Seasonal variation in growth during growth hormone therapy

Seasonal variation in growth of normal children has been well described, although the mechanism by which it occurs has not been elucidated. The growth of 52 growth hormone-deficient children treated with synthetic human growth hormone was analyzed. A similar seasonal variation was observed, with mean (+/- SEM) peak growth occurring in the summer (8.2 +/- 0.3 cm/y) and winter (7.7 +/- 0.2 cm/y), and trough growth occurring in the autumn (6.9 +/- 0.3 cm/y). Forty-seven percent of subjects grew minimally during the autumn, and only two children showed peak growth in that season. Individual variations between maximal and minimal growth seasons amounted to 3.5 +/- 0.3 cm/y. The seasonal pattern was statistically significant for the group as a whole, for the prepubertal subgroup, and for the boys. The variation persisted when the first year of treatment was excluded to avoid bias of the initial growth spurt. The season of onset of therapy did not affect total growth during the first year. The demonstration of a seasonal pattern in growth of these children suggests that the seasonal variation may be mediated by peripheral rather than central factors. Paired clonidine-provoked growth hormone levels and an integrated concentration of 24-hour growth hormone levels and serum levels of insulinlike growth hormone I measured in a control group of normally growing children were also analyzed and showed no seasonal variation. This further suggests that peripheral rather than central factors are responsible for the seasonal variation in children's growth.