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Apparent growth hormone deficiency in children with cerebral palsy
S J Coniglio1, R D Stevenson, A D Rogol
1Division of Developmental Pediatrics, Kluge Children's Rehabilitation Center, USA.
Insights
Children with cerebral palsy (CP) and growth failure often show growth hormone (GH) deficiency. Subnormal growth velocity is a key indicator, suggesting potential hypothalamic-pituitary issues or other factors.
Area of Science:
- Pediatric Endocrinology
- Neurology
- Growth Disorders
Background:
- Cerebral palsy (CP) is associated with growth failure in children.
- The growth hormone (GH) axis plays a critical role in childhood growth.
- Understanding GH axis function in CP is crucial for managing growth issues.
Purpose of the Study:
- To assess the growth hormone (GH) axis in children with CP and growth failure.
- To identify the prevalence of GH deficiency in this population.
- To determine predictors of GH deficiency.
Main Methods:
- Evaluated spontaneous and pharmacologically stimulated GH secretion.
- Measured circulating levels of insulin-like growth factor-1 (IGF-1) and IGF binding protein-3 (IGFBP-3).
- Correlated growth velocity with GH axis parameters.
Main Results:
- Six out of ten children with CP and growth failure exhibited subnormal GH secretion.
- Subnormal growth velocity was the most reliable clinical predictor of GH deficiency.
- A significant proportion of these children presented with apparent GH deficiency.
Conclusions:
- Growth hormone deficiency is surprisingly common in children with cerebral palsy and growth failure.
- Subnormal growth velocity is a key indicator for further GH axis investigation.
- Potential contributing factors include hypothalamic-pituitary abnormalities, psychosocial deprivation, and nutritional/CNS interactions.
Abstract:
Ten children with cerebral palsy (CP) and growth failure underwent assessment of the growth hormone (GH) axis, including spontaneous GH secretion, GH secretion in response to pharmacological stimulation, and circulating levels of insulin-like growth factor-1 (IGF-1) and IGF binding protein-3 (IGFBP-3). Six of the children had subnormal GH secretion consistent with GH deficiency. Subnormal growth velocity was the best clinical predictor of GH deficiency. The large percentage of these children with apparent GH deficiency is surprising. Possible mechanisms include anatomic abnormalities of the hypothalamic-pituitary axis, psychosocial deprivation, and an interaction between suboptimal nutritional status and an abnormal central nervous system.