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Growth-stimulating effects of recombinant human growth hormone in children with end-stage renal disease
B Tönshoff1, O Mehis, U Heinrich
1Department of Pediatrics, University Children's Hospital of Heidelberg, Federal Republic of Germany.
Insights
High-dose recombinant human growth hormone (rhGH) effectively treated growth hormone resistance in children with severe uremia. This therapy improved height velocity and normalized growth factors without accelerating bone age.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Growth Hormone Therapy
Background:
- Uremia is associated with growth hormone resistance, impacting growth in children.
- Children with end-stage renal disease often exhibit stunted growth due to this resistance.
Purpose of the Study:
- To investigate if supraphysiologic doses of recombinant human growth hormone (rhGH) can overcome growth hormone resistance in children with severe uremia.
- To assess the impact of rhGH therapy on linear growth and growth factor status in this patient population.
Main Methods:
- Nine stunted children with end-stage renal disease received rhGH (4 IU/m2/day) subcutaneously for one year.
- Evaluated changes in height velocity, height velocity standard deviation scores, bone age, and insulin-like growth factor (IGF) system components.
Main Results:
- Median height velocity increased significantly from 4.4 cm/yr to 8.0 cm/yr during rhGH treatment.
- Height velocity standard deviation scores improved from -2.6 to +1.5, with normal bone age advancement.
- rhGH therapy normalized the ratio of IGF-I to IGF binding protein and improved somatomedin bioactivity.
Conclusions:
- Supraphysiologic rhGH doses can effectively overcome growth hormone resistance in children with severe uremia.
- This treatment improves linear growth and normalizes the IGF-I system in pediatric end-stage renal disease patients.
- rhGH therapy offers a viable strategy for addressing growth failure in children with uremia.
Abstract:
Because patients with uremia have evidence for growth hormone resistance, we investigated whether this resistance can be overcome by administration of recombinant human growth hormone in supraphysiologic doses in children with severe uremia. Nine stunted children with end-stage renal disease (median age 5.8 years, median bone age 2.7 years) were treated with recombinant human growth hormone, 4 IU/m2/day subcutaneously, for a period of 1 year. Median height velocity was increased from 4.4 cm/yr before therapy to 8.0 cm/yr during treatment. Negative values for height velocity standard deviation scores for chronologic age were improved from a median of -2.6 to +1.5 without advancing bone age more than chronologic age. The growth hormone-insulin-like growth factor I resistance may be explained in part by the increased serum concentration of the high molecular weight insulin-like growth factor binding protein despite normal insulin-like growth factor I serum concentration. Treatment with recombinant human growth hormone improved the ratio between the serum concentrations of insulin-like growth factor I and its binding protein, and normalized the somatomedin bioactivity in the growth cartilage bioassay.