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Growth response to growth hormone-releasing hormone(1-29)-NH2 compared with growth hormone
Insights
High-dose growth hormone-releasing hormone (GHRH(1-29)-NH2) effectively promoted growth in children with hypothalamic growth hormone deficiency (GHD), comparable to traditional GH therapy. Low-dose GHRH treatment showed less efficacy.
Area of Science:
- Pediatric Endocrinology
- Hormone Therapy
- Growth Disorders
Background:
- Growth hormone deficiency (GHD) in children of hypothalamic origin requires effective treatment for growth promotion.
- Growth hormone-releasing hormone (GHRH(1-29)-NH2) is a potential therapeutic agent for GHD.
- Different dosing strategies for GHRH(1-29)-NH2 require assessment to determine optimal growth-promoting effects.
Purpose of the Study:
- To evaluate the growth-promoting efficacy of varying doses of GHRH(1-29)-NH2 in prepubertal children with hypothalamic GHD.
- To compare the effects of low-dose GHRH(1-29)-NH2, high-dose GHRH(1-29)-NH2, and standard growth hormone (GH) therapy.
Main Methods:
- Randomized controlled trial involving 43 prepubertal children with hypothalamic GHD.
- Treatment groups: low-dose GHRH(1-29)-NH2 (30 mcg/kg/day), high-dose GHRH(1-29)-NH2 (60 mcg/kg/day), and GH (0.1 IU/kg/day) for 6 months.
- Evaluations included anthropometry, bone age, GHRH stimulation tests, and insulin-like growth factor I (IGF-I) levels.
Main Results:
- Height velocity increased by at least 2 cm/year in most children across all groups.
- Height velocity was lowest in the low-dose GHRH group but comparable between the high-dose GHRH and GH groups.
- Increased height standard deviation score (SDS) for bone age was observed only in the GH-treated group; GH responses showed a priming effect with low-dose GHRH.
Conclusions:
- High-dose GHRH(1-29)-NH2 demonstrates comparable growth promotion to GH therapy in children with hypothalamic GHD.
- Low-dose GHRH(1-29)-NH2 showed less growth-promoting effect compared to high-dose GHRH and GH.
- GHRH(1-29)-NH2 treatment may influence GH secretion dynamics, with potential accumulation observed in high-dose regimens.
Abstract:
To assess the growth-promoting effect of different doses of growth hormone-releasing hormone(1-29)-NH2 (GHRH(1-29)-NH2) in GH deficiency (GHD) of hypothalamic origin, 43 prepubertal children aged between 4.3 and 18.9 years (mean 10.4 +/- 2.9 years) were randomly assigned to three treatment regimens: low-dose GHRH(1-29)-NH2 (LD group; n = 15), high-dose GHRH(1-29)-NH2 (HD group; n = 12) and GH (GH group; n = 16). The LD group received GHRH(1-29)-NH2 at 30 micrograms/kg/day s.c. in three daily doses, the HD group received 60 micrograms/kg/day s.c. in three daily doses and the GH group received GH, 0.1 IU/kg/day s.c. once daily. All children were treated for a period of 6 months. Evaluation included anthropometry, bone age, intravenous and subcutaneous GHRH(1-29)-NH2 tests and determination of insulin-like growth factor I (IGF-I) levels. An increase in height velocity of 2 cm/year or more was observed in all except two children. Height velocity during treatment was lowest in the LD group, but comparable in the HD and GH groups. An increase in height SDS for bone age occurred only in the GH-treated group. GH responses to intravenous GHRH(1-29)-NH2 showed a priming effect of the LD GHRH(1-29)-NH2 treatment, while a decrease in response occurred in the GH-treated group. Following a subcutaneous test dose of one-third of the daily dose of GHRH(1-29)-NH2, GH levels remained unchanged in both the LD and HD groups. There was accumulation of GHRH immunoreactivity over time in the HD group, but there was no correlation between measured GHRH and GH levels.(ABSTRACT TRUNCATED AT 250 WORDS)