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The effects of growth hormone therapy on spontaneous sexual development
R Stanhope1, A Albanese, P Hindmarsh
1Medical Unit, Institute of Child Health, London, UK.
Insights
Children with isolated growth hormone deficiency treated with growth hormone (GH) showed faster pubertal maturation. Optimizing final height may require manipulating puberty onset and duration alongside GH therapy.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Pubertal Development
Background:
- Isolated growth hormone (GH) deficiency affects childhood growth.
- Growth hormone therapy is a standard treatment for GH deficiency.
- Understanding GH's impact on pubertal maturation is crucial for optimizing final height.
Purpose of the Study:
- To investigate the effect of different growth hormone (GH) dosages on pubertal maturation in children with isolated GH deficiency.
- To assess whether manipulating GH dosage during puberty impacts final height prognosis.
Main Methods:
- Prospective randomized study involving 52 children with isolated GH deficiency.
- Patients received GH at 15 IU/m2/week, randomized to unaltered or doubled dose (30 IU/m2/week) at pubertal onset.
- A separate cohort of 16 short normal children received GH (25 IU/m2/week) for comparison.
Main Results:
- Boys with isolated GH deficiency showed no significant growth rate alteration but faster pubertal maturation with either GH dose.
- The study cohort had too few females for meaningful analysis.
- Short normal children treated with GH also exhibited accelerated pubertal maturation.
Conclusions:
- Growth hormone therapy in children with isolated GH deficiency can accelerate pubertal maturation.
- Achieving optimal final height may necessitate therapeutic manipulation of puberty's onset and duration.
- GH treatment's effects on pubertal events might counterbalance prepubertal growth improvements, impacting final height prognosis.
Abstract:
We have carried out a prospective randomised study in 52 (46 male, 6 female) children with isolated growth hormone (GH) deficiency treated with a GH regimen of 15 IU/m2/week administered as a daily subcutaneous injection. At the onset of the pubertal growth spurt, the patients were randomised to receive either an unaltered regimen (26 males, 1 female) or 30 IU/m2/week (20 males, 5 females). There was no change in the frequency of GH administration. The number of females in this study was too small to give a meaningful result. In contrast, the boys treated with either dose regimen showed no significant alteration in growth rate, but there was a faster than normal progression in pubertal maturation. It is concluded that the optimum final height of children with isolated GH deficiency may not be achieved in patients without the therapeutic manipulation of the onset and/or duration of puberty. 16 short normal children (9 males, 7 females) were treated with GH in a regimen of 25 IU/m2/week (range: 20-30) as a daily subcutaneous injection. The mean age for the onset of GH treatment was 11.5 and 11.0 years in the boys and girls, respectively. Our data suggest that both boys and girls had a more rapid rate of pubertal maturation than normal. It may be that in terms of final height prognosis, the events of puberty related to GH treatment counterbalance the improvement in growth prognosis during prepuberty.