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Insulin-like growth factor and growth hormone secretion in juvenile chronic arthritis
R C Allen1, M Jimenez, C T Cowell
1Department of Rheumatology, Children's Hospital, Camperdown, Sydney, Australia.
Insights
Juvenile chronic arthritis in children causes significant growth retardation, independent of steroid use. Low Insulin-like Growth Factor 1 (IGF-1) levels are linked to weight deficits, not height, suggesting multifactorial causes.
Area of Science:
- Pediatrics
- Endocrinology
- Rheumatology
Background:
- Juvenile chronic arthritis (JCA) can lead to growth disturbances in children.
- Disease activity, rather than corticosteroid treatment, is implicated in JCA-related growth retardation.
Purpose of the Study:
- To investigate Insulin-like Growth Factor 1 (IGF-1) concentrations and their relationship with growth parameters in children with JCA.
- To assess growth hormone secretion patterns in JCA patients with low IGF-1 levels.
Main Methods:
- Anthropometric assessment and measurement of IGF-1 concentrations in 23 children with JCA.
- Standardized z-scores were used to compare height and weight with age/sex matched means.
- Overnight growth hormone secretory profiles were analyzed in 10 patients.
Main Results:
- Significant decreases in height and weight z-scores were observed in children with JCA.
- Eight patients exhibited low IGF-1 z-scores (< -2.00), associated with low weight z-scores but not height.
- Growth hormone secretion was generally normal, with increased pulse frequency noted in some patients.
Conclusions:
- Disease activity in JCA is a primary driver of growth retardation.
- Low IGF-1 concentrations in JCA are likely multifactorial, possibly influenced by nutritional status, and do not typically indicate severe endocrinological dysfunction.
- Catch-up growth can occur with normalization of IGF-1 levels.
Abstract:
Insulin-like growth factor (IGF-1) concentrations were determined in a series of 23 children with juvenile chronic arthritis in conjunction with anthropometric assessment. When standardised z scores were used significant decreases in height and weight were shown in comparison with the normal age/sex matched means. Severe growth disturbance was seen, particularly in those with prolonged disease duration, which was independent of corticosteroid treatment, indicating disease activity itself is a major factor in the growth retardation. Eight children had low IGF-1 z scores--that is, less than -2.00 from age/sex matched mean. Low IGF-1 z scores were associated with low weight z scores but not with low height z scores. Overnight growth hormone secretory profiles were determined in 10 patients, including seven with low IGF-1, and showed generally normal secretion in all but one patient, who subsequently attained normal concentrations coincident with catch up growth. Increased pulse frequency of overnight secretion was commonly seen. Low IGF-1 concentrations probably result from varying factors, particularly nutritional, but do not reflect marked endocrinological abnormalities in most patients.