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Long term pulsatile growth hormone (GH)-releasing hormone therapy in children with GH deficiency
1Department of Pediatrics, University of Hong Kong, Queen Mary Hospital.
Insights
Low-dose pulsatile Growth Hormone-Releasing Hormone (GHRH) therapy effectively promoted growth in most children with GH deficiency. However, initial GHRH response did not reliably predict treatment success.
Area of Science:
- Pediatrics
- Endocrinology
- Growth Disorders
Background:
- Growth Hormone-Releasing Hormone (GHRH) is crucial for stimulating growth.
- Pulsatile GHRH administration is a potential therapeutic strategy for growth hormone deficiency (GHD).
Purpose of the Study:
- To evaluate the efficacy of low-dose pulsatile GHRH-(1-44) therapy in children with GH deficiency.
- To assess predictors of treatment response in GHRH therapy.
Main Methods:
- Seven children with GH deficiency received subcutaneous GHRH-(1-44) pulses (1 mcg/kg for 6 months, then 2 mcg/kg for 6 months).
- Growth velocity and height gain were monitored.
- Serum GH and somatomedin-C levels were measured.
Main Results:
- Five of seven children showed increased growth velocity and significant height gain (4.4-7.5 cm) after 1 year.
- Mean growth velocity increased from 2.7 cm/yr to 8.4 cm/yr at 2 months and 5.4 cm/yr at 1 year.
- Pre-treatment GH response, somatomedin-C levels, and peak GH response during therapy were not reliable predictors of clinical response.
Conclusions:
- Low-dose pulsatile GHRH-(1-44) therapy is effective in promoting linear growth in a majority of children with GHD.
- Predictive markers for successful GHRH therapy require further investigation.
Abstract:
We treated seven GH-deficient children with 3-hourly 1 microgram/kg sc pulses of GHRH-(1-44) for 6 months and 2 micrograms/kg.pulse for another 6 months. Four patients had a serum GH response to iv GHRH before treatment, and an additional patient responded to iv GHRH after 1 month of pulsatile sc GHRH administration. The mean cumulative growth velocity increased from a pretreatment mean of 2.7 +/- 0.2 (+/- SE) to 8.4 +/- 2.5 and 5.4 +/- 0.7 cm/yr after 2 months and 1 yr of treatment, respectively. Low dose pulsatile GHRH therapy was effective in promoting growth in five of seven children, with height gain ranging from 4.4-7.5 cm at the end of 1 yr's therapy. Only one of the two patients who did not respond to GHRH had an improvement in linear growth when they were subsequently treated with synthetic GH. The other patient, a 16.5-yr-old pubertal girl who had both satisfactory GH and somatomedin-C responses during GHRH therapy, did not respond to either GHRH or, later, synthetic GH. The pretreatment serum GH response to iv GHRH, the serum somatomedin-C concentrations, and the peak serum GH response during sc GHRH therapy were not reliable predictors of clinical response.