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When are we diagnosing growth hormone deficiency?
Insights
Growth hormone (GH) therapy improved height standard deviation scores (SDS) in children with GH deficiency. Early diagnosis through routine height screening and monitoring post-cranial irradiation is recommended for better outcomes.
Area of Science:
- Pediatrics
- Endocrinology
- Growth Disorders
Background:
- Growth hormone deficiency (GHD) affects children's height and development.
- Treatment initiation and outcomes for GHD have evolved over time.
- Specific GHD causes include isolated deficiency, hypothalamopituitary tumors, and cranial irradiation.
Purpose of the Study:
- To retrospectively analyze height and age at presentation for children starting growth hormone (GH) treatment.
- To evaluate the effectiveness of GH therapy in different pediatric GHD populations.
- To compare current treatment outcomes with historical data.
Main Methods:
- Retrospective analysis of 458 children treated with GH from January 1980 to June 1984.
- Categorization of patients based on GHD etiology: isolated GHD, hypothalamopituitary tumors, and cranial irradiation.
- Comparison of height standard deviation scores (SDS) before and after treatment, and against historical cohorts.
Main Results:
- Children with isolated GHD (n=309) had a mean age of 10 years and a mean height SDS of -3.73, showing improvement with treatment.
- Patients with hypothalamopituitary tumors (n=109) started GH treatment 3.3 years post-diagnosis with a mean height SDS of -2.42, demonstrating considerable improvement.
- Children with GHD secondary to cranial irradiation (n=42) had a mean height SDS of -2.45, comparable to historical UK data.
Conclusions:
- Growth hormone therapy significantly improves height SDS in children with various forms of GHD.
- Earlier diagnosis of GHD may be facilitated by routine height screening at school entry.
- Regular monitoring of height velocity in children treated for cranial irradiation is crucial for timely intervention.
Abstract:
The height and age at presentation of 458 children beginning treatment with growth hormone between January 1980 and June 1984 were retrospectively analysed. Three hundred and nine children with isolated growth hormone deficiency had a mean (SD) age of 10 (4.1) years on beginning treatment and a mean (SD) height standard deviation score (SDS) of -3.73 (0.93). One hundred and nine patients with hypothalamopituitary tumours began treatment with growth hormone on average 3.3 years after diagnosis of the tumour and at a mean (SD) height SDS of -2.42 (1.49). In both of these categories the height SDS showed a considerable improvement compared with previous reports. Forty two patients with growth hormone deficiency secondary to cranial irradiation started treatment with growth hormone on average 6.1 years after treatment for their tumours and had a height SDS of -2.45 (1.02) compared with that of -2.45 (0.98) seen in nine similar patients from the United Kingdom starting treatment with growth hormone between 1975 and 1978. Although closer surveillance of short children in the community is leading to earlier diagnosis of growth hormone deficiency, this could possibly be diagnosed earlier if routine screening of height was to be carried out at school entry. In addition, patients who have received cranial irradiation should be regularly measured and investigated when their height velocity becomes subnormal.