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Linear growth response to exogenous growth hormone in children with short stature
I D Schwartz1, C S Hu, D I Shulman
1Section of Pediatric Endocrinology, University of South Florida College of Medicine, St Petersburg.
Insights
Growth hormone (GH) therapy effectively increased height velocity in short children, regardless of their baseline GH levels or response to provocative tests. Most children achieved significant growth improvements with somatropin treatment.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Childhood Growth Disorders
Background:
- Short stature in children can stem from various factors affecting growth hormone (GH) secretion.
- Evaluating response to GH therapy is crucial for optimizing treatment outcomes.
- Categorizing patients based on endogenous GH levels and peak GH response can inform treatment strategies.
Purpose of the Study:
- To assess the efficacy of biosynthetic somatropin in improving height velocity (HV) in short children.
- To determine if baseline GH secretion dynamics influence the response to GH therapy.
- To identify predictors of growth response in children receiving GH treatment.
Main Methods:
- 38 short children were treated with biosynthetic somatropin (0.15-0.30 mg/kg/week) for a mean of 12.5 months.
- Patients were categorized into three groups based on endogenous mean 24-hour GH and peak GH response.
- Height velocity (HV) changes were measured before and during somatropin administration.
Main Results:
- Significant increases in HV were observed across all patient groups following somatropin treatment.
- 94% of Group 1, 90% of Group 2, and 73% of Group 3 subjects showed a delta HV ≥ 2.0 cm/y.
- The majority of children, irrespective of pretreatment HV, achieved an HV ≥ 2.0 cm/y during treatment.
- Negative correlations were found between delta HV and pretreatment HV, mean 24-hour GH, and peak GH.
Conclusions:
- Biosynthetic somatropin is effective in enhancing height velocity in short children.
- The response to GH therapy is substantial even in children with varying endogenous GH secretion patterns.
- Pretreatment height velocity and GH secretion levels may not be absolute predictors of treatment success, as most children benefit.
Abstract:
Response to growth hormone (GH) therapy was evaluated in 38 short children (28 males and 10 females; less than 1% in height for chronologic age [CA]) who were clinically categorized into three groups based on their endogenous mean 24-hour GH concentration (mean 24-hour GH) and peak GH response to two or more provocative agents (peak GH). All patients were treated with biosynthetic somatropin (human growth hormone) (0.15 to 0.30 mg/kg per week) injected subcutaneously three to seven times per week for a mean duration of 12.5 months. Group 1 consisted of 17 subjects (CA, 12.5 +/- 2.9 years [mean +/- SD]; bone age, 9.4 +/- 2.9 years; height velocity [HV], 3.4 +/- 1.8 cm/y; peak GH, 5.8 +/- 2.6 micrograms/L; mean 24-hour GH, 1.7 +/- 0.6 micrograms/L; and insulinlike growth factor-I, 0.40 +/- 0.24 U/mL. Group 2 consisted of 10 subjects (CA, 11.7 +/- 2.7 years; bone age, 9.2 +/- 3.0 years; HV, 3.4 +/- 1.6 cm/y; peak GH, 16.4 +/- 5.2 micrograms/L; mean 24-hour GH, 1.7 +/- 0.5 micrograms/L; and insulinlike growth factor-I, 0.49 +/- 0.27 U/mL. Group 3 consisted of 11 subjects (CA, 12.7 +/- 2.2 years; bone age, 10.2 +/- 2.4 years; HV, 3.5 +/- 1.5 cm/y; peak GH, 22.5 +/- 8.6 micrograms/L; mean 24-hour GH, 3.8 +/- 1.1 micrograms/L; and insulinlike growth factor-I, 1.07 +/- 0.69 U/mL. Following administration of somatropin, an increase (delta) in HV of 2.0 cm/y or greater occurred in 94% (16/17) of the group I subjects (delta HV of 5.1 +/- 2.6 cm/y), in 90% (9/10) of the group 2 subjects (delta HV of 4.3 +/- 2.2 cm/y), and in 73% (8/11) of group 3 subjects (delta HV of 3.7 +/- 2.3 cm/y). However, regardless of provoked and/or endogenous GH secretory dynamics, 88% of the children whose pretreatment HV was 2.0 cm/y or less, 94% whose pretreatment HV was between 2.0 and 4.0 cm/y, and 79% whose pretreatment HV was greater than 4.0 cm/y increased their HVs to 2.0 cm/y or greater while they were receiving somatropin. Significant negative correlations were observed between delta HV and pretreatment HV (r = -.67), delta HV and GH concentration expressed as a 24-hour area under the curve (r = -.33), and delta HV and peak GH (r = -.34).(ABSTRACT TRUNCATED AT 400 WORDS)