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[Growth hormone treatment in short stature of unknown origin]
1Afd. Kindergeneeskunde, Universiteitskliniek voor Kinderen en Jeugdigen Het Wilhelmina Kinderziekenhuis, Utrecht.
Insights
Growth hormone therapy accelerates growth and bone maturation in children with idiopathic short stature. While daily injections are most effective, the overall increase in predicted adult height is modest, with significant individual variations.
Area of Science:
- Pediatric Endocrinology
- Growth Disorders
- Skeletal Maturation
Context:
- Idiopathic short stature (ISS) in children is often categorized as familial short stature or constitutional delay of growth and adolescence.
- Growth hormone (GH) administration is a therapeutic option for ISS, influencing both linear growth and skeletal maturation.
- Understanding the long-term efficacy and predictability of GH treatment is crucial for clinical decision-making.
Purpose:
- To evaluate the efficacy of growth hormone (GH) therapy in children with idiopathic short stature (ISS).
- To assess the impact of GH on growth acceleration versus bone age advancement.
- To investigate inter-individual variability in treatment response and the predictability of outcomes.
Summary:
- Growth hormone (GH) administration in children with idiopathic short stature (ISS) accelerates linear growth but also hastens bone maturation.
- A Dutch prospective study indicated that daily GH injections are more efficacious than thrice-weekly administration, demonstrating a dose-response relationship.
- The average predicted adult height increase was modest (3 cm over 4-5 years), with significant inter-individual differences in growth and bone maturation response that were not predictable by clinical or biochemical factors.
Impact:
- GH therapy offers a modest benefit in final height for children with ISS, highlighting the importance of individualized treatment approaches.
- The findings underscore the limitations in predicting treatment outcomes, necessitating further research into predictive biomarkers.
- This study informs clinical practice regarding the expectations and variability associated with GH treatment for short stature in children.
Abstract:
Most children with idiopathic short stature can be classified under the diagnoses familial short stature and constitutional delay of growth and adolescence. Administration of growth hormone leads to faster growth, but also faster bone maturation. Daily injections are more efficacious than three injections per week. There is a dose-response relationship. In a Dutch prospective study, the acceleration of growth was only slightly more than bone age advance, so that the average predicted adult height increased only by 3 cm over a period of 4-5 year. In an untreated control group final height was 1 cm lower than predicted. There were great inter-individual differences in terms of growth and bone maturation, which could not be predicted on the basis of clinical and biochemical variables.