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Weight relative to height before and during growth hormone therapy in prepubertal children
P B Kaplowitz1, A C Rundle, S L Blethen
1Department of Pediatrics, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0140, USA. PKaplowitz@hsc.vcu.edu
Insights
Recombinant human growth hormone (rhGH) therapy impacts weight for height differently based on diagnosis. Children with idiopathic short stature and some organic deficiencies gain weight, while those with tumors may lose weight.
Area of Science:
- Pediatrics
- Endocrinology
- Growth Hormone Therapy
Background:
- Growth hormone deficiency and short stature are significant pediatric concerns.
- Assessing body composition changes during growth hormone therapy is crucial for treatment efficacy.
- The Genentech National Cooperative Growth Study database provides extensive longitudinal data.
Purpose of the Study:
- To analyze weight-for-height changes in patients receiving recombinant human growth hormone (rhGH).
- To compare these changes across different diagnostic categories including idiopathic growth hormone deficiency (IGHD), organic GH deficiency (OGHD), and idiopathic short stature (ISS).
- To evaluate short-term (1 year) and longer-term (3 years) effects of rhGH therapy.
Main Methods:
- Utilized the Genentech National Cooperative Growth Study database.
- Analyzed weight for height standard deviation score (WTHTZ) in 3460 patients at baseline and 1 year.
- Examined WTHTZ in a subset of 450 patients over 3 years of rhGH treatment.
Main Results:
- Children with IGHD and ISS showed a progressive increase in WTHTZ over three years of rhGH therapy.
- Patients with OGHD due to craniopharyngiomas, CNS tumors, leukemia, or irradiation were overweight at baseline and decreased WTHTZ in the first year.
- The increase in WTHTZ in ISS and some OGHD suggests muscle mass gain exceeding fat loss, while fat loss predominates in neoplasm-related OGHD.
Conclusions:
- rhGH therapy differentially affects weight for height based on the underlying diagnosis.
- In IGHD and ISS, rhGH promotes a healthier weight-for-height profile, likely through increased muscle mass.
- In certain OGHD subgroups, particularly those with neoplasms, rhGH may lead to a reduction in overweight status, primarily through fat mass reduction.
Abstract:
We used the Genentech National Cooperative Growth Study database to examine differences in weight relative to height (weight for height standard deviation score or WTHTZ) in 3460 patients at enrollment and after one year of therapy with recombinant human growth hormone (rhGH), and in a subset of 450 patients treated for three years with rhGH. The major diagnostic categories were idiopathic growth hormone deficiency (IGHD), organic GH deficiency (OGHD), and idiopathic short stature (ISS). Children with IGHD and ISS were underweight for height at baseline but had a progressive increase in WTHTZ during three years of rhGH therapy. The same pattern applied to children with IGHD associated with septo-optic dysplasia and CNS trauma or infection. However, children with OGHD associated with craniopharyngiomas, other CNS tumors, leukemia, or CNS irradiation were overweight when starting rhGH and showed a decrease in WTHTZ during the first year of rhGH therapy. The increase in WTHTZ during rhGH treatment in children with ISS and OGHD suggests that the GH-induced increase in muscle mass exceeded loss of fat mass. Because children with neoplasm-related OGHD were overweight at baseline, the decline in WTHTZ during the first year of rhGH therapy suggests that loss of fat mass is the predominant effect in this subgroup.