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Growth hormone deficient children treated from before two years old fail to catch-up completely within five years of
Insights
Early growth hormone (GH) therapy for idiopathic growth hormone deficiency (GHD) initiated before age two shows initial catch-up growth but does not fully correct height deficits by year five. Prolonged treatment is likely necessary for complete height attainment.
Area of Science:
- Pediatric Endocrinology
- Growth Disorders
- Hormone Therapy
Background:
- Idiopathic growth hormone deficiency (GHD) affects childhood growth.
- Early intervention is crucial for managing GHD and optimizing growth outcomes.
Purpose of the Study:
- To evaluate the effectiveness of very early growth hormone (GH) therapy in achieving complete height catch-up in children with GHD.
- To determine if daily GH injections initiated before age two can fully correct initial height deficits within five years.
Main Methods:
- Retrospective analysis of 12 patients with idiopathic GHD treated with daily GH injections (0.6-0.7 IU/kg/week) from before age two for 60 months.
- Assessment of growth response, height deficiency for chronological age (CA), and bone age (BA) over the five-year treatment period.
Main Results:
- All patients experienced a significant growth spurt in the first year, with sustained, albeit attenuated, growth over five years.
- Height deficiency for CA progressively decreased (from -3.7 to -1.0 SDS), with a cumulative gain of 2.7 SDS.
- No patient achieved their target percentile by year five, with average height (CA) remaining below target height (TH).
Conclusions:
- Very early GH therapy in GHD children, even with modern protocols, does not guarantee complete catch-up growth by the fifth year.
- A longer duration of treatment is likely required for GHD patients to reach their target percentile.
- Emphasizes the critical role of early diagnosis and sustained, long-term treatment for optimal GHD management.
Abstract:
We retrospectively investigated growth response to therapy of 12 patients with idiopathic growth hormone deficiency (GHD), who received GH (0.6-0.7 IU/kg/week) in daily subcutaneous injections from before 2 years of age and for a period of 60 months, in order to ascertain whether very early treatment can enable GHD children to catch-up quickly and completely their initial height deficiency. The onset of therapy was followed in all patients during the 1st year by a significant growth spurt, which persisted, even though attenuated, during the following 4 years. Height deficiency for chronological age (CA) significantly and progressively decreased during the entire study period (from -3.7 +/- 1.9 to -1.0 +/- 1.0 SDS, p < 0.0025), with a cumulative height gain of 2.7 +/- 1.6 SDS. In spite of this catch-up growth no patient attained the target percentile by the 5th year of therapy and their average height (CA) was still lower with respect to the average target height (TH) at the last check-up. Because of the significant bone age (BA) delay still persisting in most patients, a further and complete catch-up growth is likely to occur during the next years of treatment, as suggested by the finding that average height (BA) at the last examination was higher than average TH. It is concluded that: a) in spite of modern therapeutical schedules with daily GH injections and frequent adjustments of doses, GHD children, even though treated from before two years of age, fail to catch-up completely their initial height deficiency, at least by the 5th year of therapy; b) a more prolonged treatment is probably needed to allow them to attain their target percentile. This emphasizes the importance of both early diagnosis and long-lasting treatment.