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Final height in non-growth hormone deficient children treated with growth hormone. The Italian Multicentre Study
S Bernasconi1, M E Street, C Volta
1Dipartimento di Scinze Ginecologiche, Ostetriche e Pediatriche, University of Modena, Italy.
Insights
Growth hormone (GH) therapy increased height velocity in short children without GH deficiency but did not significantly improve final adult height compared to initial predictions. Further research is needed for optimal treatment outcomes.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Childhood Growth Disorders
Background:
- Short stature in children without growth hormone deficiency (N-GHD) is a clinical challenge.
- Growth hormone (GH) therapy is sometimes considered for these children.
- Evaluating the efficacy of GH in improving final height is crucial.
Purpose of the Study:
- To assess the final achieved height in children with N-GHD treated with GH.
- To compare final height with predicted adult height and target height.
Main Methods:
- Multicenter retrospective study of 71 N-GHD children treated with GH.
- Evaluated height, height velocity, bone age, and predicted adult height before and during treatment.
- Analyzed final height SDS relative to target height and initial predictions.
Main Results:
- GH treatment significantly increased height velocity in N-GHD children.
- Final height standard deviation score (SDS) was similar to initial predicted adult height SDS and target height SDS.
- A higher proportion of prepubertal boys achieved final height greater than or equal to initial predicted height compared to pubertal boys.
Conclusions:
- GH therapy effectively enhances height velocity in short N-GHD children.
- However, final adult height is not definitively improved compared to initial predictions.
- Treatment outcomes may differ based on the timing of GH initiation relative to puberty.
Objective:
To evaluate the final height of nongrowth hormone deficient (N-GHD) children treated with growth hormone (GH).
Design:
Multicentre retrospective study.
Patients:
71 (54M/17F) N-GHD children (peak GH after pharmacological stimulation > 14-24 mU/l) who had been treated for 4.19 +/- 0.14 years with GH (0.69 +/- 0.02 IU/kg/week).
Measurements:
Height (H) and height velocity (HV) expressed as standard deviation score (SDS) for chronological age (CA) and bone age (BA), BA/CA ratio, and predicted adult height (PAHSDS) were evaluated before and during treatment, and at each pubertal stage. Target height (TH), and final height (FH) were also calculated, and expressed as SDS.
Results:
In the whole group, HSDS for CA increased significantly after the first year on GH, and remained significantly increased for 4 years. This did not occur to HSDS for BA, owing to a significant increase in BA/CA after the first year of therapy. In addition, this increase coincided with stages 4 and 5 of puberty. HVSDS for CA and BA also increased significantly after the first year of treatment, and remained significantly elevated for 4 years. PAHSDS did not change significantly during treatment. FHSDS (-1.69 +/- 0.07) was similar to PAHSDS (-1.6 +/- 0.12) and target height (THSDS) (-1.46 +/- 0.08). FHSDS was > or = THSDS in 36.6% of the patients, and > or = initial PAHSDS in 34.5%. Male patients were subdivided into 2 groups (A and B). Patients in Group A (n = 26) started treatment at puberty, while group B (n = 28) consisted of subjects who started therapy during prepubertal years. Height, height velocity and predicted adult height showed the same pattern as in the whole group, in each subgroup. BA/CA advanced significantly in group A after the second year on GH and in group B, after at least 3 years of therapy. FHSDS, THSDS, and PAHSDS were similar in both groups (-1. 7 +/- 0.13, -1.29 +/- 0.2 and -1.39 +/- 0.15 in group A and -1.48 +/- 0.11, -1.85 +/- 0.15 and -1.36 +/- 0.12 in group B, respectively). However, in group B (prepubertal), FHSDS was > or = initial PAHSDS in 60% of the patients and > or = THSDS in 40.7%, while in group A (pubertal), FHSDS was > or = initial PAHSDS only in 22.7% of the patients and > or = THSDS in 34.6%. FHSDS was found to be correlated with THSDS, PAHSDS at the onset of treatment, and after 1 year of treatment. The age at the beginning of puberty, and the duration of puberty were appropriate in all groups.
Conclusions:
GH treatment was effective in increasing height velocity of short non-GH-deficient children, but final height was not definitely improved with respect to initial predicted adult height.