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Correlation between pituitary growth hormone reserve and degree of growth failure in children with short stature
S Kajiwara1, N Igarashi, E Imura
1Department of Pediatrics, School of Medicine, Kanazawa University, Japan.
Insights
Children with growth failure and pituitary growth hormone (GH) deficiency show reduced growth and bone age correlating with lower releasable GH pools. Lower GH pools are linked to other pituitary hormone deficiencies.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Physiology
- Pituitary Disorders
Background:
- Assessing the releasable pituitary growth hormone (GH) pool is crucial for understanding growth failure.
- Children with GH deficiency (GHD) and normal short stature (NSS) require distinct diagnostic approaches.
Purpose of the Study:
- To investigate the correlation between the releasable pituitary GH pool and the severity of growth failure in children.
- To classify GHD and NSS groups based on GH response to provocative testing and correlate with clinical parameters.
Main Methods:
- Studied 30 children with GHD (Group I) and 19 with NSS (Group II).
- Classified subgroups based on GH response to insulin, arginine, and GH-releasing hormone (GHRH).
- Evaluated body length, growth velocity, bone age, plasma somatomedin C (Sm-C) levels, and incidence of other pituitary hormone deficiencies.
Main Results:
- GHD subgroups with lower GH responses (Ia, Ib) exhibited significantly reduced body length, growth velocity, and retarded bone age compared to subgroup Ic.
- Plasma Sm-C levels were decreased in Ia and Ib compared to Ic.
- Higher incidence of combined pituitary hormone deficiencies and perinatal distress was observed in Ia and Ib.
- In NSS, subgroup IIa showed significantly decreased body length and growth velocity compared to IIb.
Conclusions:
- The size of the releasable pituitary GH pool is directly correlated with growth parameters in children with GHD.
- Lower GH pools in GHD are associated with impaired growth, bone maturation, and increased risk of other pituitary hormone deficiencies.
- Even in children with normal short stature, GH responsiveness can differentiate growth patterns.
Abstract:
The correlation between a releasable pituitary growth hormone (GH) pool and degree of growth failure was examined in 30 children with GH deficiency (group I) and 19 children with normal short stature (group II). Based on the responsiveness of GH to GH-releasing hormone (GHRH), group I, with low GH responses (below 7 ng/ml) to both insulin and arginine, was classified into three subgroups; Ia (peak value less than 10 ng/ml, n = 19), Ib (10-20 ng/ml, n = 5) and Ic (above 20 ng/ml, n = 6). Group II, with a GH response above 10 ng/ml to either insulin or arginine, was also divided into IIa (below 20 ng/ml, n = 5) and IIb (above 20 ng/ml, n = 14). Body length and growth velocity in Ia and Ib were significantly reduced vs Ic; bone age in Ia was retarded vs Ic; plasma somatomedin C (Sm-C) levels in Ia and Ib were decreased vs Ic, who had almost normal levels (0.90 +/- 0.55 U/ml). The incidence of other combined pituitary hormone deficiencies and previous perinatal distress was definitely high in Ia and Ib, but zero in Ic. In group II also, body length and growth velocity were significantly decreased in IIa vs IIb (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)