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Subcutaneous growth hormone administration in growth-hormone-deficient children. Continuous plus pulsatile overnight
L Cavallo1, F De Luca, S Bernasconi
1Department of Biomedicine of Developing Age, University of Bari, Italy.
Insights
This study compared two growth hormone (GH) administration methods in children with GH deficiency. Neither the physiological pattern nor daily subcutaneous injections significantly improved growth response or insulin-like growth factor-I levels.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Metabolic Disorders
Background:
- Children with isolated idiopathic growth hormone (GH) deficiency often require long-term treatment.
- Optimizing GH administration schedules may enhance growth response.
- Previous treatments involved daily subcutaneous (s.c.) injections.
Purpose of the Study:
- To compare a physiological GH dosing pattern with daily s.c. administration.
- To evaluate growth response in children previously treated successfully with GH.
- To assess if a modified GH delivery improves growth outcomes.
Main Methods:
- 10 children with idiopathic GH deficiency participated.
- Two treatment regimens were compared: daily s.c. injection vs. continuous/pulsatile infusion.
- Growth velocity, insulin-like growth factor-I, and bone age advancement were measured over 12 months.
Main Results:
- Both treatment regimens resulted in similar mean height SDS increases.
- No significant differences were observed in growth velocity between the two methods.
- Circulating insulin-like growth factor-I patterns and bone age advancement showed no significant variations.
Conclusions:
- A physiological GH administration pattern did not demonstrate superior efficacy over daily s.c. injections.
- Current treatment schedules appear equally effective for previously responsive children.
- Further research may explore other factors influencing growth response in GH deficiency.
Abstract:
The aim of this study, performed in 10 children, was to verify if a treatment schedule, better reproducing the growth hormone (GH) physiological pattern, could achieve a greater growth response than daily s.c. administration in previously successfully treated children with an isolated idiopathic GH deficiency. A 1-month washout period was observed between the previous regimen and this study. GH (0.6 U/kg/week, the same as given previously) was administered weekly in 6 equal doses. Three children received the daily dose by a single s.c. administration (at 20.00 h) and the other 7 through a 27-gauge infusion needle inserted s.c., using a mini infusion pump permitting a constant delivery of 50% of the daily dose (20.00-08.00 h) and the administration of the other 50% through 3 equal pulses (at 20.00, 24.00, and 04.00 h). After 6 months each child changed regimen undergoing the other one with a 1-month washout interval. During the 12 months of therapy, the mean height increased from -3.2 (SE 0.45) to -2.8 (SE 0.37) SDS. When evaluating the circulating insulin-like growth factor-I pattern as well as the growth velocity and the ratio bone age increase/height age increase, no differences were noted between the two treatment regimens.