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Human growth hormone therapy of non-growth hormone deficient children
1University Children's Hospital, University of Tübingen, FRG.
Insights
Biosynthetically derived human growth hormone (hGH) can promote growth in short children not meeting classical growth hormone deficiency (GHD) criteria. Further studies are needed to define optimal hGH dosing for specific short stature patient groups.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Short Stature Management
Background:
- Classical criteria for growth hormone deficiency (GHD) exclude children with normal hGH response to stimuli.
- Short children not meeting GHD criteria may still benefit from human growth hormone (hGH) treatment.
- A subset of short children exhibit low spontaneously secreted or bioinactive growth hormone.
Purpose of the Study:
- To investigate the efficacy of hGH in short children who do not meet classical GHD criteria.
- To identify specific subgroups of short children who respond positively to hGH therapy.
- To explore the relationship between hGH dosage, growth response, and side effects.
Main Methods:
- Administration of biosynthetically derived hGH to short children.
- Evaluation of growth rates in response to hGH treatment.
- Assessment of children with clinical features of GHD, delayed bone age, and low somatomedin levels.
Main Results:
- Short children not meeting classical GHD criteria showed increased growth rates with hGH treatment.
- Children with specific GHD features, delayed bone age, and low somatomedin levels responded to hGH substitution.
- Some children with other growth disorders experienced growth increments with higher hGH doses.
Conclusions:
- hGH therapy shows potential for short children outside traditional GHD diagnoses.
- Further long-term studies are essential to optimize hGH dosing and identify target populations.
- Ethical considerations regarding hGH dose-response and side effects in short stature require careful evaluation.
Abstract:
With biosynthetically derived human growth hormone (hGH) available in large quantities, attempts will be made to promote growth in short children who do not fulfill the 'classical' criteria for growth hormone deficiency (GHD). By these criteria, GHD is excluded if hGH levels to pharmacological stimuli exceed a definite level. Several studies have shown that a variety of short children, who are not growth hormone deficient by these criteria, will demonstrate an increased growth rate with hGH treatment. A subpopulation of children with clinical features of GHD, delayed bone age and low somatomedin levels, have low levels of spontaneously secreted growth hormone or 'bioinactive' growth hormone. These children increase their growth rates to substitution doses of hGH. In other children whose growth disorder is not likely to be caused by a disorder in the growth hormone-somatomedin axis, growth increments are occasionally seen on higher hGH doses. Future long-term studies--carefully considering the ethics of such approaches--will have to evaluate the relationships between hGH dose and both metabolic and growth responses and side effects in children with short stature in order to define more specifically further target groups of short children who will benefit from hGH therapy.