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Growth hormone treatment in short children--short-term and long-term effects on growth
1Department of Paediatrics II, University of Gothenburg, Sweden.
Insights
Growth hormone (GH) therapy significantly increases height velocity in short children. Children with lower natural GH secretion show the best response to GH treatment, indicating personalized treatment potential.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Child Development
Background:
- Short stature in children can impact growth and development.
- Growth hormone (GH) is crucial for normal growth.
- Assessing endogenous GH secretion is important for treatment decisions.
Purpose of the Study:
- To evaluate the efficacy of GH therapy in short children.
- To investigate the relationship between endogenous GH levels and treatment response.
- To analyze growth patterns during and after GH treatment.
Main Methods:
- A cohort of 40 prepubertal short children received GH therapy (0.1 IU/kg/day).
- Height velocity was measured before, during, and after treatment.
- Endogenous GH secretion was assessed using 24-hour sampling and provocation tests.
Main Results:
- Mean height velocity increased from 4.6 to 7.5 cm/year after 1 year of GH therapy.
- Children with lower endogenous GH secretion (<300 mU/L/24h) showed the greatest height increment.
- Continued GH therapy in prepubertal children led to sustained height velocity, with some exceeding their predicted final height.
Conclusions:
- GH therapy is effective in improving height velocity in short children.
- Lower endogenous GH secretion predicts a better response to exogenous GH treatment.
- GH therapy can lead to sustained growth, potentially surpassing predicted final height in some children.
Abstract:
Short children with normal GH responses to arginine-insulin provocation testing and various amounts of spontaneously secreted GH over 24 hours participated in an ongoing study with GH, 0.1 IU/kg/day. A total of 40 prepubertal children have been treated for 1 year. Their mean height velocity increased from 4.6 to 7.5 cm/year. The children with the slowest pretreatment height velocity showed the best increment. An inverse relationship was found between the endogenous GH secretion and the increment in growth; 80% of the children had an endogenous GH secretion of less than 300 milliunits/litre/24 hours, estimated as area under the curve above the calculated baseline. They all showed an increment in height above 2 cm. The remaining 20% all had an endogenous GH secretion of more than 300 milliunits/litre/24 hours, estimated as area under the curve above the calculated baseline. Twenty-four of the children were prepubertal for the following 4 years, and their GH therapy continued. Their height velocity changed from 4.2 cm/year before therapy to 8.1, 6.7, 6.0 and 4.9 cm/year for the 1st, 2nd, 3rd and 4th years on treatment. Many of them have passed their expected final height, but have still not stopped growing. Those children who were in early puberty when GH treatment started went into a rapid growth spurt and have now stopped growing. They have all reached but not improved their expected final height. In 15 of the children GH treatment was stopped after 1-3 years. Their mean height velocity for the first post-treatment year was 5.1 cm/year; thus, for the group as a whole no 'catch down' was observed.(ABSTRACT TRUNCATED AT 250 WORDS)