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Vitamin D and Parathyroid Hormone during Growth Hormone Treatment
Teodoro Durá-Travé1,2,3, Fidel Gallinas-Victoriano2,3
1Department of Pediatrics, School of Medicine, University of Navarra, Avenue Irunlarrea 1, 31008 Pamplona, Spain.
Insights
Children with growth hormone deficiency (GHD) and those treated with recombinant human growth hormone (rhGH) do not have increased vitamin D deficiency. PTH levels increased during rhGH treatment.
Area of Science:
- Pediatric Endocrinology
- Nutritional Science
- Growth Hormone Therapy
Background:
- Controversy exists regarding the interaction between vitamin D, parathyroid hormone (PTH), and the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis.
- Understanding vitamin D and PTH status in children with GH deficiency (GHD) is crucial for optimizing treatment.
- Recombinant human growth hormone (rhGH) is a standard treatment for GHD.
Purpose of the Study:
- To assess vitamin D and PTH status in children with GHD at diagnosis and during rhGH treatment.
- To compare vitamin D and PTH levels in GHD children with a healthy control group.
Main Methods:
- Longitudinal and descriptive study of 110 children (aged 3.3–9.1 years) with GHD treated with rhGH.
- Clinical and laboratory evaluations (including vitamin D, PTH, calcium, phosphorus, IGF-1) performed at diagnosis and at 12, 24, 36, and 48 months of treatment.
- Comparison with 377 healthy children (aged 3.8–9.7 years) as a control group.
Main Results:
- No significant difference in vitamin D deficiency prevalence between GHD and control groups at diagnosis (13.6% vs. 11.43%).
- Vitamin D deficiency prevalence remained stable throughout rhGH treatment in the GHD group.
- Serum calcium, phosphorus, and calcidiol levels showed no significant differences; however, PTH levels significantly increased (p < 0.001) during rhGH treatment.
Conclusions:
- Prepubertal children with GHD do not exhibit a higher risk of vitamin D deficiency compared to healthy peers.
- rhGH treatment does not alter vitamin D status in children with GHD.
- A significant increase in PTH levels is observed during rhGH therapy in children with GHD.
Abstract:
Background. There is some controversy concerning a potential interaction between vitamin D and PTH and the GH/IGF-1 axis. The goal of this study is to assess vitamin D and PTH status in children with GH deficiency at diagnostic and during treatment with rhGH. Methods. Longitudinal and descriptive study in 110 patients, aged 3.3−9.1 years, with GH deficiency (GHD group) treated with rhGH. At diagnosis and after 12, 24, 36, and 48 months of treatment, a clinical (height, weight, and bone age) and laboratory (phosphorus, calcium, calcidiol, PTH, IGF-1) evaluation was performed. Concurrently, 377 healthy children, aged 3.8−9.7 years, were enrolled and constituted a control group. Vitamin D status was stated in accordance to the U.S. Endocrine Society criteria. Results. No significant differences were found in the prevalence of vitamin D deficiency among control (11.43%) and GHD (13.6%) groups at the moment of diagnosis, remaining without significant changes at 12 (12.9%), 24 (14.6%), 36 (13.1%), and 48 months (13.3%) of treatment. There were not any significant differences in serum levels of calcium, phosphorus, and calcidiol, but a steady increase (p < 0.001) in PTH was detected. Conclusions. Prepubertal patients with GH deficient do not appear to have a higher risk of vitamin D deficiency than healthy subjects, and with treatment with rhGH, no changes in the organic content of vitamin D were observed although a significant increase in PTH levels was detected.
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