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Voice Abnormality in Adults with Congenital and Adult-Acquired Growth Hormone Deficiency

North Western Medical Physics (C.M., K.M.) and Department of Endocrinology (S.S.), Christie Hospital, M20 4BX Manchester, United Kingdom; North Western Medical Physics (T.W.), Withington Hospital, M20 2LR Manchester, United Kingdom; and Division of Endocrinology, Metabolism, and Molecular Medicine (H.M., G.B.), Northwestern University; Feinberg School of Medicine, Chicago, Illinois 60611

Address all correspondence and requests for reprints to: Gerhard Baumann, M.D., Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, Illinois 60611. E-mail: gbaumann{at}northwestern.edu; or Professor C. J. Moore, North Western Medical Physics, Christie Hospital National Health Service Trust, Wilmslow Road, Withington, Manchester M20 4BX, United Kingdom. E-mail: chris.moore{at}physics.cr.man.ac.uk.

Context: Adult males with congenital, untreated, severe GH deficiency (GHD) due to genetic GHRH receptor deficiency exhibit distinctive, high-pitched, and raspy voice characteristics.

Objective/Design: To determine the physical underpinning of this phenomenon, we performed voice recordings, translarynx impedance measurements, spectral analysis, and estimates of spectral complexity [approximate entropy (ApEn)] in four affected men. Results were compared with those obtained in four men with untreated adult-onset GHD and a normal male population.

Results: Congenital GHD subjects had a high-pitched voice with a fundamental frequency typical of normal females (174–266 Hz). Their frequency spectra were characterized by abnormal harmonics, with reversal/interruption of the normal amplitude decay among higher-order harmonics, findings consistent with a creaky quality of the voice. Patients with adult-onset GHD, acquired at ages 31, 38, and 40 yr, had a normal male pitch (fundamental frequency, 117–154 Hz) but pathologically low ApEn values, corresponding to a breathy quality of the voice and suggesting abnormal vocal fold function. A fourth patient who acquired GHD at age 22 yr had a pitch intermediate between male and female, high ApEn, and a spectral pattern similar to the congenital GHD patients.

Conclusions: This study demonstrates an effect of GH on laryngeal size and vocal fold compliance that results in a high pitch and disordered spectral quality. The time of onset of GHD determines which type of abnormality predominates.