THE SIGNIFICANCE OF LABORATORY CLASSIFICATION OF ISOLATED GROWTH HORMONE DEFICIENCY. (original) (raw)
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No Improvement of Adult Height in Non-growth Hormone (GH) Deficient Short Children with GH Treatment
Clinical Pediatric Endocrinology, 2006
It is still in doubt whether the standard-dose growth hormone (GH) used in Japan (0.5 IU/ kg/week, 0.167 mg/kg/week) for growth hormone deficiency is effective for achieving significant adult height improvement in non-growth hormone deficient (non-GHD) short children. We compared the growth of GH-treated non-GHD short children with that of untreated short children to examine the effect of standard-dose GH treatment on non-GHD short children. GH treatment with recombinant human growth hormone (rhGH) was started before the age of 11 yr in 64 boys and 76 girls with non-GHD short stature registered at the Foundation for Growth Science who have now reached their adult height. In 119 untreated boys and 127 untreated girls whose height standard deviation score (SDS) was below -2 SD at the age of 6 yr, height growth was followed until 17 yr. Height SDS was significantly lower before GH treatment in the GH-treated group than at the age of 6 yr in the untreated group, in both sexes. Adult height and adult height SDS were significantly greater in the untreated group than in the GH-treated group, in both sexes, although the change in height SDS did not differ significantly. Height SDS was significantly lower before GH treatment in the GH-treated group than at the age of 6 yr in the untreated group, so 57 boys and 57 girls whose height SDS at the age of 6 yr in the untreated group closely matched the height SDS before GH treatment in the GHtreated group were chosen for comparison. Height SDS did not differ significantly between the GH-treated group before GH treatment and the untreated group at the age of 6 yr, nor were there differences between these subgroups in adult height, adult height SDS, or height SDS change, in either sex. The effect of GH treatment is reported to be dose-dependent and doses over 0.23 mg/kg/ week are reported to be necessary to improve adult height in non-GHD short children. Currently, the GH dose is fixed at 0.175 mg/kg/week in Japan, and we expected to find, and indeed concluded, that ordinary GH treatment in Japanese, non-GHD short children does not improve adult height.
Oman Medical Journal, 2017
M any conditions of short stature are classified as idiopathic due to the inability to identify the underlying etiology. 1,2 Families of children with idiopathic short stature (ISS) seek medical intervention, and growth hormone (GH) therapy is often requested. Several studies have assessed the efficacy and safety of GH therapy in ISS over the past two decades. Nonetheless, the use of GH treatment for this indication is still debatable. This issue, along with the high cost of GH treatment, 2,3 has resulted in a denial of health insurance coverage in many regions, including the United Arab Emirates (UAE). We sought to evaluate the effect of GH therapy in ISS patients in our region and compare it to the effect seen in patients with GH deficiency (GHD), the first and most commonly approved indication for GH. Given the high rate of consanguinity in our local society 4 and its potential effect on the underlying etiologies of ISS, we assumed that the outcome of GH treatment in our patient population with ISS might be different from what has been reported in other cohorts. 3,5,6 This is the first study to assess the outcome of GH therapy on final adult height in patients with ISS in UAE and Gulf region.
Final height in non-growth hormone deficient children treated with growth hormone
Clinical Endocrinology, 1997
OBJECTIVE To evaluate the final height of nongrowth hormone deficient (N-GHD) children treated with growth hormone (GH). DESIGN Multicentre retrospective study. PATIENTS 71 (54M/17F) N-GHD children (peak GH after pharmacological stimulation >14-24 mU/l) who had been treated for 4 . 19 Ϯ 0 . 14 years with GH (0 . 69 Ϯ 0 . 02 IU/kg/week). MEASUREMENTS Height (H) and height velocity (HV) expressed as standard deviation score (SDS) for chronological age (CA) and bone age (BA), BA/CA ratio, and predicted adult height (PAHSDS) were evaluated before and during treatment, and at each pubertal stage. Target height (TH), and final height (FH) were also calculated, and expressed as SDS. RESULTS In the whole group, HSDS for CA increased significantly after the first year on GH, and remained significantly increased for 4 years. This did not occur to HSDS for BA, owing to a significant increase in BA/ CA after the first year of therapy. In addition, this increase coincided with stages 4 and 5 of puberty. HVSDS for CA and BA also increased significantly after the first year of treatment, and remained significantly elevated for 4 years. PAHSDS did not change significantly during treatment. FHSDS (¹1 . 69 Ϯ 0 . 07) was similar to PAHSDS (¹1 . 6 Ϯ 0 . 12) and target height (THSDS) (¹1 . 46 Ϯ 0 . 08). FHSDS was уTHSDS in 36 . 6% of the patients, and уinitial PAHSDS in 34 . 5%. Male patients were subdivided into 2 groups (A and B). Patients in Group A (n ¼ 26) started treatment at puberty, while group B (n ¼ 28) consisted of subjects who started therapy during prepubertal years. Height, height velocity and predicted adult height showed the same pattern as in the whole group, in each subgroup. BA/CA advanced significantly in group A after the second year on GH and in group B, after at least 3 years of therapy. FHSDS, THSDS, and PAHSDS were similar in both groups (¹1 . 7 Ϯ 0 . 13, ¹1 . 29 Ϯ 0 . 2 and ¹1 . 39 Ϯ 0 . 15 in group A and ¹1 . 48 Ϯ 0 . 11, ¹1 . 85 Ϯ 0 . 15 and ¹1 . 36 Ϯ 0 . 12 in group B, respectively). However, in group B (prepubertal), FHSDS was уinitial PAHSDS in 60% of the patients and уTHSDS in 40 . 7%, while in group A (pubertal), FHSDS was уinitial PAHSDS only in 22 . 7% of the patients and уTHSDS in 34 . 6%. FHSDS was found to be correlated with THSDS, PAHSDS at the onset of treatment, and after 1 year of treatment. The age at the beginning of puberty, and the duration of puberty were appropriate in all groups. CONCLUSIONS GH treatment was effective in increasing height velocity of short non-GH-deficient children, but final height was not definitely improved with respect to initial predicted adult height.
The Journal of Clinical Endocrinology & Metabolism, 2006
Context: Treatment with GH has been used to correct the growth deficit in children with GH deficiency (GHD). Although successful in increasing height velocity, such treatment often falls short of helping patients achieve full genetic height potential. Objective: This study set out to analyze near-final height (FH) data from a cohort of GH-treated children with idiopathic GHD. Design, Setting, and Participants: Of 1258 evaluable patients in the Pfizer International Growth Database (KIGS) with GHD, 980 were of Caucasian origin, and 278 were of Japanese origin; 747 had isolated GHD (IGHD), and 511 had multiple pituitary hormone deficiencies (MPHD). Main Outcome Measures: Near-FH, relation to midparental height, and factors predictive of growth outcomes were the main outcome measures. Results: Median height SD scores (SDS) at the start of treatment were Ϫ2.4 (IGHD) and Ϫ2.9 (MPHD) for Caucasian males and Ϫ2.6 (IGHD) and Ϫ3.4 (MPHD) for females, respectively; comparable starting heights were Ϫ2.9 (IGHD) and Ϫ3.6 (MPHD) for Japanese males and Ϫ3.3 (IGHD) and Ϫ4.0 (MPHD) for females, respectively. Corresponding near-adult height SDS after GH treatment were Ϫ0.8 (IGHD) and Ϫ0.7 (MPHD) for Caucasian males and Ϫ1.0 (IGHD) and Ϫ1.1 (MPHD) for females, respectively; and Ϫ1.6 (IGHD) and Ϫ1.9 (MPHD) for Japanese males and Ϫ2.1 (IGHD) and Ϫ1.8 (MPHD) for females, respectively. Differences between near-adult height and midparental height ranged between Ϫ0.6 and ϩ0.2 SDS for the various groups, with the closest approximation to MPH occurring in Japanese males with MPHD. The first-year increase in height SDS and prepubertal height gain was highly correlated with total height gain, confirming the importance of treatment before pubertal onset. Conclusions: It is possible to achieve FH within the midparental height range in patients with idiopathic GHD treated from an early age with GH, but absolute height outcomes remain in the lower part of the normal range. Patients with MPHD generally had a slightly better long-term height outcome.
Endokrynologia Polska
Assessment of growth hormone (GH) secretion is based on stimulation tests. Low GH peaks in stimulation tests, together with decreased insulin-like growth factor-I (IGF-I) secretion, confirm a diagnosis of GH deficiency (GHD). However, limitations in interpreting the test results and discrepancies between GH and IGF-I secretion in particular patients have both been reported. GH therapy should improve the prognosis of adult height (PAH). The aim of the study was to compare the deficit of height at diagnosis, IGF-I secretion and PAH in children with either decreased (in varying degrees of severity) or normal GH secretion in stimulation tests. The analysis comprised 540 short children (373 boys, 167 girls), aged 11.7 +/- 3.2 years. In all the patients two GH stimulation tests were performed, IGF-I serum concentration was measured, bone age was assessed and PAH was calculated. According to the GH peak in the two stimulation tests, the patients were classified into the following groups: s...
Adult Height in Patients Treated for Isolated Growth Hormone Deficiency: Role of Birth Weight
Hormone Research, 2005
range -2.87 to -2.29) and -0.73 (range -1.30 to 0.14) respectively (p ! 0.000001) and interestingly also for body mass index SDS (BMI SDS) at retesting, 0.08 (range 0.30 to -1.51) and 0.61 (range 0.73 to -1.10) respectively (p ! 0.04). We observed no signifi cant differences between groups A and B in height (expressed as the SDS for chronological age, height SDS) at diagnosis (p = 0.75), height SDS at start of puberty (p = 0.51), height SDS at retesting (p = 0.50), target height SDS (TH SDS) (p = 0.47), AH SDS (p = 0.92), corrected height SDS (height SDS -TH SDS) (p = 0.60), BMI SDS at diagnosis (p = 0.25), GH dosage (p = 0.34) and therapy duration (p = 0.52). GH treatment with a standard dose in short IGHD children leads to a normalization of AH without any signifi cant difference between SGA and AGA patients.
Final height of patients treated for isolated GH deficiency: examination of 83 patients
European Journal of Endocrinology, 1997
The aim of the present study was to evaluate retrospectively the influence of various auxological and laboratory parameters on final height in a group of GH-deficient children after replacement therapy and to compare their final height with that of a group of short children with normal GH secretion and hence not treated. The final height was evaluated of 83 patients (51 males and 32 females) affected by idiopathic isolated GH deficiency and treated with recombinant human GH (hGH) for 2-7 years. Inclusion criteria at the start of treatment were short stature (mean height for chronological age in standard deviation score (SDS) -2.21) due to idiopathic isolated GH deficiency (GH peak…