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Improved growth response to GH treatment in irradiated children
B Lannering1, K Albertsson-Wikland
1Department of Pediatrics I, Gothenburg University, Göteborg, Sweden.
Insights
Children treated with growth hormone (GH) after cranial radiotherapy showed improved growth rates. However, their response was less than those with idiopathic growth hormone deficiency (GHD), suggesting radiotherapy impacts GH effectiveness.
Area of Science:
- Pediatric endocrinology
- Oncology
- Radiotherapy effects
Background:
- Cranial radiotherapy can impair growth in children.
- Growth hormone (GH) therapy is used to address growth issues.
- Understanding GH efficacy in post-radiotherapy patients is crucial.
Purpose of the Study:
- To evaluate the growth response to high-dose human GH (hGH) in children treated with radiotherapy for cranial tumors.
- To compare the growth outcomes with those of short children and children with idiopathic growth hormone deficiency (GHD).
Main Methods:
- Fifteen children receiving radiotherapy for cranial tumors were treated with hGH (0.1 IU/kg/day s.c.) for two years.
- Growth rates were compared to pre-treatment rates and to control groups of short children and children with GHD.
- Spontaneous 24-hour GH secretion was measured in all groups.
Main Results:
- The mean growth rate increased to 5.0 cm/y in the first year and 3.8 cm/y in the second year.
- The first-year growth response was significantly lower than in GHD children but higher than in short children.
- Growth increment correlated inversely with spontaneous GH secretion levels across the groups.
Conclusions:
- High-dose hGH treatment improves growth in children post-cranial radiotherapy.
- The growth response is attenuated compared to idiopathic GHD, indicating radiotherapy-induced factors may affect GH action.
- Spontaneous GH secretion levels may predict growth response to GH therapy in these populations.
Abstract:
The growth response to two years of GH treatment was studied in fifteen children after radiotherapy for a cranial tumor. The growth response was compared to that of short children (-2 SD) and that of children with idiopathic growth hormone deficiency (GHD) of similar ages. All children were treated with hGH 0.1 IU/kg/day s.c.; which is a higher dose and frequency than previously reported for irradiated children. On this protocol the growth rate increased 5.0 +/- 0.5 cm/y (mean +/- SEM) the first year and 3.8 +/- 0.7 cm/y the second year compared to the growth rate the year before GH-treatment. Although the net gain in growth was higher than previously reported, the first year growth response was significantly reduced (p less than 0.05) compared to that of GHD-children (7.6 +/- 0.5 cm/y) but exceeded (p less than 0.05) that of short children (3.4 +/- 0.3 cm/y). The median spontaneous 24 h-GH secretion was 209 mU/l in the short children, 52 mU/l in the irradiated children and 16 mU/l in the idiopathic GHD children. Thus the growth increment varied inversely to the spontaneous GH secretion observed in the three groups.