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Predictors of growth response to growth hormone in otherwise normal short children
Insights
Recombinant human growth hormone (GH) therapy improved height velocity in short children. Pretreatment growth velocity and integrated GH concentration (IC-GH) best predict treatment outcomes in children with normal GH response.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Child Development
Background:
- Short stature affects children's growth and development.
- Recombinant human growth hormone (GH) is a treatment option.
- Predicting treatment response is crucial for optimizing outcomes.
Purpose of the Study:
- To evaluate the efficacy of recombinant human GH in short prepubertal children.
- To identify predictors of growth response to GH therapy.
- To compare different doses of GH therapy.
Main Methods:
- Sixty short prepubertal children received daily recombinant human GH (0.1 or 0.05 IU/kg) for 1 year.
- GH reserve was assessed via provocative tests and integrated GH concentration (IC-GH).
- Height velocity and bone age were monitored throughout the study.
Main Results:
- Overall height velocity increased significantly (p < 0.001).
- Higher GH dose (0.1 IU/kg) showed significantly greater growth velocity (p < 0.01).
- Pretreatment height velocity and IC-GH inversely correlated with 1-year growth velocity.
Conclusions:
- Pretreatment growth velocity and IC-GH are key predictors of GH therapy response in short children with normal GH secretion.
- Children with low pretreatment growth velocity and low IC-GH benefit most from GH therapy.
- GH therapy effectively increases height velocity in short children, with dose-dependent effects.
Abstract:
Sixty prepubertal short children (39 boys) with heights less than 2 SD for age and gender were treated daily for 1 year with recombinant human growth hormone (GH), either 0.1 IU/kg (group 0.1, n = 32) or 0.05 IU/kg (group 0.05, n = 28). Reserve of GH was determined by at least one GH provocative stimulus and 24-hour continuous blood withdrawal to determine the integrated concentration of GH (IC-GH). All participants had a GH response to provocative tests greater than 10 micrograms/L. The height velocity (mean +/- SD) of the group as a whole increased from 4.46 +/- 1.02 to 7.59 +/- 1.65 cm/yr (p less than 0.001). The growth velocity of group 0.1 was significantly greater than that of group 0.05 (8.1 +/- 1.5 vs 7.0 +/- 1.65 cm/yr; p less than 0.01). Bone age did not advance more than 1 year during the treatment period. Growth velocity after 1 year of GH therapy was inversely correlated with the IC-GH in both groups, as was the pretreatment height velocity. We found no correlation of growth velocity during GH therapy with other measures such as parental heights, bone age/chronologic age ratio, maximal GH response to provocative tests, chronologic age, or pretreatment insulin-like growth factor I levels. We conclude that the best predictors for the 1-year growth outcome of short children with a normal GH response to provocative tests are the pretreatment growth velocity and the IC-GH. The short-term benefit from GH therapy in children with a normal growth velocity and a normal IC-GH is poor, whereas marked growth acceleration is noted in children with a low growth velocity and a low 24-hour IC-GH.