Papel da leptina no crescimento sem GH de crianças e adolescentes portadores de craniofaringioma / Leptin role in the metabolism of children and adolescents with craniopharyngioma

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Craniopharyngioma (CF) is a tumor of the sellar and suprasellar regions, more commonly found in children, its course being associated with hypophyseal hormones deficiency, especially growth hormone (GHD). Affected children have reduced growth rates (GR) and short stature. However, after tumor resection, patients have been reported to exhibit normal or increased growth rates, even in the presence of GH deficiency. The underlying mechanisms to this phenomenon are not clear, yet they are known to be associated with weight gain. Recently, a direct relation between leptin, GH and the body mass index (BMI) has been reported. With the objective of establishing correlations between leptin, growth rate (GR) and BMI; correlate leptin and IGF-I with GH, and verify if exogenous GH modifies the leptin profile in patients with CF and GHD, 15 GH-deficient and impuberal patients with CF, 7 boys and 8 girls, under the age of 18, were studied. According to the use of GH replacement therapy, patients were divided into 2 groups (1 and 2), respectively treated and non treated, and were evaluated for GR and BMI, leptinemia, insulinemia, lipidogram and IGF-I during the first 2 years after the first surgery. Correlation was established between BMI and leptinemia and, for the patients in group 2, correlations were established between GR and IGF-I, insulinemia, the HOMA index and leptinemia. After the first neurosurgery, 13 patients evolved with hypocortisolism, 11 with established diabetes insipidus, 12 with hypothyroidism and all patients were GH-deficient. Mean growth rate Z-score values (Z-GR) in the 1st and 2nd year, respectively, were: group 1: 0.61 and 1.86 and group 2: 0.85 and 0.94. Final Z-BMI values ranged from -0.24 to 2.74 for group 1 and from -0.12 to 2.88 for group 2. There was no correlation between Z-BMI and Z-GR. The patients showed hyperleptinemia (MZ-leptin = 10.58; SD = 14.08), with positive correlation between leptin values and the final Z-BMI (P=0.0095). There was no correlation between leptin values and Z-GR. The correlation between insulin and Z-BMI was only significant in group 1 (P = 0.001). Insulin did not correlate with GR in group 2. The correlation between IGF-I and GR was only positive in the 1st year (P = 0.007). There was t correlation between leptin and the IGF I in group 2. We conclude that there was a positive correlation between leptin values and the IMC in patients with CF and DGH; there was no correlation between leptin and GR; there was no positive correlation between IGF I and leptin in patients with CF and GHD not treated with hGH, and there was no statistical difference in leptin values between treated and non-treated groups.

ASSUNTO(S)

craniofaringioma hipopituitarismo leptin adolescent criança craniopharyngioma leptina human growth hormone/deficiency adolescente crescimento hormônio do crescimento humano/deficiência child hypopituitarism acromegaly

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