Growth parameters and predictors of growth in short children with and without growth hormone (GH) deficiency treated with human GH: a randomized controlled study (original) (raw)
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The Journal of Clinical Endocrinology & Metabolism, 2005
In children, GH secretion and sensitivity to GH are influenced by developmental changes. It is not clear whether the response to GH in very young children with GH deficiency (GHD) is the same as that in older, prepubertal children. A cohort of 265 children (180 males and 85 females) with idiopathic GHD from KIGS (Pfizer International Growth Database), with treatment started at less than 3 yr of age (mean age, 1.9 yr; group I) was compared with a cohort of 509 children (331 males and 178 females; group II) with treatment started at 7-8 yr of age (mean age, 7.5 yr). The following differences (P < 0.01) were found (given in mean values) between groups I and II at the start of GH treatment: 9% vs. 5% breech delivery, 38% vs. 14% multiple pituitary hormone deficiency, 4.2 vs. 5.9 ng/ml maximum GH in response to tests, ؊0.1 vs. ؊0.8 midparental height (MPH) SD score (SDS), ؊3.1 vs. ؊2.5 height SDS, 0.83 vs. 0.66 IU/kg⅐wk GH dose. After the first year of GH, the results were: 13.3 vs. 8.6 cm/yr height velocity, and 1.7 vs. 0.6 maximum change in height SDS. Using the previously developed growth prediction models for prepubertal children with idiopathic GHD more than 2 yr of age, our analysis revealed differences in the indexes of responsiveness in prediction models (Studentized residuals SDS, 0.7 vs.؊0.3) and strikingly higher responsiveness to treatment among the young cohort, but with large scatter. Thus, new prediction models of height velocity (centimeters per year) were derived by means of mul-
Arquivos Brasileiros de Endocrinologia & Metabologia, 2014
Objectives: GH therapy is still controversial, except in severe GH deficiency (SGHD). The objective of this study was to compare the response to growth hormone (GH) therapy in children with partial GH insensitivity (PGHIS) and mild GH deficiency (MGHD) with those with SGHD.Subjects and methods: Fifteen PGHIS, 11 MGHD, and 19 SGHD subjects, followed up for more than one year in the Brazilian public care service, were evaluated regarding anthropometric and laboratory data at the beginning of treatment, after one year (1 st year) on treatment, and at the last assessment (up to ten years in SGHD, up to four years in MGHD, and up to eight years in PGHIS).Results: Initial height standard deviation score (SDS) in SGHD was lower than in MGHD and PGHIS. Although the increase in 1 st year height SDS in comparison to initial height SDS was not different among the groups, height-SDS after the first year of treatment remained lower in SGHD than in MGHD. There was no difference in height-SDS at t...
THE SIGNIFICANCE OF LABORATORY CLASSIFICATION OF ISOLATED GROWTH HORMONE DEFICIENCY.
International Journal of Advanced Research (IJAR), 2019
Background:Short Stature (SS) is defined as a standing height more than 2 standard deviations (SDs) below the mean (or below the 2.5 percentile) for sex. Causes of short stature include familial short stature, constitutional delay, endocrinopathies (e.g. Growth Hormone Deficiency), chronic systemic diseases and syndromic causes of SS. Aim of the study:To show the significance of the laboratory classification of isolated GHD to help for adjustment of dosages and duration of GH treatment. Methods:A retrospective study of children with isolated Growth Hormone Deficiency (GHD) who have been registered in GH Unit in the Al-Zahraa teaching hospital for Maternity and Children at Al Najaf city, Iraq from March 2012 to September 2016. A total number of 122 patients included in this study all of them on GH replacement .The population study were classified according to post-stimulation peak serum GH level into Mild GHD (>8 − <10ng/ml ) ,Moderate GHD (≥5 − ≤ 8ng/ml) and Severe GHD (< 5ng/ml). The cases also grouped according to age into 3 age groups (Group A: < 6 years, Group B: ≥ 6 − <11 years and Group C: ≥11years), sex and residency. In each of these age groups, comparison done between Mild, Moderate and severe isolated GHD. Results:This study showed that in Group A (35 cases) there was no statistically significant difference between Mild, Moderate and Severe isolated GHD regarding pre-treatment height and rate of the height velocity after the first year of GH treatment (p-value=0.6 for pre-treatment height and 0.74 for rate of height velocity H.V.). In Group B (50 cases) and Group C (37 cases) also no statistically significant difference, Group B (p-value=0.53 for pre-treatment height and p-value= 0.92 for H.V.) and Group C (p-value=0.63 for pre-treatment height, p-value= 0.92 for H.V.) Conclusion:No significance of classification of short stature children with isolated GHD according to stimulated peak GH value with cut-off less 10 ng/ml.
Clinical Endocrinology, 2003
To compare the relative utility of GH stimulation tests and assays of spontaneous GH secretion as predictors of change in height standard deviation score at the end of GH treatment in children with short stature. We retrospectively studied 116 children (67 boys and 49 girls) with subnormal growth rates and short stature, defined as a height of more than 2SD below the mean for age and sex. The patients were classified according to their pattern of findings on baseline pharmacological GH stimulation tests and a 12-h assay of nocturnal spontaneous GH secretion. Twenty-eight patients (24%) had normal hormone levels by both methods (group I); 14 (12%) had normal levels by stimulation tests but subnormal levels by the physiological assay (group II); 48 (41%) had subnormal levels on pharmacological stimulation, with normal physiologic levels (group III); and 26 (22%) had subnormal levels by both methods (group IV). All children in groups II and IV, and 27 in group III, designated IIIb, were treated with recombinant GH at 0.7 U (0.23 mg/kg) of body weight per week. GH secretory patterns were related to final height SD scores and other growth parameters, after the patients had attained their adult stature 6.7 +/- 2.2 years (SD) after GH evaluation. The five groups were similar with respect to mean baseline height SD scores for chronological as well as bone age. Whether assessed as absolute or parentally adjusted (relative) values, mean gains in height SD scores were significantly greater in treated patients with physiological hormone deficiency (groups II and IV) than in those with normal hormone levels (group I, untreated controls). Relative height gains were 1.03 +/- 1.45 cm (6.6 +/- 9.28 cm) and 1.85 +/- 1.21 cm (SDS; 11.8 +/- 7.74 cm) in groups II and IV respectively, compared with only 0.11 +/- 0.42 cm (0.7 +/- 2.68 cm) in group I (P &amp;amp;amp;lt; 0.01 and P &amp;amp;amp;lt; 0.001). GH treatment failed to improve either the absolute or parentally adjusted final height of patients with GH deficiency by stimulation tests but normal levels by physiological assay. Long-term administration of GH to short children with normal spontaneous GH secretion is not associated with an appreciable increase in adult height.