持续未经治疗的垂体功能减退症会导致终身高严重不足。未经治疗的儿童达到的终身高标准差分值 (SDS) 为 -4 至 -6。[28]Wit JM, Kamp GA, Rikken B. Spontaneous growth and response to growth hormone treatment in children with growth hormone deficiency and idiopathic short stature. Pediatr Res. 1996;39:295-302.http://www.ncbi.nlm.nih.gov/pubmed/8825803?tool=bestpractice.com[29]Ranke MB, Price DA, Albertsson-Wikland K, et al. Factors determining pubertal growth and final height in growth hormone treatment of idiopathic growth hormone deficiency: analysis of 195 patients of the Kabi Pharmacia International Growth Study. Horm Res. 1997;48:62-71.http://www.ncbi.nlm.nih.gov/pubmed/9251922?tool=bestpractice.com
GHD 对心血管疾病发病和死亡的长期影响尚不明确。但是,GHD 成人患者的脂肪量会升高,去脂体重和骨重会降低,经常超重并且脂质升高。他们通常情绪低落,生活质量受到影响。GH 治疗可以逆转和减少诸多异常情况。[77]Amato G, Carella C, Fazio S, et al. Body composition, bone metabolism, and heart structure and function in growth hormone (GH)-deficient adults before and after GH replacement therapy at low doses. J Clin Endocrinol Metab. 1993;77:1671-1676.http://www.ncbi.nlm.nih.gov/pubmed/8263158?tool=bestpractice.com[78]Carroll PV, Christ ER, Bengtsson BA, et al. Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. Growth Hormone Research Society Scientific Committee. J Clin Endocrinol Metab. 1998;83:382-395.http://press.endocrine.org/doi/full/10.1210/jcem.83.2.4594http://www.ncbi.nlm.nih.gov/pubmed/9467546?tool=bestpractice.com与中断治疗相比,持续治疗可以改善成人骨密度。因此,将来可将治疗例行推荐给患有严重 GHD 的成人。
在特发性单一的 GHD 患者中,发现垂体后叶未下降也可视为永久性 GHD 的特定标记[79]Maghnie M, Ghirardello S, Genovese E. Magnetic resonance imaging of the hypothalamus-pituitary unit in children suspected of hypopituitarism: who, how and when to investigate. J Endocrinol Invest. 2004;27:496-509.http://www.ncbi.nlm.nih.gov/pubmed/15279086?tool=bestpractice.com(虽然其他研究已表明情况并非总是如此),[80]Léger J, Danner S, Simon D, et al. Do all patients with childhood-onset growth hormone deficiency (GHD) and ectopic neurohypophysis have persistent GHD in adulthood? J Clin Endocrinol Metab. 2005;90:650-656.http://press.endocrine.org/doi/full/10.1210/jc.2004-1274http://www.ncbi.nlm.nih.gov/pubmed/15546901?tool=bestpractice.com并且它与患者发展为联合垂体激素缺乏症 (CPHD) 的风险比发展为单一的 GHD 的风险高 2 倍相关。[81]Pellini C, di Natale B, De Angelis R, et al. Growth hormone deficiency in children: role of magnetic resonance imaging in assessing aetiopathogenesis and prognosis in idiopathic hypopituitarism. Eur J Pediatr. 1990;149:536-541.http://www.ncbi.nlm.nih.gov/pubmed/2112091?tool=bestpractice.com[82]Bozzola M, Mengarda F, Sartirana P, et al. Long-term follow-up evaluation of magnetic resonance imaging in the prognosis of permanent GH deficiency. Eur J Endocrinol. 2000;143:493-496.http://www.eje-online.org/content/143/4/493.longhttp://www.ncbi.nlm.nih.gov/pubmed/11022195?tool=bestpractice.com[83]Chen S, Léger J, Garel C, et al. Growth hormone deficiency with ectopic neurohypophysis: anatomical variations and relationship between the visibility of the pituitary stalk asserted by magnetic resonance imaging and anterior pituitary function. J Clin Endocrinol Metab. 1999;84:2408-2413.http://press.endocrine.org/doi/full/10.1210/jcem.84.7.5849http://www.ncbi.nlm.nih.gov/pubmed/10404812?tool=bestpractice.com此外,与单一的 GHD 相比,垂体柄缺失与 CPHD 相关。[2]Mehta A, Hindmarsh PC, Mehta H, et al. Congenital hypopituitarism: clinical, molecular and neuroradiological correlates. Clin Endocrinol (Oxf). 2009;71:376-382.http://www.ncbi.nlm.nih.gov/pubmed/19320653?tool=bestpractice.com[82]Bozzola M, Mengarda F, Sartirana P, et al. Long-term follow-up evaluation of magnetic resonance imaging in the prognosis of permanent GH deficiency. Eur J Endocrinol. 2000;143:493-496.http://www.eje-online.org/content/143/4/493.longhttp://www.ncbi.nlm.nih.gov/pubmed/11022195?tool=bestpractice.com这些数据表明 MRI 对患有单一的 GHD 的患者可用于预后判断。一般情况下,如患有完全垂体功能减退症相关的 GHD,则其成年期可能患 GH 缺乏症。