O ombro na deficiência congênita do hormônio do crescimento

• Ano de defesa: 2023
• Autor(a) principal: Junior, Hertz Tavares dos Santos
• Orientador(a): Oliveira, Manuel Hermínio de Aguiar
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Programa de Pós-Graduação: Pós-Graduação em Ciências da Saúde
• Palavras-chave em Português: GH; Receptor de GHRH; IGF1; Tendão supraespinal; Espaço subacromial; Ombro
• Palavras-chave em Inglês: GH; GHRH receptor; IGF-1; Supraspinatus tendon; Subacromial space; Shoulder
• Link de acesso: https://ri.ufs.br/jspui/handle/riufs/23336

The shoulder is the most mobile joint in the entire human body. Arm elevation requires the integrity of a set of muscles, bones and tendons. Individuals with short stature often need to raise their arms above the shoulder girdle and may have functional restriction or shoulder injuries. The impact of isolated growth hormone (GH) deficiency (IGHD) on joints is not yet well defined. A large cohort of individuals with marked short stature due to severe IGHD, caused by a homozygous mutation (c.57+1G→A) in the GHRH receptor (GHRHR) gene (GHRHR OMIM n.618157) has been described in the Brazilian city of Itabaianinha. These IGHD individuals have a higher prevalence of hip joint and genu valgus problems than local controls, with no apparent clinical significance. Despite reduced areal bone mineral density (BMD) (due to reduced bone size), they have volumetric BMD like normal controls. The joint range of motion in these individuals with IGHD was normal in the elbows, knees and hips, but has not yet been evaluated in the shoulder. The objective of this work was to evaluate the structure of the shoulder and its degree of disability in these adult individuals with untreated IGHD. A cross-sectional study was carried out in 20 GH-naive IGHD subjects and 20 age- matched controls. They underwent shoulder ultrasonography (US) and completed the Hand, Shoulder, and Arm Disability Questionnaire (DASH). The thickness of the anterior, medial and posterior portions of the supraspinatus tendon and subacromial space was measured, and the number of individuals with tendinosis or rupture of the supraspinatus tendon was recorded by US. As expected, the absolute US measurements were lower in IGHD, but the magnitude of the reduction was most pronounced in the thickness of the anterior portion of the supraspinatus tendon. The number of individual with tears was higher in the control group (p=0.02). DASH score was similar between IGHD and controls, but IGHD subjects complained less of symptoms (p=0.002). In conclusion, adults with lifetime IGHD have fewer tendinous injuries than controls. and complain less of problems in performing upper extremity activities.