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Is growth hormone deficiency a useful diagnosis?
Insights
Short children
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Research
Background:
- Human growth hormone (hGH) deficiency is traditionally diagnosed based on low secretion levels.
- A spectrum of hGH secretion exists, impacting growth velocity in children.
Purpose of the Study:
- To characterize the relationship between endogenous hGH secretion and growth velocity in short children.
- To explore the impact of hGH pulse amplitude on growth.
- To define therapeutic implications for exogenous hGH administration.
Main Methods:
- Analysis of endogenous hGH secretion levels in short children.
- Application of asymptotic regression to model growth velocity against hGH secretion.
- Evaluation of hGH pulse amplitude's role in growth modulation.
Main Results:
- A continuum exists from very low hGH secretion (formerly hGH deficient) to higher secretion in children with varying growth velocities.
- Growth velocity in short children shows an asymptotic relationship with endogenous hGH secretion.
- hGH pulse amplitude significantly modulates the growth response.
Conclusions:
- The findings challenge the binary definition of hGH deficiency, highlighting a secretory continuum.
- Exogenous hGH administration is expected to benefit all short children, with the most significant gains in those with the slowest growth and lowest endogenous hGH.
- Understanding this relationship optimizes therapeutic strategies for growth disorders.
Abstract:
Evidence is presented that there is a continuum in endogenous hGH secretion ranging from those children with poor growth velocities who secrete very little, formerly called hGH deficient, to those with normal growth velocities who secrete a much greater amount. The relationship between growth velocity and hGH secretion in short children is described by an asymptotic regression. Further, the relationship between growth and hGH is modulated by hGH pulse amplitude. The therapeutic implications of this relationship are that any short child given hGH will grow more rapidly, and that those children growing most slowly with the least endogenous hGH secretion will have the greatest increment in height velocity for a standard dose of exogenous hGH.