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Treatment of short normal children with growth hormone--a cautionary tale?
J M Walker1, S A Bond, L D Voss
1Department of Paediatrics, Southampton General Hospital, UK.
Insights
Recombinant human growth hormone (rhGH) therapy in short children significantly altered body composition, increasing lean body mass and decreasing fat mass. However, rhGH did not show a specific effect on resting energy expenditure per kilogram of lean body mass.
Area of Science:
- Pediatric Endocrinology
- Metabolic Research
- Growth Hormone Therapy
Background:
- Short normal children often receive growth hormone therapy.
- Understanding the metabolic impact of recombinant human growth hormone (rhGH) is crucial.
Purpose of the Study:
- To investigate the effects of rhGH on body composition and resting energy expenditure (REE) in short normal children.
- To determine if rhGH influences REE independent of changes in lean body mass (LBM).
Main Methods:
- Randomized controlled trial involving 41 short normal children.
- Intervention group received daily rhGH injections (30 IU/m2 per week) for 6 months.
- Control group received no treatment; body composition and REE were measured.
Main Results:
- rhGH therapy led to significant fat mass loss (up to 76%) and LBM increase (up to 25%) compared to controls.
- LBM was the primary determinant of total REE (kJ/24 h).
- While total REE increased in treated children, REE per kg LBM did not differ significantly from the untreated group.
Conclusions:
- rhGH significantly impacts body composition in short children but does not appear to have a specific effect on resting energy expenditure per unit of lean body mass.
- The profound metabolic effects warrant caution in using rhGH for otherwise healthy short children until mechanisms are fully understood.
Abstract:
41 short normal children were randomly allocated either to daily injections of growth hormone (rhGH) at 30 IU/m2 per week or to no treatment. 6 months of rhGH therapy produced up to 76% loss of fat mass and up to 25% increase in lean body mass (LBM). These changes were significantly different from those in the untreated group. LBM was the main determinant of resting energy expenditure (REE) expressed as kJ/24 h. REE expressed as kJ/kg LBM per 24 h correlated negatively with height, which was responsible for 66% of the variance in REE kJ/kg LBM per 24 h. Short children therefore expend more energy than tall children in fulfilling basic metabolic needs. After 6 months REE kJ/24 h increased significantly in treated children. However, treated children did not differ significantly from untreated children in REE kJ/kg LBM per 24 h. rhGH does not therefore seem to have a specific effect upon REE. The possibility that rhGH produces profound metabolic effects should limit its use in otherwise healthy children until the mechanism of action is more clearly elucidated.