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Growth of short children during and after discontinuation of growth hormone therapy
1Pediatric Endocrine Unit, Kaplan Hospital, Hadassah Medical School, Hebrew University, Jerusalem, Israel.
Insights
Children with low spontaneous growth hormone (GH) secretion showed better response to GH therapy. Continued observation is recommended for these children after GH therapy cessation.
Area of Science:
- Pediatric endocrinology
- Growth hormone therapy
- Child growth disorders
Background:
- Assessing spontaneous growth hormone (GH) secretion is crucial for understanding treatment response.
- The impact of GH therapy discontinuation on growth requires further investigation.
- Identifying predictors of treatment success in short children is essential.
Purpose of the Study:
- To evaluate the relationship between spontaneous GH secretion and GH therapy response.
- To determine the effect of GH therapy discontinuation on growth.
- To compare GH therapy outcomes based on baseline GH secretion levels.
Main Methods:
- Measured 24-h integrated GH concentration (ICGH) in 150 short children.
- Administered GH therapy for 4 years, followed by a 1-year observation period off therapy.
- Analyzed growth response in prepubertal children with low ICGH (< 3.2 mcg/L) versus normal ICGH (≥ 3.2 mcg/L).
Main Results:
- Children with low ICGH demonstrated a superior growth response to GH therapy compared to those with normal ICGH.
- Normal growth velocity was regained 6-12 months after GH therapy cessation.
- Three children in the low ICGH group developed classic GH deficiency post-therapy.
Conclusions:
- Short-term GH therapy can effectively improve growth channels in short children.
- Children with low spontaneous GH secretion benefit more from GH therapy.
- Continued monitoring and retesting are advised for children with low ICGH when growth velocity declines.
Abstract:
We have attempted to evaluate the relationship between spontaneous growth hormone (GH) secretion and the response to GH therapy as well as the effect of discontinuation of GH therapy on further growth. The 24-h integrated concentration of GH (ICGH) was determined in 150 short children (< 2 SD for age) with a GH response to clonidine stimulation of more than 10 mcg/L. The patients were treated with GH for 4 yr and were observed for 1 yr following cessation of GH treatment. Twenty-two out of 52 patients who had an ICGH of less than 3.2 mcg/L (group LICGH) and 28 out of 60 patients who had an ICGH of more than 3.2 mcg/L (group NICGH) were followed without GH therapy. Only patients who remained prepubertal throughout the study were included in the analysis. The growth response of the LICGH to GH was better than that of the NICGH children. Patients regained normal growth velocity 6-12 months after discontinuation of GH therapy. Three children of the LICGH subsequently developed classic GH deficiency. These studies demonstrate that short-term GH therapy can improve the growth channel. Children with a low ICGH grow better on GH than children with a normal ICGH. Children with a low ICGH need continued observation and retesting when growth velocity is low.