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    Öğe
    Adherence to Growth Hormone Therapy: Results of a Multicenter Study
    (Amer Assoc Clinical Endocrinologists, 2014) Aydın, Banu Küçükemre; Aycan, Zehra; Sıklar, Zeynep; Berberoğlu, Merih; Öcal, Gönül; Çetinkaya, Semra; Darendeliler, Feyza
    Objective: To evaluate the adherence to growth hormone (GH) therapy and identify the influencing factors and outcomes in children. Methods: A total of 217 GH-naive patients in 6 pediatric endocrinology clinics were enrolled in the study. Structured questionnaires were filled out and patients were evaluated at the initiation and 3rd, 6th, and 12th months of therapy. Patients were categorized into 4 adherence segments based on percentage of doses omitted at each evaluation period, classified as excellent if 0%, good if 5%, fair if 5 to 10%, and poor if > 10%. Results: There was a decrement in adherence to GH therapy during the study period (P = .006). Patients who showed excellent and good adherence to therapy had better growth velocity and growth velocity standard deviation scores (SDSs) (P = .014 and P = .015, respectively). A negative correlation between growth velocity SDS and number of missed injections was also observed (r = -.412; P = .007). A positive correlation between delta insulin-like growth factor-1 (IGF-1) SDS and growth velocity was demonstrated (r = .239; P = .042). IGF-1 levels were significantly higher in patients who showed excellent and good adherence to therapy (P = .01). Adherence was better in boys than in girls (P = .035), but adherence rates were not associated with age, cause of GH treatment, socioeconomic status, person who administered the injections, type of injection device, or GH product. Conclusion: Poor adherence to GH therapy was common in our group of patients and was one of the factors underlying suboptimal growth during therapy. Before considering other problems that can affect growth, clinicians should confirm good adherence to therapy.
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    Öğe
    Experience with long-term glucocorticoid treatment in congenital adrenal hyperplasia: Growth pattern compared with genetic height potential
    (Walter De Gruyter Gmbh, 2006) Aycan, Zehra; Öcal, Gönül; Berberoğlu, Merih; Çetinkaya, Ergun; Adıyaman, Pelin; Evliyaoğlu, Olcay
    Objective: Long-term replacement treatment with high doses of steroids in congenital adrenal hyperplasia (CAH) is known to have a negative influence on growth. We evaluated the effects of long-term steroid treatment in patients with classical CAH on height development in relation to genetic height potential. Patients and Methods: Twenty-three patients with CAH (16 females, 7 males, mean age: 9.8 +/- 3.5 years) were included in this longitudinal study. The effect of steroid treatment on growth was determined by monitoring patients for 8.61 +/- 3.46 years (2-17 years) while they were treated with hydrocortisone at a mean dosage of 17.64 +/- 3.60 mg/m(2)/day. The height standard deviation scores (Ht-SDS), target Ht-SDS, and corrected Ht-SDS for target height was calculated for all patients. Predicted adult height according to bone age was calculated and it was determined whether height was developing according to the genetic height potential. In addition, patients were grouped as 'tight control' or 'poor control' according to their mean serum 17OH-progesterone or ACTH levels while on treatment. We evaluated whether height development was different for the tight and poor control groups. Results: The mean chronological age of our patients at the time of the study was 9.89 +/- 3.53 years, Ht-SDS -0.77 +/- 1.57, target height (TH) 161.03 +/- 6.54 cm, TH-SDS -0.60 +/- 0.90, predicted height (PH) 157.2 +/- 11.16 cm, PH-SDS -1.1 +/- 1.69, and corrected Ht-SDS -0.75 +/- 1.14. There was no significant difference between the actual Ht-SDS and TH-SDS of our patients (p > 0.05) but the corrected Ht-SDS was less than zero. Only 28.5% of our patients had normal height according to their genetic potential while 71.5% were shorter than their genetic height potential. While the Ht-SDS and corrected Ht-SDS were similar in the tight and poor metabolic control groups, the predicted height was significantly greater in the tight control group. Conclusion: We demonstrated that a hydrocortisone dose of 17.64 +/- 3.60 mg/m(2)/day in classical CAH had a negative influence on height development for genetic height potential in 8.5 years of follow-up and that it is necessary to use the lowest possible steroid dosage by individualizing the dose.
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    Öğe
    The relationship between IGF-1 response and 1st year height velocity on two different doses of GH in idiopathic GH deficiency (IGHD): a randomized, prospective clinical study
    (Karger, 2009) Bundak, Rüveyde; Arslanoğlu, Ilknur; Berberoğlu, Merih; Sıklar, Zeynep; İşgüven, Pinar; Öcal, Gönül
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