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Predicting the response of growth hormone-deficient children to long term treatment with human growth hormone
Insights
Short-term human growth hormone (hGH) response in children predicts long-term treatment outcomes. This finding helps predict a child's final height during 1 year of hGH therapy.
Area of Science:
- Pediatrics
- Endocrinology
- Growth Disorders
Background:
- Growth hormone deficiency (GHD) affects children's height.
- Previous studies indicated short-term height gains with human growth hormone (hGH) treatment.
- The predictive value of this short-term response for long-term outcomes was not established.
Purpose of the Study:
- To determine if the acute height increase in GH-deficient children treated with hGH predicts their long-term response to 1 year of therapy.
- To establish a predictive model for long-term growth based on short-term treatment response.
Main Methods:
- Eighteen GHD children (aged 8-16 years) were monitored over 108 weeks.
- A 10-day hGH treatment course was administered, followed by periods of treatment and observation.
- Growth rates were measured during different treatment and control phases.
Main Results:
- A strong positive correlation (r=0.91, P<0.001) was found between growth rates during short-term (10-day) and long-term (48-week) hGH treatment.
- The equation y = 0.027 + 1.17x accurately predicts long-term growth (y) from short-term response (x).
- The prediction of height increment over 48 weeks has an average standard error of +/- 1.2 cm/yr.
Conclusions:
- The acute response to 10 days of hGH treatment is a reliable predictor of a child's long-term growth response.
- This predictive model allows for better estimation of final height outcomes in children with GH deficiency undergoing treatment.
- Clinicians can use this predictive tool to manage expectations and treatment strategies for pediatric GHD.
Abstract:
A previous study showed that when GH-deficient children below the third percentile in height are treated with 0.168 U human GH (hGH)/kg BW3/4 for 10 days, their height increases by 0.3--1.9 cm during the next 8 weeks. The present study determined whether this acute response would predict the child's long term response to 1 yr of treatment with the same dose of hGH given three times a week. Eighteen GH-deficient children and adolescents, aged 8--16 yr, were measured every 2 weeks over 108 weeks. After a control period of 12 weeks (period 1), the patient received hGH for 10 days. During the remainder of the 12 weeks of period 2 and during the next 12 weeks (period 3), hGH was not given. Patients recieved hGH three times a week during periods 4 and 5 (24 weeks each). Periods 6 and 7 (12 weeks each) were posttreatment control periods. During periods 1, 3, 6, and 7, rate of growth was less than 0.2 cm/month. During period 2, the rate ranged between 0.1--0.8 cm/month. During periods 4 and 5, the growth rate ranged from 0.2--1.0 cm/month. Rate of growth during periods 4 and 5 (y) was related to rate during period 2 (x) by the equation y = 0.027 + 1.17 x. The correlation coefficient between y and x was 0.91 (P less than 0.001). The increment in height which will occur during 48 weeks of treatment can be predicted from the response to 10 days of treatment by this equation. The SE of the prediction averages +/- 1.2 cm/yr.