pituitary, gonads and hypothyroidism *$ et a!0
3e#art(e&t of Pediatrics of Pro4i&cia! *os#ita!, "hich is affi!iated to
Sha&do& U&i4ersit%0 A tota! of 25 ir!s f$!fi!!ed the i&c!$sio&
criteria, sho"i& t%#ica! s%(#to(s a&d si&s of h%#oth%roidis(; !o"
free th%ro'i&e .>T
C
1 !e4e!s .<++05 #(o!BL1 a&d e!e4ated th%rotro#i&
.TS*1 !e4e!s .≥50 (IUBL1 .910 Af these, 22 ir!s "ith PP* "ere
i&c!$ded i& the fi&a! a&a!%sis0 The ir!s "ere di4ided i&to t"o ro$#s;
ro$# A had PP* "ith se'$a! #recocit% .& = 81, a&d ro$# D had
PP* "itho$t se'$a! #recocit% .& = +C10 PP* "as co&fir(ed @%
reressio& of the h%#er#!astic #it$itar% !a&d after th%roid hor(o&e
re#!ace(e&t thera#%0 Se'$a! #recoc-it% "as defi&ed as @reast
de4e!o#(e&t a&dBor 4ai&a! @!eedi&0 A o&adotro#i&-re!easi&
hor(o&e .G&R*1 sti(-$!atio& test "as #erfor(ed i& ir!s "ith
se'$a! #recocit%0 Gir!s "ho had #eaG !$tei&isi& hor(o&e to fo!!ic!e-
sti($-!ati& hor(o&e .L*B>S*1 ratio >009 a&d #eaG L* > 5 IUBL
"ere co&sidered to ha4e #$@erta! acti4atio& of the h%#otha!a(ic–
#it$itar%–o&ada! .*PG1 a'is .:10 Gir!s "ho had other s%ste(ic
i!!&esses, other e&docri&e a&d (eta@o!ic disorders a&d chro(oso(e
a@&or(a!ities, "ere e'c!$ded0 Gir!s "ith co&ditio&s that ca& affect
ro"th a&d #$@ert% "ere a!so e'c!$ded0
A!! ir!s recei4ed th%roid hor(o&e re#!ace(e&t thera#%
.!e4oth%ro'i&e sodi$( 90–+00 !B(
2
Bda%1 after dia&osis0 3osae
"as adJ$sted for "eiht a&d th%roid f$&ctio&0 Th%roid f$&ctio& tests
"ere #erfor(ed e4er% 2 "eeGs if the th%roid f$&ctio& "as a@&or(a!0
C!i&ica!, hor(o&a! a&d i(ai& #ara(eters "ere recorded i& detai!
after 3 (o&ths of thera#%0 I&for(ed co&se&t "as o@tai&ed fro( the
ir!6s #are&ts, a&d the st$d% "as a##ro4ed @% the ethics co((it-tee
of the Pro4i&cia! *os#ita! Affi!iated to Sha&do& U&i4ersit%0
!inica! e"aminations
*eiht "as (eas$red "itho$t shoes to the &earest 00+ c( $si& a
sta&dard stadio(eter0 Dod% "eiht "as (eas$red "ith s$@Jects
"eari& !iht c!othi& to the &earest 00+ G $si& a& e!ectro&ic sca!e0
The deree of adi#osit% "as e'#ressed as @od% (ass i&de' .D-I1
.GB(
2
10 Sta&dard de4iatio& scores .S3Ss1 of heiht a&d D-I "ere
ca!c$!ated $si& refere&ce 4a!$es i& Chi&ese chi!dre& .810 P$@erta!
staes "ere assessed @% #h%sica! e'a(i&atio&s, accordi& to the
criteria esta@!ished @% Ta&&er .810 Dreast staes .D+–D51 "ere
e4a!$ated @% i&s#ectio& a&d #a!#atio&0 P$@ic hair staes .P*+–P*51
"ere e4a!$ated @% i&s#ectio&0 Gir!s "itho$t c!i&ica! si&s of #$@ert%
.staes D+ a&d P*+1 "ere co&sidered as #re#$@erta!0 A!!
e'a(i&atio&s "ere #erfor(ed @% trai&ed staff0
#aboratory measurements
>asti& @!ood sa(#!es "ere co!!ected a&d ce&trif$ed to o@tai&
ser$(s, "hich "ere the& stored at :0$C0 Ser$(-free triiodoth%ro&i&e
.>T
3
1, >T
C
, TS*, a&tith%roid #ero'idase a&ti@od% .a&ti-TPA A@1 a&d
a&tith%ro!o@$!i& a&ti@od% .a&ti-T A@1 "ere (eas$red @% a&
a$to(ated che(i!$(i&esce&t i(($&oassa% s%ste( .Ad4ia Ce&ta$r?
Sie(e&s, -$&ich, Ger(a&%10 Refere&ce ra&es for >T
3
, >T
C
, TS*,
a&ti-TPA A@ a&d a&ti-T A@ "ere
305–905 #(o!BL
,
++05–220:
#(o!BL, 0035–505 (IUBL, 0–90
IUB(L a&d 0–90 IUB(L,
res#ecti4e!%0 The se&siti4it% of
each assa% "as 003 #(o!BL
.>T
3
1, +03 #(o!BL .>T
C
1, 0000+
(IUBL .TS*1, 00+ IUB(L .a&ti-
TPA A@1 a&d +0 IUB(L .a&ti-
T A@10 The i&tra-assa% a&d
i&terassa% coefficie&ts of
4ariatio& "ere <CK for these
#ara(eters0 Ser$( >S* a&d L*
!e4e!s "ere deter(i&ed at
@ase!i&e a&d 30 a&d 90 (i&
after s$@c$ta&eo$s
ad(i&istratio& of 205 !BG
.(a'i($( +00 !1 Tri#tore!i&
.3eca#e#t%!, >erri&,
S"itFer!a&d10 Ser$( >S*, L*,
#ro!acti& .PRL1, estradio! .E
2
1
a&d testostero&e .T1 "ere
(eas$red a$to-(atica!!% @%
che(i!$(i&esce&ce $si& a
Roche Co@as E+:0
i(($&oassa% a&a!%Fer .Roche
3ia&ostics, -a&&-hei(,
Ger(a&%10 Refere&ce ra&es for
>S*, L*, PRL, E
2
a&d T "ere
+00–C02 IUBL, 0002–00+8 IUBL,
C0:8–2303 !BL, 5–20 &BL a&d
0003–0098 !BL, res#ecti4e!%0
The se&siti4-it% of each assa%
"as 00+ IUBL .>S*1, 00+ IUBL
.L*1, 000C: !BL .PRL1, 5 &BL
.E
2
1 a&d 0002 !BL .T10 The
i&tra-assa% a&d i&terassa%
coefficie&ts of 4ariatio& "ere
<8K i& these assa%s0 No
si&ifica&t cross-reacti4it% "as
fo$&d @et"ee& hor(o&es0
%mage measurements
Do&e ae .DA1 "as deter(i&ed
@% a si&!e @!i&ded o@ser4er
$si& a !eft ha&d-"rist
radiora#h accordi& to
Gre$!ich a&d P%!e sta&dards
.+010
*%#otha!a($s–#it$itar%
-RI "as #erfor(ed $si& a 300
T Sca&&er .Sie(e&s, Er!a&e&,
Ger(a&%1 i& the saitta! a&d
coro&a! #!a&es o& T+- a&d T2-
"eihted i(aes0 The s!ice
thicG&ess "as 3 ((0 The heiht
of #it$itar% !a&d "as (eas$red
a&d co&trast-e&ha&ced -RI of
the h%#er#!astic #it$itar% "as
#erfor(ed0
I(ai& #ara(eters for the
$ter$s a&d o4aries "ere as
fo!!o"s; $teri&e 4o!$(e .UE1,
o4aria& 4o!$(e .AE1 a&d
fo!!ic$!ar dia(eter .>31, "hich
"ere a!! o@tai&ed @%
tra&sa@do(i&a! #e!4ic
so&ora#h% $si& a 305--*F
tra&s-d$cer .LAGIL 8 s%ste(,
GE hea!thcare, -i!"a$Gee, 2I,
USA10 A& o4aria& c%st "as
defi&ed as a fo!!ic$!ar str$ct$re
!arer tha& 20 ((0 A!!
(eas$re(e&ts "ere carried o$t
@% the sa(e trai&ed
so&ora#her0
Statistica! ana!ysis
Nor(a!!% distri@$ted 4aria@!es
"ere e'#ressed as (ea&s
sta&dard de4iatio& .S310
SGe"ed distri@$ted 4ari-a@!es
"ere e'#ressed as (edia&
.i&terM$arti!e ra&e10
Co(#ariso&s @et"ee& ro$# A
a&d ro$# D "ere a&a!%sed
$si& the i&de#e&de&t sa(#!e t-
test for #ara(etric 4aria@!es a&d
$si& the -a&&–2hit&e% &-test
for &o&#ara(etric 4aria@!es0
Cateorica! 4aria@!es "ere
co(#ared @% chi-sM$ared test0
Paired data @efore a&d after
treat(e&t "ere a&a!%sed "ith
#ara(etric test .#aired t-test1
a&d &o&#ara-(etric test
.2i!co'o& si&ed ra&Gs test10
Pearso& corre!a-tio&s "ere $sed
for #ara(etric 4aria@!es, a&d
S#ear(a& corre!atio&s "ere
$sed for &o&#ara(etric
4aria@!es0 A t"o-tai!ed #-4a!$e
<0005 "as co&sidered
statistica!!% si&ifica&t0
Statistica! a&a!%ses "ere carried
o$t $si& sta&dard co(-#$ter
soft"are SPSS 4ersio& +:00
.SPSS I&c0, Chicao, IL, USA10
eCC ©20+3
>o$&datio& Acta Pædiatrica0 P$@!ished @% 5oh& 2i!e% H So&s
Ltd 20+C 103, ##0 eC3IeC8
*$ et a!0
Ta@!e + C!i&ica! s%(#to(s a&d si&s of h%#oth%roidis( i& PP* #atie&ts
Gro$# A Gro$# D #-
S%(#to(s a&d si&s .& = 81 .& = +C1 Ea!$e
3e!a%ed ro"th 5 .9205K1 +2.850:K1 002++
2eiht ai& 3 .3:05K1 9.C208K1 00809
3r% sGi& 5 .9205K1 :.50K1 005:+
P$ff% face C .50K1 5.350:K1 005+2
Co&sti#atio& C .50K1 9.C208K1 00:C9
Goitre C .50K1 5.350:K1 005+2
-e(or% !oss 3 .3:05K1 5.350:K1 00833
S!$ish s#eech a&d s!o" 3 .3:05K1 9.C208K1 00809
(o4e(e&t
PP* = #it$itar% h%#er#!asia seco&dar% to #ri(ar% h%#oth%roidis(? Gro$# A;
PP* "ith se'$a! #recocit%? Gro$# D; PP* "itho$t se'$a! #recocit%0
RESULTS
'ase!ine characteristics
At st$d% e&tr%, a!! ir!s sho"ed t%#ica! s%(#to(s a&d si&s of
h%#oth%roidis( .Ta@!e +10 -RI sca&s sho"ed (arGed
ho(oe&eo$s!% e&!ared #it$itar% !a&d "ith s$#rase!!ar
e'te&sio&0 There "ere &o &e$ro!oica! s%(#-to(s s$ch as
headache i& the ir!s0 I& ro$# A, the ae at o&set of
h%#oth%roidis( "as +05 .000, 50C1 %ears0 The d$ratio& of c!i&ica!
si&s a&d s%(#to(s "as 803 .+08, +0001 %ears0 No #atie&t (et the
criteria for a #$@erta! acti4atio& of the *PG a'is0 Si' ir!s had o&e
or (ore e#isodes of 4ai&a! @!eedi&0 T"o ir!s had iso!ated @reast
de4e!o#(e&t "itho$t a&% other si&s of se'$a! (at$ratio&0 No ir!
"as #rese&ted "ith a!actorrhoea a&d #$@ic hair0 Pe!4ic $!traso$&d
i(ai& sho"ed @i!atera! ($!tic%stic o4aries0 A4aria& c%sts "ere
fo$&d i& #atie&t + a&d #atie&t 3 .Ta@!e 210 I& #atie&t +, the i&itia!
chief co(#!ai&ts "ere a@do(i&a! #ai& a&d 4ai&a! @!eedi&0 She
"as dia&osed "ith a !are !eft o4aria& c%st @% !oca! hos#ita! a&d
$&der"e&t re(o4a! of the c%st0 The histo#atho!o% sho"ed
hae(orrhae a&d (%'oede(ato$s i&fi!tratio& "ithi& the @e&i&
c%st0 A4aria& c%st rea##eared "ithi& fe" (o&ths, so she "as
referred to o$r de#art(e&t0 Gir!s i& ro$# D "ere a!! at the
#re#$@erta! stae0 The ae at o&set of h%#oth%roidis( "as +03
.000, :031 %ears0 The d$ratio& of c!i&ica! si&s a&d s%(#to(s "as
903 .200,
Pituitary, gonads and hypothyroidism
8021 %ears0 There "ere &o si&ifica&t differe&ces i& the ae at o&set
a&d d$ratio& of h%#oth%roidis( @et"ee& the t"o ro$#s .@oth # >
000510
(ormona! and imaging parameters be)ore treatment
As sho"& i& Ta@!e 3, there "as &o si&ifica&t differe&ce i&
chro&o!oica! ae .CA1 @et"ee& ro$# A a&d ro$# D .# > 000510
As e'#ected, de!a%ed DA, !o" heiht S3S a&d hih D-I S3S
"ere fo$&d i& ir!s0 The (ea& 4a!$es of DA, heiht S3S a&d D-I
S3S "ere si(i!ar i& @oth ro$#s .a!! # > 000510 -ea& ser$( >T
3
a&d >T
C
!e4e!s "ere @e!o", a&d TS* !e4e!s "ere a@o4e the &or(a!
refere&ce ra&es i& a!! ir!s0 Eiht ir!s i& ro$# A a&d o&e ir! i&
ro$# D had TS* > +50 (IUBL0 Ser$( a&ti-TPA A@ a&dBor a&ti-
T A@ "ere #ositi4e i& +2 ir!s .5C05K10 Gir!s had si&ifica&t!%
hiher 4a!$es of TS*, >S*, PRL, E
2
, T, #it$itar% heiht, UE, AE
a&d >3 i& ro$# A tha& i& ro$# D .a!! # < 000510 Ser$( !e4e!s of
>T
3
, >T
C
a&d L* "ere &ot differe&t @et"ee& ro$#s .a!! # > 000510
I& PP* ir!s, si&ifica&t corre!atio&s of #it$itar% heiht "ith
ser$( >T
3
, >T
C
.>i0 +1 a&d PRL !e4e!s "ere o@ser4ed .r = 005C5,
# = 00008, r = 0059:, # = 00009 a&d r = 00999, # = 0000+,
res#ecti4e!%10 UE "as #ositi4e!% cor-re!ated "ith PRL !e4e!s .r =
0058+, # = 0000510 AE "as #ositi4e!% corre!ated "ith >S* !e4e!s .r
= 00522, # = 000+310 >3 "as #ositi4e!% corre!ated "ith PRL !e4e!s
.r = 00C82, # = 0003+10 A si&ifica&t #ositi4e corre!atio& @et"ee&
ser$( PRL a&d >S* !e4e!s "as a!so o@ser4ed .r = 0099:, # =
0000+10
(ormona! and imaging parameters a)ter treatment
After 3 (o&ths of !e4oth%ro'i&e treat(e&t, the c!i&ica! s%(#to(s
a&d si&s of h%#oth%roidis( i(#ro4ed, a&d th%roid f$&ctio&
ret$r&ed to &or(a! i& a!! ir!s0 P$@erta! de4e!o#(e&t i& ro$# A
"as $&der co&tro!0 *eiht S3S i& ro$# A a&d ro$# D i&creased
si&ifica&t!% co(#ared "ith that @efore treat(e&t .# = 0000C, # =
0000C10 D-I S3S i& ro$# A a&d ro$# D decreased si&ifica&t!%
co(#ared "ith that @efore treat(e&t .# = 00005, # < 00000+10 >T
3
a&d >T
C
!e4e!s "ere si&ifica&t!% hiher tha& @efore treat(e&t i&
ro$# A .# = 00002, # < 00000+1 a&d ro$# D .# < 00000+, # <
00000+1? TS*, >S*, PRL, E
2
, #it$itar% heiht, UE, AE
Ta@!e 2 Dase!i&e characteristics of ir!s "ith #it$itar% h%#er#!asia a&d se'$a! #recocit% seco&dar% to #ri(ar% h%#oth%roidis(
Patie&t CA .%ears1 DA .%ears1
+ +200 800
2 +20C 800
3 90C C05
C ++08 805
5 ++00 805 D+BP*+ +
9 C00 300 D3BP*+ 3
: 805 900 D3BP*+ 0
8 90: 500 D+BP*+ +
CA = Chro&o!oic ae? DA = Do&e ae? >3 = >o!!ic$!ar dia(eter? R = Riht? L =
Left0
©20+3 >o$&datio& Acta
Pædiatrica0 P$@!ished @%
5oh& 2i!e% H So&s Ltd
20+C 103, ##0 eC3IeC8
eC5
Pituitary, gonads and hypothyroidism *$ et a!0
Ta@!e 3 C!i&ica!, hor(o&a! a&d i(ai& #ara(eters i& PP* #atie&ts @efore treat(e&t
Para(eters Gro$# A .& = 81 Gro$# D .& = +C1 #-Ea!$e Refere&ce
CA .%ears1 80+ 302 800 20+ 008C9 –
DA .%ears1 90: 20C :0C 200 00C9: –
*eiht S3S 20+3 +0+2 205C +008 00C+2 –
D-I S3S +098 +0C5 +089 +052 00:88 –
>T3 .#(o!BL1 +02 +00 202 +09 00+C5 305–905
>TC .#(o!BL1 20: +08 308 300 00253 ++05–220:
TS* .(IUBL1 >+50 +0+08 +505N <00000+ 0035–505
>S* .IUBL1 908 300 30+ +0C 000++ +00–C02
L* .IUBL1 00+ .00+, 00:1 00+ .00+, 0051 00+82 0002–00+8
PRL .!BL1 :+05 5800 320C ++09 0002C C0:8–2303
E2 .&BL1 580+ .2908, +98051 +008 .500, 55031 00029 5–20
T .!BL1 0008 .0003, 00+51 0003 .0002, 000C1 0003+ 0003–0098
Pit$itar% .c(1 +050 0059 0088 0029 0003C –
UE .(L1 +208+ 8029 9000 90+C 00038 –
AE .(L1 508+ .200:, +90:C1 +090 .+003, 20201 00009 –
>3 .c(1 +0+3 00C3
*
0053 00+3 000+8 –
PP* = Pit$itar% h%#er#!asia seco&dar% to #ri(ar% h%#oth%roidis(? CA = Chro&o!oica! ae? DA = Do&e ae? S3S = Sta&dard de4iatio& score? D-I = Dod% (ass
i&de'? >T3 = >ree triiodoth%ro&i&e? >TC = >ree th%ro'i&e? TS* = Th%rotro#i&? >S* = >o!!ic!e-sti($!ati& hor(o&e? L* = L$tei&isi& hor(o&e? PRL = Pro!acti&?
E2 = Estradio!? T = Testostero&e? Pit$itar% = the heiht of #it$itar% !a&d? UE = Uteri&e 4o!$(e? AE = A4aria& 4o!$(e? >3 = >o!!ic$!ar dia(eter? Gro$# A; PP*
"ith se'$a! #recocit%? Gro$# D; PP* "itho$t se'$a! #recocit%0
NA&e #atie&t "ith TS* > +50 (IUBL "as e'c!$ded0
*
T"o #atie&ts "ith o4aria& c%sts "ere e'c!$ded0
>i$re + Dase!i&e corre!atio& of #it$itar% heiht "ith ser$( >TC !e4e!s i& #it$itar%
h%#er#!asia seco&dar% to #ri(ar% h%#oth%roidis( #atie&ts "ith se'$a! #recocit% .fi!!ed
s%(@o!s1 a&d "itho$t se'$a! #recocit% .o#e& s%(@o!s10
a&d >3 4a!$es "ere si&ifica&t!% !o"er tha& @efore treat-(e&t i&
ro$# A .# < 00000+, # = 0003:, # = 000+3, # = 000+2, # = 0000+, # =
000+8, # = 000+2 a&d # = 00003,
res#ecti4e!%1 a&d ro$# D .# < 00000+, # = 00039,
# < 00000+, # = 00039, # < 00000+, # = 0002C, # = 00002
a&d # = 0000+, res#ecti4e!%1? ser$( T !e4e!s i& ro$# A "ere
si&ifica&t!% !o"er tha& @efore treat(e&t .# = 000+81? there "as &o
si&ifica&t differe&ce i& ser$( L* !e4e!s i& ro$# A @efore a&d after
treat(e&t .# = 00C951? ser$( L* a&d T !e4e!s i& ro$# D re(ai&ed
$&cha&ed after treat(e&t
.# = 003C5, # = 0008C10 The
!e4e!s of UE a&d AE "ere
si&ifica&t!% hiher i& ro$# A
tha& i& ro$# D .# = 000C2, # =
000281? there "ere &o
si&ifica&t differe&ces i&
c!i&ica!, hor(o&a! a&d other
i(ai& #ara(eters @et"ee&
ro$#s .a!! # > 00051 .Ta@!e C10
There "ere fi4e ir!s i& ro$# A
a&d three ir!s i& ro$# D "ith
a@&or(a! i(ai& fi&di&s at 3
(o&ths0 Pit$itar%, UE, AE a&d
>3 reressed to &or(a! "ithi&
8 (o&ths of thera#%0
3ISCUSSIAN
I& this st$d%, "e e'a(i&ed
"hether hor(o&a!, #it$itar% a&d
o&ada! #ara(eters "ere
differe&t i& PP* ir!s "ith
se'$a! #recocit% co(#ared to
PP* ir!s "itho$t se'$a!
#recocit% @efore a&d after 3
(o&ths of !e4oth%ro'i&e
thera#%0 2e fo$&d that PP*
ir!s "ith se'$a! #recocit% had
i&creased ser$( hor(o&a!
!e4e!s, #it$itar% heiht a&d
o&ada! siFe0 These
a@&or(a!ities #roressi4e!%
reressed fo!!o"i& !e4-
oth%ro'i&e thera#%0 I& additio&,
"e a!so fo$&d i&teractio&s
a(o& hor(o&es, #it$itar% a&d
o&ads i& PP* ir!s0
Pit$itar% h%#er#!asia has
@ee& "e!! esta@!ished0
3ecreased th%roid hor(o&es
direct!% or i&direct!% i&crease
TS* a&d h%#otha!a(ic
th%rotro#i&-re!easi& hor(o&e
.TR*1 secretio&s @% (ea&s of a
&eati4e feed@acG (ech-a&is(
.++10 Co&ti&$o$s hih TR*
!e4e!s sti($!ate th%ro-tro#h a&d
!actotro#h ce!!s #ro!iferatio&
"ith s$@seM$e&t e&!are(e&t of
the #it$itar% !a&d .+210 PRL as
"e!! as TS* !e4e!s are e!e4ated
$&der the sti($!atio& of TR*
.+310 The #it$itar% h%#er#!asia
is re!ated to the se4erit% of
h%#oth%-roidis( .+C10 I& o$r
#atie&ts, #it$itar% heiht "as
&eati4e!% corre!ated "ith
ser$( >T
3
a&d >T
C
!e4e!s a&d
#ositi4e!%
eC9 ©20+3
>o$&datio& Acta Pædiatrica0 P$@!ished @% 5oh& 2i!e% H So&s
Ltd 20+C 103, ##0 eC3IeC8
*$ et a!0 Pituitary, gonads and hypothyroidism
Ta@!e C C!i&ica!, hor(o&a! a&d i(ai& #ara(eters i& PP* #atie&ts after 3 (o&ths of !e4oth%ro'i&e treat(e&t
Para(eters Gro$# A .& = 81 Gro$# D .& = +C1 #-Ea!$e Refere&ce
*eiht S3S +0:+ +028 2000 +039 00925
D-I S3S +020 +059 +00C +055 008+8
305–905 >T3 .#(o!BL1 :0C 303 902 +02 0023+
>TC .#(o!BL1 +80+ C00 +80: 500 00898 ++05–220:
TS* .(IUBL1 308 208 508 :00 00C9: 0035–505
>S* .IUBL1 303 20+ 20C 008 002:8 +00–C02
L* .IUBL1 00+ .00+, 00C1 00+ .00+, 0021 008:0 0002–00+8
PRL .!BL1 2+03 +802 +305 :02 00300 C0:8–2303
E2 .&BL1 +C09 .802, +90C1 ++09 .500, +:0:1 00C88 5–20
T .!BL1 0003 .0002, 00081 0003 .0002, 00031 00C:8 0003–0098
Pit$itar% .c(1 0098 0025 0058 0028 003:C
UE .(L1 9058 30:0 3059 20:8 000C2
AE .(L1 2038 .+002, 30321 +00: .00::, +05C1 00028
>3 .c(1 0059 002:N 00C5 00+0 00239
PP* = Pit$itar% h%#er#!asia seco&dar% to #ri(ar% h%#oth%roidis(? S3S = Sta&dard de4iatio& score? D-I = Dod% (ass i&de'? >T3 = >ree triiodoth%ro&i&e?
>TC = >ree th%ro'i&e? TS* = Th%rotro#i&? >S* = >o!!ic!e-sti($!ati& hor(o&e? L* = L$tei&isi& hor(o&e? PRL = Pro!acti&? E2 = Estradio!? T = Testostero&e?
Pit$itar%, the heiht of #it$itar% !a&d? UE = Uteri&e 4o!$(e? AE = A4aria& 4o!$(e? >3 = >o!!ic$!ar dia(eter? Gro$# A; PP* "ith se'$a! #recocit%? Gro$# D; PP*
"itho$t se'$a! #recocit%0
NT"o #atie&ts "ith o4aria& c%sts "ere e'c!$ded0
corre!ated "ith ser$( PRL !e4e!s0 TS* !e4e!s, PRL !e4e!s a&d
#it$itar% heiht "ere hiher i& PP* ir!s "ith se'$a! #recocit%0 A$r
data s$est that ser$( TS* a&d PRL !e4e!s are corre!ated "ith
#it$itar% h%#er#!asia0
I& this st$d%, ser$( >S* !e4e!s "ere i&creased a@o4e L* !e4e!s i&
PP* ir!s0 A$r res$!t "as i& accorda&ce "ith (ost #re4io$s re#orts
.C,+510 The (echa&is( re!ated to the cha&e i& o&adotro#i&
secretio& is &ot c!ear %et0 Doth TS* a&d o&adotro#i&s are
!%co#rotei& hor(o&es co(#osed of a co((o& a-s$@$&it a&d a
$&iM$e @-s$@$&it0 Go&adotro-#i&s are a!so i&creased d$e to the
hor(o&a! o4er!a# .+10 The decreased (eta@o!ic c!eara&ce rate i&
h%#oth%roidis( i&creased ser$( hor(o&a! !e4e!s0 *o"e4er, it has
@ee& de(o&strated that >S* @$t &ot L* !e4e!s are sti($!ated @%
TR* !e4e!s .+910 I& additio&, the freM$e&c% of G&R* #$!ses re$!ates
s%&thesis a&d secretio& of o&adotro#i&s differ-e&tia!!%0 >ast G&R*
#$!ses #refere&tia!!% i&crease L* secretio&, a&d s!o" G&R* #$!ses
fa4o$r >S* secretio& .+:10 PRL (ai&!% s$##resses L* secretio& @%
s!o"i& G&R* #$!se freM$e&c% .+810 Therefore, it (iht @e reaso&-
a@!e that PRL !e4e!s "ere #ositi4e!% corre!ated "ith >S* !e4e!s i&
PP* ir!s, a&d >S* !e4e!s "ere hiher i& PP* ir!s "ith se'$a!
#recocit%0
The #atho#h%sio!o% of se'$a! #recocit% seco&dar% to #ri(ar%
h%#oth%roidis( re(ai&s $&certai&0 -a&% theories ha4e @ee&
#ost$!ated0 A&asti et a!0 .+81 de(o&strated that reco(@i&a&t h$(a&
TS* co$!d act direct!% o& the h$(a& >S* rece#tor in +itro i& a dose-
de#e&de&t (a&&er0 Go&ada! sti($!atio& i& #ri(ar% h%#oth%roidis( is
!iGe!% d$e to the acti4atio& of the "i!d-t%#e >S* rece#tor, "hich is
(ore s$sce#ti@!e to hih !e4e!s of TS* .2010 -oreo4er, hih !e4e!s of
PRL co$!d e&ha&ce o4aria& se&siti4it% to o&adotro#i&s .2+10 I& PP*
ir!s "ith se'$a! #recocit%, the o&ada! sti($!atio& res$!ted i&
o4aria& fo!!ic$!ar c%sts, 4ai&a! @!eedi& a&d @reast de4e!o#(e&t0
The e!e4ated
ser$( E
2
a&d T !e4e!s "ere d$e
to the decreased (eta@o!ic
c!eara&ce rate a&d the o&ada!
sti($!atio&0 E!e4ated TS*
!e4e!s co$!d act thro$h its o"&
rece#tor i& the $ter$s a&d
o4aries to i&d$ce (%'oede(a
.22,2310 *isto!oica! e'a(-
i&atio&s of the $ter$s a&d
o4aries sho"ed #ro!iferati4e
e&do(etri$( a&d oede(ato$s
stro(a .2C,2510 Therefore, the
e&!ared $ter$s a&d o4aries
"ere attri@$ted to the o&ada!
sti($!atio& a&d
(%'oede(ato$s i&fi!tratio&0
AE "as #ositi4e!% re!ated "ith
>S*0 UE a&d >3 "ere
#ositi4e!% re!ated "ith PRL0
A$r data i&dicate that the
i&creased >S* a&d PRL !e4e!s
ha4e effects o& o&ada!
sti($!atio&0 The differe&t
corre!atio& @et"ee& o&ads a&d
ser$( >S* a&d PRL !e4e!s (a%
@e d$e to s(a!! sa(#!e siFe of
PP* ir!s0
Pit$itar% h%#er#!asia
seco&dar% to #ri(ar%
h%#oth%roid-is( ir!s "ith
se'$a! #recocit% sho"ed hiher
4a!$es of TS*, >S*, PRL, E
2
,
T, #it$itar% heiht, UE, AE a&d
>3 tha& PP* ir!s "itho$t
se'$a! #recocit%0 The decrease
i& hor(o&a! !e4e!s, #it$itar%
heiht a&d o&ada! siFe after
!e4oth%ro'i&e thera#% i(#!ies
that #ri(ar% h%#oth%roidis( is
the ca$se of these
a@&or(a!ities0 I& the ir!s, a!!
a@&or(a!ities re4ersed after 8
(o&ths of thera#%0 The
reco4er% ti(e 4aried fro( a
"eeG to a fe" (o&ths i&
#re4io$s!% re#orted cases
.C,5,29,2:10
The #re4io$s!% re#orted
i&cide&ce of #it$itar% h%#er#!a-
sia i& chi!dre& .0–+2 %ears of
ae1 "ith h%#oth%roidis( .TS*
≥ 50 (IUBL1 "as 80K .910 It
"as 88K i& the ir!s0 The
re#orted i&cide&ce of se'$a!
#recocit% i& chi!dre& "ith
h%#oth%roidis( .TS* ≥ +00
(IUBL1 "as 2CK .2810 Se'$a!
#recocit% occ$rred i& 39K of
PP* ir!s .TS* ≥ 50 (IUBL10
LacG of a"are&ess, de!a%ed
dia&osis a&d $&&ecessar%
treat(e&t i& the ir!s res$!ted i&
the hih #re4a!e&ce of #it$itar%
h%#er#!asia a&d se'$a!
#recocit%0
I& co&c!$sio&, #it$itar%
h%#er#!asia a&d se'$a!
#recocit% seco&dar% to #ri(ar%
h%#oth%roidis( i&4o!4e a
co(#!e' (echa&is(0 >$rther
!arer sca!e c!i&ica! st$dies a&d
a&i(a!
©20+3 >o$&datio& Acta
Pædiatrica0 P$@!ished @%
5oh& 2i!e% H So&s Ltd 20+C 103, ##0 eC3IeC8 eC:
Pituitary, gonads and hypothyroidism
st$dies are &eeded to co&fir( o$r c!i&ica! fi&di&s a&d to e'#!ore
the e'act (echa&is(0
AC7NA2LE3GE-ENT
2e are ratef$! to a!! chi!dre& a&d their #are&ts for #artici#ati& i&
this st$d%0
CAN>LICT A> INTEREST
No co&f!icti& i&terests to dec!are0
>UN3ING
This research recei4ed &o s#ecific ra&t fro( a&% f$&di& ae&c%0
Refere&ces
1. 2%G 55E, Gr$(@ach --0 S%&dro(e of #recocio$s (e&str$atio& a&d
a!actorrhea i& J$4e&i!e h%#oth%roidis(; a& e'a(#!e of hor(o&a!
o4er!a# i& #it$itar% feed@acG0 , Pediatr +890? 5:; C+9–350
2. Ca(#a&er AD, Sca#i&e!!i A, -achado RA, 3os Sa&tos RE, DeF&os
G2, AoGi T0 Pri(ar% h%#oth%roidis( #rese&ti& as o4aria& t$(or
a&d #recocio$s #$@ert% i& a #re#$@erta! ir!0
-yneco! .ndocrino! 2009? 22; 385–80
3. Dro"&e LP, Dos"e!! *D, Crott% E5, A6*ara S-, DirGe(eier 7L,
G$i!!er(a& RP0 Ea& 2%G a&d Gr$(@ach s%&dro(e re4isited; i(ai&
a&d c!i&ica! fi&di&s i& #re-a&d #ost#$@erta! ir!s0 Pediatr /adio!
2008? 38; 538–C20
4. Dara&o"sGi E, *oe!er 20 A& $&$s$a! #rese&tatio& of acM$ired
h%#oth%roidis(; the Ea& 2%G–Gr$(@ach s%&dro(e0 .ur ,
.ndocrino! 20+2? +99; 53:–C20
5. *$&o!d A, A!Fe& G, 2$d% SA, D!$etters-Sa"atFGi R, La&d(a&& E,
Reiter A, et a!0 A4aria& t$(or i& a +2-%ear o!d fe(a!e "ith se4ere
h%#oth%roidis(; a case of Ea& 2%G a&d Gr$(@ach s%&dro(e0
Pediatr '!ood ancer 2008? 52; 9::–80
6. 7ha"aJa N-, Taher D-, Darha( -E, Naser AA, *adid% A-, Ah(ad
AT, et a!0 Pit$itar% e&!are(e&t i& #atie&ts "ith #ri(ar%
h%#oth%roidis(0 .ndocr Pract 2009? +2; 28–3C0
7. S$@s#ecia!t% Gro$# of E&docri&o!o%, *ereditar% a&d -eta@o!ic
3iseases, Societ% of Pediatrics, Chi&ese -edica! Associatio&0
G$ide!i&es for dia&osis a&d treat(e&t of ce&tra! .tr$e1 #recocio$s
#$@ert%0 0honghua .r 1e 0a 0hi 200:? C5; C29–:0
8. Li *, 5i C), Oo& PN, Oha& )L0 *eiht a&d "eiht sta&dardiFed
ro"th charts for Chi&ese chi!dre& a&d ado!esce&ts aed 0 to +8 %ears0
0honghua .r 1e 0a 0hi 2008? C:; C8:–820
9. Ta&&er 5-, 2hiteho$se R*0 C!i&ica! !o&it$di&a! sta&dards for heiht,
"eiht, heiht 4e!ocit%, "eiht 4e!ocit%, a&d staes of
#$@ert%0 2rch 3is hi!d +8:9? 5+; +:0–80
10. Gre$!ich 22, P%!e SI0 Radiora#hic at!as of sGe!eta!
de4e!o#(e&t of the ha&d a&d "rist0 2m , 4ed Sci +858? 238; 3830
11.Chia(o!era -I, 2o&disford >E0 Th%rotro#i&-re!easi& hor(o&e
a&d the th%roid hor(o&e feed@acG (echa&is(0 .ndocrino!ogy
2008? +50; +08+–90
12. Pioro EP, Scheitha$er D2, La"s ER 5r, Ra&da!! RE, 7o4acs
7T, *or4ath E0 Co(@i&ed th%rotro#h a&d !actotro#h ce!!
*$ et a!0
h%#er#!asia si($!ati& #ro!acti&-secreti& #it$itar% ade&o(a i&
!o&-sta&di& #ri(ar% h%#oth%roidis(0 Surg 5euro! +888?
29: 2+8–290
13. Asa SL, EFFat S0 The #athoe&esis of #it$itar% t$(o$rs0 5at
/e+ ancer 2002? 2; 839–C80
14. 2o!a&sG% L5, Lea4itt G3, E!ias D5, Lee *5, 3as(aha#atra A,
D%r&e 20 -RI of #it$itar% h%#er#!asia i& h%#oth%roidis(0
5euroradio!ogy +889? 38; 50–20
15. Shar(a ), DaJ#ai A, -itta! S, 7a@ra -, -e&o& PS0 A4aria&
c%sts i& %o$& ir!s "ith h%#oth%roidis(; fo!!o"-$# a&d effect of
treat(e&t0 , Pediatr .ndocrino! 4etab 2009? +8; 885–8000
16. Dr$der 5-, Sa($e!s -*, Dre(&er 25, Rid"a% EC, 2ier(a&
-E0 *%#oth%roidis(-i&d$ced (acroorchidis(; $se of a o&adotro#i&-
re!easi& hor(o&e ao&ist to $&dersta&d its (echa&is( a&d a$(e&t
ad$!t stat$re0 , !in .ndocrino! 4etab +885? 80; ++–90
17. 3a!Gi& AC, *aise&!eder 35, Arto!a&o GA, E!!is TR, -arsha!!
5C0 The freM$e&c% of o&adotro#i&-re!easi&-hor(o&e sti($!atio&
differe&tia!!% re$!ates o&adotro#i& s$@$&it (esse&er ri@o&$c!eic
acid e'#ressio&0 .ndocrino!ogy +888?
125: 8+:–2C0
18. CooG CD, Ni##o!dt TD, 7!etter GD, 7e!ch RP, -arsha!! 5C0
Na!o'o&e i&creases the freM$e&c% of #$!sati!e !$tei&iFi& hor(o&e
secretio& i& "o(e& "ith h%#er#ro!acti&e(ia0 , !in .ndocrino!
4etab +88+? :3; +088–+050
19. A&asti 5N, >!acG -R, >roeh!ich 5, Ne!so& L-, Nis$!a DC0 A
#ote&tia! &o4e! (echa&is( for #recocio$s #$@ert% i& J$4e&i!e
h%#oth%roidis(0 , !in .ndocrino! 4etab +885? 80; 2:9–80
20. R%a& GL, >e& P, d6A!4a CD, Oha& -, Ea& Eoorhis D5, Pi&to
E-, et a!0 E4a!$ati& the ro!es of fo!!ic!e-sti($!ati& hor(o&e
rece#tor #o!%(or#his(s i& o&ada! h%#ersti($!atio& associated "ith
se4ere J$4e&i!e #ri(ar% h%#oth%roidis(0 , !in .ndocrino! 4etab
200:? 82; 23+2–:0
21. Ad4is 5, Richards 5, AJeda S0 *%#er#ro!acti&e(ia-i&d$ced
#recocio$s #$@ert%; st$dies o& the (echa&is( .s1 @% "hich #ro!acti&
e&ha&ces o4aria& #roestero&e res#o&si4e&ess to o&adotro#i&s i&
#re#$@erta! rats0 .ndocrino!ogy +88+? +08; +333–C20
22. 2i!!ia(s GR0 E'trath%roida! e'#ressio& of TS* rece#tor0 2nn
.ndocrino! 6Paris7 20++? :2; 98–:30
23. AhaJa&o4a L, Sta4re$s-E4ers A, Li&de@er -, La&dre& D-,
S#arre LS, *o4atta A0 Th%roid-sti($!ati& hor(o&e rece#tor a&d
th%roid hor(o&e rece#tors are i&4o!4ed i& h$(a& e&do(etria!
#h%sio!o%0 8erti! Steri! 20++? 85; 230–:0
24. Si!4er *70 5$4e&i!e h%#oth%roidis( "ith #recocio$s se'$a!
de4e!o#(e&t0 , !in .ndocrino! 4etab +858? +8; 889–8+0
25. *a&se& 7A, Tho SP, *a&!% -, -oret$FFo R2, -c3o&o$h
PG0 -assi4e o4aria& e&!are(e&t i& #ri(ar% h%#oth%roidis(0 8erti!
Steri! +88:? 9:; +98–:+0
26. Sar!is N5, Dr$cGer-3a4is >, 3o##(a& 5L, SGar$!is -C0 -RI-
de(o&stra@!e reressio& of a #it$itar% (ass i& a case of #ri(ar%
h%#oth%roidis( after a "eeG of ac$te th%roid hor(o&e thera#%0 , !in
.ndocrino! 4etab +88:? 82; 808–++0
27. )a(ashita ), 7a"a($ra T, >$JiGa"a R, -ochiF$Gi *, AG$@o
-, Arita 70 Reressio& of @oth #it$itar% a&d o4aria& c%sts after
ad(i&istratio& of th%roid hor(o&e i& a case of #ri(ar%
h%#oth%roidis(0 %ntern 4ed 200+? C0; :5+–50
28. Ca@rera S-, 3i-e!io LA, E$ster EA0 I&cide&ce a&d
characteristics of #se$do#recocio$s #$@ert% @eca$se of se4ere #ri(ar%
h%#oth%roidis(0 , Pediatr 20+3? +92; 93:–80
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