Avaliação laboratorial e por imagem da saúde óssea de crianças e adolescentes com deficiência de hormônio do crescimento em tratamento

Abstract

Introduction: Growth hormone deficiency (GHD) has been considered a cause of secondary osteoporosis in children. Recently, however, the consequences of this disease on the skeletal health of these patients have been questioned and remain uncertain. Objective: To search for reports on bone health in children and adolescents with GHD before reaching their final height, summarizing and discussing the relevant findings of the literature published until now. Methods: A non-systematic review of national and international medical literature was performed in PUBMED and BIREME libraries. The following descriptors were used: hypopituitarism; growth hormone, deficiency; growth hormone; osteoporosis; bone diseases, metabolic; vitamin D; bone density; densitometry; tomography and ultrasonography. Results: Several factors may contribute to bone damage in patients with GHD, among them: the deficit of growth hormone (GH) itself; other pituitary hormone deficiencies and their replacement therapies and usual nutritional deficits as hypovitaminosis D and low calcium intake. While some studies have demonstrated impairment of bone quantity and quality, even after adjustment for height, others have noted absence of bone damage in these patients. There seems to be insufficient evidence of a higher risk of fractures when GHD is isolated. Conclusions: Bone health in children and adolescents with GHD is insufficiently and sometimes wrongly documented and the studies are controversial. This occurs because bone mass assessment in these individuals is complex. Despite the obvious importance of GH in the regulation of bone metabolism, it is not yet clear whether these patients have compromised bone health and what are the factors that could optimize bone mass gain and could prevent present and future bone morbidity.