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Constitutional delay in growth: comparison of linear growth with serum growth hormone response to provocative tests
Insights
Children with constitutional delay in growth (CDG) may have reduced growth hormone (GH) secretion. Provocative testing showed lower mean peak GH levels in CDG patients compared to normal children, suggesting a diminished GH reserve.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Physiology
- Child Development
Background:
- Constitutional delay in growth (CDG) is a common cause of short stature in children.
- Accurate diagnosis of CDG is crucial for appropriate management and to rule out other growth disorders.
- Growth hormone (GH) plays a vital role in linear growth and development.
Purpose of the Study:
- To compare peak serum growth hormone (GH) levels in children with CDG versus normal children after provocative testing.
- To evaluate the utility of provocative testing in identifying children with CDG.
- To investigate potential differences in GH secretory capacity between CDG and normal children.
Main Methods:
- Serum GH levels were measured following insulin and arginine administration in 26 children with CDG and 7 normal children.
- Height and linear growth were monitored in all subjects.
- Diagnostic criteria included history, physical examination, bone age, and growth follow-up.
Main Results:
- While most CDG patients were identifiable through standard assessments, two showed growth <4 cm/year despite normal provocative tests.
- Group mean peak GH levels were significantly lower (p<0.05) in CDG patients compared to controls.
- One CDG child exhibited a subnormal GH response to both provocative tests.
Conclusions:
- Children with CDG may possess a diminished capacity for growth hormone secretion.
- Provocative testing can reveal subtle differences in GH reserve, even in cases with typical CDG presentation.
- Further investigation into GH secretion patterns in CDG is warranted.
Abstract:
The peak levels of serum growth hormone (GH) obtained in response to administration of insulin and arginine in 26 children with constitutional delay in growth (CDG) are compared to similar test results in 7 normal children. Heights at the time of testing, and follow-up linear growth, are documented in all subjects. Most patients with constitutional delay in growth could be identified on the basis of history, physical examination, bone age radiograph, and yearly follow-up of growth. Only two patients exhibited growth of less than 4 cm per year; both had normal responses to provocative testing. In response to provocative testing, individual patients with constitutional delay in growth revealed peak levels of serum GH which were within the normal range, but the group mean peak value was less (p less than 0.05) than in normal children. One child with clinical constitutional delay in growth revealed a subnormal response to both provocative tests. The results suggest that children with constitutional delay in growth may have a diminished reserve for secreting growth hormone.