Analysis Of One Case Of Growth Hormone Deficiency Accompanied With Polycystic Ovarian Syndrome And Review Of The Associated Literature

Objective By summarizing the clinical manifestations,examination,diagnosis and treatment of one patient with Adult Growth Hormone Deficiency(AGHD)accompanied with Polycystic Ovarian Syndrome(PCOS),and analyzing how to indentify and deal with adults growth hormone deficiency and PCOS.To improve the acquaintance and understanding of this critical disease.Methods We retrospectively analyzed the clinical features,laboratory examinations and imaging characteristics of a patient of growth hormone deficiency accompanied with polycystic ovarian syndrome,who was hospitalized in the First Affiliated Hospital of Dalian Medical University Hospital in June 27,2016.A brief review of the related literatures were summarized about the diagnosis,treatment and prognosis of this disease.Results This 22-year-old obese female patient,Who was sent to our hospital because of her short stature accompanied with menstrual rare 4 years,amenorrhea for 2 years.This patient was a normal childbirth,but she was underweight and short(unspecified figure)when she was born.She was 131 cm and stopped growing when she was just 10.Her height was lower 3SD than peers in the same area,age,sex and race.So the short stature was diagnosed clearly.The intellectual development had no obvious difference with peers and there was no history of chronic diseases and head trauma.Denying a similar medical history in her family,father’s height 163 cm,mother’s 163 cm and brother’s 166 cm.Both of growth hormone(GH<0.05ng/ml)and Insulin like growth factor-1(IGF-142.30ng/ml)were low.The insulin hypoglycemia test failed to induce hypoglycemia,so we think this was associated with insulin resistance.Next,the arginine test indicated that GH reservation were inadequate,showing a lack of growth hormone.Although the radio graphs both hands and biped showed the closure of the epiphysis,adult growth hormone deficiency could easily causes fat accumulation metabolic abnormalities.This patient got obnorminal abesity,insulin resistance and glucose tolerance,we suggested that small doses of growth hormone could be used to regulate metabolism,and height,weight,waist circumference,body mass index,blood,blood pressure,blood glucose,liver function,blood lipids,thyroid function should be monitor.The dose of growth hormone was adjusted according to clinical response,side effects and insulin-like growth factor-1 level.When she was 13,menarche happened;4 years ago,the menstrual cycle gradually extended and the amount of menstruation gradually decreased;2 years ago,amenorrhea.The diagnosis of secondary amenorrhea was clear.Gynecologic Color Doppler Ultrasound showed that the size of the left ovary was normal and the follicles the largest d=6mm,were more than 12;The size of the right ovary was also normal and the follicles,the largest d=7mm,were more than 12.Serum estradiol 32.00pg/ml was not low,and luteinizing hormone(7.57 m IU/ml)and follicle stimulating hormone(6.51 m IU/ml)were not high.Gynecologic Color Doppler Ultrasonography has not seen the dysgenesis of uterus and ovary,so it can be excluded from amenorrhea caused by congenital ovarian dysplasia syndrome.Although the patient had no hirsutism and acne,and blood testosterone(0.22ng/ml)is not high,gynecologic Color Doppler Ultrasound pointed out polycystic ovary,As a result,PCOS was diagnosed in a comprehensive way.Obesity,no obvious dry mouth,polypodiatosis,polyuria,but the neck and groin have black spiny skin performance,75 g oral glucose tolerance test demonstrated fasting blood glucose was 5.47mmol/L,fasting insulin 43.97 m IU/L,after glucose load 2 hours,blood glucose was 15.01mmol/L,insulin 225.28 m IU/L,glycosylated hemoglobin 5.3%,HOMA-IR 10.69,which illustrated insulin resistance and inpaired glucose tolerance.This patient performed polycystic ovary syndrome caused by insulin resistance.Metformin and progesterone were given oral administration to improve insulin resistance and regulate hormone levels.The level of hormone,blood glucose,insulin,glycosylated hemoglobin were monitored,and the diagnosis and treatment were clear before left hospital.Conclusions : Deficiency of growth hormone in adults results in a syndrome characterized by increased fat mass,impaired quality of life,decreased in bone mass and integrity,insulin resistance and impaired glucose tolerance.AGHD accompanied with PCOS are very heterogeneous condition and poorly understood.Not only growth hormone is a treatment of growth hormone deficiency,but also may improves the ovulation and pregnancy rate of patients on the basis of improving metabolism.