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Growth response to growth hormone therapy following cranial irradiation
P E Clayton1, S M Shalet, D A Price
1Department of Child Health, Royal Manchester Children's Hospital, Pendelbury, UK.
Insights
Growth hormone (GH) therapy improved growth velocity in children with cranial irradiation (C-PRGHD) and idiopathic GH deficiency (IGHD). While C-PRGHD patients achieved acceptable final height, they did not show height SDS catch-up like IGHD patients.
Area of Science:
- Pediatric Endocrinology
- Pediatric Oncology
- Growth Hormone Therapy
Background:
- Cranial irradiation can affect growth in children, particularly those with brain tumors or receiving CNS leukemia prophylaxis.
- Growth hormone (GH) deficiency is a known complication impacting linear growth.
- Understanding the response to GH therapy in cranially irradiated children is crucial for optimizing growth outcomes.
Purpose of the Study:
- To compare the growth response to GH therapy in children with cranial irradiation (C-PRGHD) versus those with isolated idiopathic GH deficiency (IGHD).
- To evaluate the efficacy of GH therapy in achieving final height in these two distinct pediatric populations.
Main Methods:
- Retrospective study comparing 12 cranially irradiated children (C-PRGHD) with 14 children with isolated idiopathic GH deficiency (IGHD) undergoing GH therapy.
- Analysis of growth parameters including standing height, sitting height, leg length, bone age (BA) retardation, and growth velocity (cm/year and SDS for BA).
- Comparison of pre-treatment characteristics and response to GH therapy over time, including pubertal onset and final height attainment.
Main Results:
- C-PRGHD patients had better baseline height SDS and less bone age retardation than IGHD patients.
- Both groups showed significant increases in growth velocity during the first two years of GH treatment.
- C-PRGHD patients entered puberty earlier, completing growth sooner, resulting in no change in height SDS compared to catch-up growth observed in IGHD patients.
Conclusions:
- GH therapy significantly enhances growth velocity in both C-PRGHD and IGHD children.
- While GH therapy helps C-PRGHD patients maintain their centile and achieve acceptable final height, it does not lead to the same degree of height catch-up seen in IGHD patients.
- Early puberty onset in C-PRGHD patients limits the potential for significant height SDS improvement despite GH treatment.
Abstract:
The growth response to growth hormone (GH) therapy has been studied in 12 children who received irradiation to the cranium alone either for brain gliomas, distant from the hypothalamic-pituitary axis, or as prophylaxis against CNS leukaemia. Seven children have completed GH treatment (mean duration 4 years) and five are presently on GH (mean duration 1.2 years). This response has been compared to that seen in 14 children with isolated idiopathic GH deficiency (IGHD), following GH therapy. Before treatment, the cranially irradiated patients (C-PRGHD) had higher standard deviation scores (SDS) for standing height, sitting height and leg length, and less bone age (BA) retardation, but started treatment at a similar age, and with a similar pre-treatment growth velocity and GH peak to standard provocative tests, compared to IGHD patients. GH produced a significant and similar increase in growth velocity (cm/year and SDS for BA) over the first 2 years' treatment in both groups. However C-PRGHD patients entered puberty and thus completed growth earlier than the IGHD group. As a result, cranially-irradiated children showed no change in height SDS with GH therapy, compared to catch-up growth in IGHD. Nevertheless, GH has enabled C-PRGHD patients to maintain their centile position and to achieve a more acceptable final height.
