Thymic hyperplasia in a child treated with growth hormone

Lynda Polgreen, Marie E Steiner, Charles A Dietz, Juan C Manivel, Anna Petryk

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: To report a case of thymic hyperplasia diagnosed three months after initiation of recombinant human growth hormone (GH) for the treatment of GH deficiency. Design: Retrospective chart review was conducted to evaluate the temporal relationship between treatment with GH and thymic enlargement in a 7-year-old girl who had a history of embryonal rhabdomyosarcoma of the nasopharynx diagnosed at the age of 3 years. Results: The diagnosis of GH deficiency was made based on clinical and auxological criteria, an insufficient response to clonidine-arginine stimulation testing (peak GH level of 4.8 μg/L) and low insulin-like growth factor 1 (IGF-1) level (30 ng/mL, -2.7 SD). The patient was started on GH at a dose of 0.3 mg/kg/week. At the initiation of treatment with GH, the baseline growth velocity was 0.8 cm/year (-6.0 SD) and height was 112.5 cm (-1.7 SD). After three months of treatment with GH, her height increased by 4.2 cm (from -1.7 to -1.2 SD), and the IGF-1 level from -2.7 SD to -1.1 SD. A chest CT performed at that time for recurrence surveillance showed 89% increase in thymic volume relative to previous scan before treatment with growth hormone. A thoracoscopic biopsy of the thymus was performed and revealed hyperplasia with normal thymic architecture without evidence of malignancy. Conclusions: The timing of the development of thymic hyperplasia, along with data from in vitro and in vivo animal studies showing that GH and IGF-1 can directly stimulate growth of the thymus, suggests that GH contributed to the development of thymic hyperplasia in this patient.

Original languageEnglish (US)
Pages (from-to)41-46
Number of pages6
JournalGrowth Hormone and IGF Research
Volume17
Issue number1
DOIs
StatePublished - Feb 1 2007

Fingerprint

Thymus Hyperplasia
Growth Hormone
Somatomedins
Thymus Gland
Embryonal Rhabdomyosarcoma
Therapeutics
Nasopharynx
Human Growth Hormone
Clonidine
Growth
Hyperplasia
Arginine

Keywords

  • Growth hormone deficiency
  • Hematopoietic cell transplantation
  • Immune system
  • Insulin-like growth factor I
  • Thymic rebound
  • Thymus

Cite this

Thymic hyperplasia in a child treated with growth hormone. / Polgreen, Lynda; Steiner, Marie E; Dietz, Charles A; Manivel, Juan C; Petryk, Anna.

In: Growth Hormone and IGF Research, Vol. 17, No. 1, 01.02.2007, p. 41-46.

Research output: Contribution to journalArticle

Polgreen, Lynda ; Steiner, Marie E ; Dietz, Charles A ; Manivel, Juan C ; Petryk, Anna. / Thymic hyperplasia in a child treated with growth hormone. In: Growth Hormone and IGF Research. 2007 ; Vol. 17, No. 1. pp. 41-46.
@article{fec8b2b607e044e9bd070ea83b089ab0,
title = "Thymic hyperplasia in a child treated with growth hormone",
abstract = "Objective: To report a case of thymic hyperplasia diagnosed three months after initiation of recombinant human growth hormone (GH) for the treatment of GH deficiency. Design: Retrospective chart review was conducted to evaluate the temporal relationship between treatment with GH and thymic enlargement in a 7-year-old girl who had a history of embryonal rhabdomyosarcoma of the nasopharynx diagnosed at the age of 3 years. Results: The diagnosis of GH deficiency was made based on clinical and auxological criteria, an insufficient response to clonidine-arginine stimulation testing (peak GH level of 4.8 μg/L) and low insulin-like growth factor 1 (IGF-1) level (30 ng/mL, -2.7 SD). The patient was started on GH at a dose of 0.3 mg/kg/week. At the initiation of treatment with GH, the baseline growth velocity was 0.8 cm/year (-6.0 SD) and height was 112.5 cm (-1.7 SD). After three months of treatment with GH, her height increased by 4.2 cm (from -1.7 to -1.2 SD), and the IGF-1 level from -2.7 SD to -1.1 SD. A chest CT performed at that time for recurrence surveillance showed 89{\%} increase in thymic volume relative to previous scan before treatment with growth hormone. A thoracoscopic biopsy of the thymus was performed and revealed hyperplasia with normal thymic architecture without evidence of malignancy. Conclusions: The timing of the development of thymic hyperplasia, along with data from in vitro and in vivo animal studies showing that GH and IGF-1 can directly stimulate growth of the thymus, suggests that GH contributed to the development of thymic hyperplasia in this patient.",
keywords = "Growth hormone deficiency, Hematopoietic cell transplantation, Immune system, Insulin-like growth factor I, Thymic rebound, Thymus",
author = "Lynda Polgreen and Steiner, {Marie E} and Dietz, {Charles A} and Manivel, {Juan C} and Anna Petryk",
year = "2007",
month = "2",
day = "1",
doi = "10.1016/j.ghir.2006.10.005",
language = "English (US)",
volume = "17",
pages = "41--46",
journal = "Growth Hormone and IGF Research",
issn = "1096-6374",
publisher = "Elsevier Ltd",
number = "1",

}

TY - JOUR

T1 - Thymic hyperplasia in a child treated with growth hormone

AU - Polgreen, Lynda

AU - Steiner, Marie E

AU - Dietz, Charles A

AU - Manivel, Juan C

AU - Petryk, Anna

PY - 2007/2/1

Y1 - 2007/2/1

N2 - Objective: To report a case of thymic hyperplasia diagnosed three months after initiation of recombinant human growth hormone (GH) for the treatment of GH deficiency. Design: Retrospective chart review was conducted to evaluate the temporal relationship between treatment with GH and thymic enlargement in a 7-year-old girl who had a history of embryonal rhabdomyosarcoma of the nasopharynx diagnosed at the age of 3 years. Results: The diagnosis of GH deficiency was made based on clinical and auxological criteria, an insufficient response to clonidine-arginine stimulation testing (peak GH level of 4.8 μg/L) and low insulin-like growth factor 1 (IGF-1) level (30 ng/mL, -2.7 SD). The patient was started on GH at a dose of 0.3 mg/kg/week. At the initiation of treatment with GH, the baseline growth velocity was 0.8 cm/year (-6.0 SD) and height was 112.5 cm (-1.7 SD). After three months of treatment with GH, her height increased by 4.2 cm (from -1.7 to -1.2 SD), and the IGF-1 level from -2.7 SD to -1.1 SD. A chest CT performed at that time for recurrence surveillance showed 89% increase in thymic volume relative to previous scan before treatment with growth hormone. A thoracoscopic biopsy of the thymus was performed and revealed hyperplasia with normal thymic architecture without evidence of malignancy. Conclusions: The timing of the development of thymic hyperplasia, along with data from in vitro and in vivo animal studies showing that GH and IGF-1 can directly stimulate growth of the thymus, suggests that GH contributed to the development of thymic hyperplasia in this patient.

AB - Objective: To report a case of thymic hyperplasia diagnosed three months after initiation of recombinant human growth hormone (GH) for the treatment of GH deficiency. Design: Retrospective chart review was conducted to evaluate the temporal relationship between treatment with GH and thymic enlargement in a 7-year-old girl who had a history of embryonal rhabdomyosarcoma of the nasopharynx diagnosed at the age of 3 years. Results: The diagnosis of GH deficiency was made based on clinical and auxological criteria, an insufficient response to clonidine-arginine stimulation testing (peak GH level of 4.8 μg/L) and low insulin-like growth factor 1 (IGF-1) level (30 ng/mL, -2.7 SD). The patient was started on GH at a dose of 0.3 mg/kg/week. At the initiation of treatment with GH, the baseline growth velocity was 0.8 cm/year (-6.0 SD) and height was 112.5 cm (-1.7 SD). After three months of treatment with GH, her height increased by 4.2 cm (from -1.7 to -1.2 SD), and the IGF-1 level from -2.7 SD to -1.1 SD. A chest CT performed at that time for recurrence surveillance showed 89% increase in thymic volume relative to previous scan before treatment with growth hormone. A thoracoscopic biopsy of the thymus was performed and revealed hyperplasia with normal thymic architecture without evidence of malignancy. Conclusions: The timing of the development of thymic hyperplasia, along with data from in vitro and in vivo animal studies showing that GH and IGF-1 can directly stimulate growth of the thymus, suggests that GH contributed to the development of thymic hyperplasia in this patient.

KW - Growth hormone deficiency

KW - Hematopoietic cell transplantation

KW - Immune system

KW - Insulin-like growth factor I

KW - Thymic rebound

KW - Thymus

UR - http://www.scopus.com/inward/record.url?scp=33847192050&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33847192050&partnerID=8YFLogxK

U2 - 10.1016/j.ghir.2006.10.005

DO - 10.1016/j.ghir.2006.10.005

M3 - Article

C2 - 17141546

AN - SCOPUS:33847192050

VL - 17

SP - 41

EP - 46

JO - Growth Hormone and IGF Research

JF - Growth Hormone and IGF Research

SN - 1096-6374

IS - 1

ER -