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The response to treatment with pituitary growth hormone: the New Zealand experience
J H Livesey1, R C Cuneo, R A Donald
1Department of Endocrinology, Princess Margaret Hospital, Christchurch.
Insights
Human pituitary growth hormone (GH) treatment significantly increased height velocity in growth hormone deficient children. However, growth rates declined over time, with treatment cessation causing a marked reduction in growth.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Childhood Growth Disorders
Background:
- Growth hormone deficiency (GHD) impairs linear growth in children.
- Human pituitary growth hormone (hPGH) has been used to treat GHD.
- Long-term effects and response variability require further investigation.
Purpose of the Study:
- To analyze the efficacy of human pituitary growth hormone (GH) treatment in New Zealand children with GHD.
- To assess growth response, bone age advancement, and factors influencing treatment outcomes.
- To evaluate the impact of GH discontinuation on growth velocity.
Main Methods:
- Retrospective analysis of 43 children with GHD treated with intramuscular hPGH (1979-1985).
- Measurement of height velocity (cm/yr) before and during treatment.
- Assessment of bone age advancement relative to chronological age.
- Correlation analysis of treatment response with baseline parameters and GH levels.
Main Results:
- Significant increase in height velocity during the first three years of GH treatment (p < 0.001).
- Height velocity declined between treatment years 1-2 and 2-3, despite continued significant gains in relative height.
- Bone age advancement accelerated after the second year of treatment.
- Treatment response negatively correlated with initial height and peak pre-treatment plasma GH response.
- GH discontinuation led to a significant reduction in growth rate (7.5 to 2.5 cm/yr).
Conclusions:
- Human pituitary growth hormone (GH) is effective in improving height velocity in children with GHD.
- Growth response may diminish over time, and bone age can accelerate.
- Factors like initial height and GH secretion capacity influence treatment outcomes.
- Cessation of GH therapy results in a substantial decrease in growth rate.
Abstract:
Ninety-four growth hormone deficient New Zealand children were treated with thrice weekly intramuscular injections of human pituitary growth hormone (GH) from 1979 to 1985 and the results from 43 children were analysed in detail. Their height velocity was mean (SD) 4.0 (1.9) cm/yr immediately prior to treatment and 8.5 (3.1) cm/yr in the first year of treatment. In each of the first three years of treatment the height velocity was significantly increased (p less than 0.001), but there was a significant decline in height velocity between the first and second, and second and third years. Nevertheless each year of treatment gave a highly significant gain in relative height. Bone age did not advance more rapidly than chronological age during the first two years of treatment, but did so subsequently. The response to GH, as assessed by the increase in relative height, was negatively correlated with the relative height at the start of treatment and with the maximum pretreatment plasma GH response to insulin hypoglycaemia. There was no correlation with pretreatment relative height velocity or aetiology of GH deficiency. Height velocity improved in five of 14 children treated with thyroxine after starting GH. Discontinuation of GH for one year in 34 children resulted in a highly significant reduction in growth rate from 7.5 (2.4) cm/yr to 2.5 (2.0) cm/yr, however four prepubertal children continued to grow at a rate exceeding 4 cm/yr.
