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M N N, J K, S R S, Raavi V. Methylation Status of IGF-Axis Genes in the Placenta of South Indian Neonates with Appropriate and Small for Gestational Age. Fetal Pediatr Pathol 2024; 43:5-20. [PMID: 37975569 DOI: 10.1080/15513815.2023.2280660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Altered methylation patterns of insulin-like growth factor (IGF)-axis genes in small for gestational age (SGA) have been reported in different populations. In the present study, we analyzed the methylation status of IGF-axis genes in the placenta of appropriate for gestational age (AGA) and SGA neonates of South Indian women. METHODS Placental samples were collected from AGA (n = 40) and SAG (n = 40) neonates. The methylation of IGF-axis genes promoter was analyzed using MS-PCR. RESULTS IGF2, H19, IGF1, and IGFR1 genes promoter methylation was 2.5, 1.5, 5, and 7.5% lower in SGA compared to AGA, respectively. Co-methylation of IGF-axis genes promoter was 40% and 20% in AGA and SGA, respectively. IGF-axis gene promoter methylation significantly (p < 0.05) influenced the levels of IGFBP3 protein, birth weight, mitotic index, gestational weeks, and IGFR1 and IGFR2 gene expression. CONCLUSION IGF-axis genes methylation was lower in SGA than in AGA, and the methylation significantly influenced the IGF-axis components.
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Affiliation(s)
- Nithya M N
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research (Deemed to be University), Kolar, Karnataka, India
| | - Krishnappa J
- Department of Paediatrics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (Deemed to be University), Kolar, Karnataka, India
| | - Sheela S R
- Department of Obstetrics and Gynaecology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (Deemed to be University), Kolar, Karnataka, India
| | - Venkateswarlu Raavi
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research (Deemed to be University), Kolar, Karnataka, India
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Al Khalifah RA, Alhakami A, AlRuthia Y, Al Sarraj HZ, Abulqasim J, Al-Rasheedi A, NurHussen A, Naji A. The long-term growth, cost-effectiveness, and glycemic effects of growth hormone therapy on children born small for gestational age over 10 years: a retrospective cohort study. J Pediatr Endocrinol Metab 2022; 35:1357-1368. [PMID: 36203313 DOI: 10.1515/jpem-2022-0379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to report our 10-year experience of treating short children born small for gestational age (SGA) by comparing the long-term growth, metabolic safety, and cost-effectiveness of recombinant human growth hormone (rhGH) therapy in short children born SGA with those in rhGH-treated children with growth hormone deficiency (GHD) and Turner syndrome. METHODS We performed a 10-year retrospective cohort study at King Saud University Medical City. We included children aged 3-16 years who received rhGH for GHD, SGA, or Turner syndrome for >1 year. RESULTS A total of 166 children received rhGH therapy for GHD, 58 for SGA, and 16 for Turner syndrome. During the last study visit, the average height change was 21 cm for GHD children and 14 cm for children born SGA (p-value <0.001). The height SDS change was 0.84 for GHD children and 0.55 for SGA children (p-value=0.004). The average cost-effectiveness ratios for treating GHD and SGA children were USD 1,717.22 and USD 1,157.19 per centimeter gained, respectively. Moreover, the mean incremental cost-effectiveness ratio for GHD vs. SGA patients was USD 2,820.39 per centimeter gained. Dysglycemia developed in 70 patients: 43 (36.44%), 22 (40.74%), and 5 (13%) in the GHD, SGA, and Turner syndrome groups, respectively. CONCLUSIONS rhGH is effective in height improvement of short children. However, pursuing rhGH treatment for children born SGA requires a shared decision-making approach to balance the modest benefit of final adult height gain with the long-term metabolic effects, considering the acceptable costs on the Saudi healthcare system.
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Affiliation(s)
- Reem Abdullah Al Khalifah
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amal Alhakami
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Division, Department of Clinical Science, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hadeel Zohair Al Sarraj
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Endocrinology Division, Department of Pediatrics, Ad Diriyah Hospital, Riyadh Third Health Cluster, Riyadh, Saudi Arabia
| | - Jumana Abulqasim
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ameinah Al-Rasheedi
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pediatrics, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Akram NurHussen
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ammar Naji
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Lee HS, Kum CD, Rho JG, Hwang JS. Long-term effectiveness of growth hormone therapy in children born small for gestational age: An analysis of LG growth study data. PLoS One 2022; 17:e0266329. [PMID: 35472208 PMCID: PMC9041836 DOI: 10.1371/journal.pone.0266329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose
Growth hormone (GH) treatment has been used to improve growth in short children who were born small for gestational age (SGA). The aim of this study was to investigate the long-term efficacy of GH treatment in these children.
Methods
Data from a multicenter observational clinical trial (ClinicalTrials.gov NCT01604395, LG growth study) were analyzed for growth outcome and prediction model in response to GH treatment. One hundred fifty-two children born SGA were included.
Results
The mean age of patients born SGA was 7.13 ± 2.59 years. Height standard deviation score (SDS) in patients born SGA increased from -2.55 ± 0.49 before starting treatment to -1.13 ± 0.76 after 3 years of GH treatment. Of the 152 patients with SGA, 48 who remained prepubertal during treatment used model development. The equation describing the predicted height velocity during 1st year of GH treatment is as follows: the predictive height velocity (cm) = 10.95 + [1.12 x Height SDS at initial treatment (score)] + [0.03 x GH dose (ug/kg/day)] + [0.30 x TH SDS at initial treatment (score)] + [0.05 x age (year)] + [0.15 x Weight SDS at initial treatment (score)] ± 1.51 cm.
Conclusions
GH treatment improved growth outcome in short children born SGA. We also developed a prediction model that is potentially useful in determining the optimal growth outcome for each child born SGA.
Trial registration
ClinicalTrials.gov Identifier: NCT01604395.
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Affiliation(s)
- Hae Sang Lee
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Change Dae Kum
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Jung Gi Rho
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
- * E-mail:
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Tidblad A, Gustafsson J, Marcus C, Ritzén M, Ekström K. Metabolic Effects of Growth Hormone Treatment in Short Prepubertal Children: A Double-Blinded Randomized Clinical Trial. Horm Res Paediatr 2022; 93:519-528. [PMID: 33684919 DOI: 10.1159/000513518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Growth hormone (GH) is a central hormone for regulating linear growth during childhood and also highly involved in the metabolism of lipids, carbohydrates, and protein. However, few studies report on how treatment with GH during childhood influences metabolic parameters. Our aim was to investigate metabolic effects of different doses of GH in short children with GH peak levels in the low to normal range. DESIGN Thirty-five prepubertal short children (<-2.5 SDS), aged 7-10 years, with peak levels of GH between 7 and 14 μg/L during an arginine-insulin tolerance test, were randomized to 3 different doses (11/33/100 μg/kg/day) of GH treatment for 2 years. Auxological and metabolic investigations were performed. These included metabolites in blood and interstitial microdialysis fluid, dual-energy X-ray absorptiometry, frequently sampled intravenous glucose tolerance test (FSIVGTT), and stable isotope examinations of rates of glucose production and lipolysis. RESULTS At 24 months, the high-dose group (HD) had higher fasting insulin compared with the standard-dose (SD) and low-dose (LD) groups (HD: 111.7 vs. SD: 61.2 and LD: 46.0 pmol/L [p < 0.001]) and showed signs of insulin resistance (HOMA-IR, HD: 4.20 vs. SD: 2.17 and LD: 1.71 (LD) [p < 0.001]). The FSIVGTT also demonstrated higher acute insulin response (p < 0.05). Few other metabolic differences were found at 24 months, but a decreased insulin sensitivity index (Si) could already be seen at 12 months for both SD and HD compared with the LD group (p < 0.05). CONCLUSION Treatment with GH resulted in a dose-dependent decrease in insulin sensitivity, demonstrated by higher levels of fasting insulin and signs of insulin resistance in both HOMA indices and FSIVGTT examinations.
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Affiliation(s)
- Anders Tidblad
- Department of Women's and Children's Health, Division of Pediatric Endocrinology, Karolinska Institutet, Stockholm, Sweden,
| | - Jan Gustafsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Martin Ritzén
- Department of Women's and Children's Health, Division of Pediatric Endocrinology, Karolinska Institutet, Stockholm, Sweden
| | - Klas Ekström
- Department of Women's and Children's Health, Division of Pediatric Endocrinology, Karolinska Institutet, Stockholm, Sweden
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Inzaghi E, Deodati A, Loddo S, Mucciolo M, Verdecchia F, Sallicandro E, Catino G, Cappa M, Novelli A, Cianfarani S. Prevalence of copy number variants (CNVs) and rhGH treatment efficacy in an Italian cohort of children born small for gestational age (SGA) with persistent short stature associated with a complex clinical phenotype. J Endocrinol Invest 2022; 45:79-87. [PMID: 34255311 DOI: 10.1007/s40618-021-01617-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Multiple factors influence intrauterine growth and lead to low birth sizes. The impact of genetic alterations on both pre- and post-natal growth is still largely unknown. The aim of this study was to investigate the prevalence of CNVs in an Italian cohort of SGA children with persistent short stature and complex clinical phenotype. rhGH treatment efficacy was evaluated according to the different genotypes. SUBJECTS AND METHODS Twenty-four SGA children (10F/14M) with persistent short stature associated with dysmorphic features and/or developmental delay underwent CNV evaluation. RESULTS CNVs were present in 14/24 (58%) SGA children. Six patients had a microdeletion involving the following regions: 3q24q25.1, 8p21.2p12, 15q26, 19q13.11, 20q11.21q12, 22q11.2. In three females, the same microdeletion involving 17p13.3 region was identified. In two different patients, two microduplications involving 10q21.3 and Xp11.3 region were observed. A further female patient showed both an 11q12.1 and an Xq27.1 microduplication, inherited from her mother and from her father, respectively. In a boy, the presence of a 12p13.33 microdeletion and a 19q13.43 microduplication was found. GH treatment efficacy, expressed by height gain and height velocity in the first 12 months of therapy, was similar in subjects with and without CNVs. CONCLUSIONS These results show that pathogenic CNVs are common in SGA children with short stature associated with additional clinical features. Interestingly, the involvement of 17p13.3 region occurs with a relative high frequency, suggesting that genes located in this region could play a key role in pre- and post-natal growth. rhGH therapy has similar efficacy in the short term whether CNVs are present or not.
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Affiliation(s)
- E Inzaghi
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.
| | - A Deodati
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - S Loddo
- Translational Cytogenomics Research Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - M Mucciolo
- Translational Cytogenomics Research Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - F Verdecchia
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - E Sallicandro
- Translational Cytogenomics Research Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - G Catino
- Translational Cytogenomics Research Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - M Cappa
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - A Novelli
- Translational Cytogenomics Research Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - S Cianfarani
- Dipartimento Pediatrico Universitario Ospedaliero, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institute and University Hospital, Stockholm, Sweden
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Identification of Growth Patterns in Low Birth Weight Infants from Birth to 5 Years of Age: Nationwide Korean Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031206. [PMID: 33572910 PMCID: PMC7908118 DOI: 10.3390/ijerph18031206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate the nationwide growth pattern of infants in Korea according to the birth-weight group and to analyze the effect of growth on development. A total of 430,541 infants, born in 2013 and who received the infant health check-up regularly from 6 months to 60 months of age, were included. The weight, height, head circumferences percentiles, and neurodevelopment using screening tests results were compared among the birth-weight groups. Using longitudinal analysis, the study found a significant difference in height, weight, and head circumference, respectively, according to age at health check-up, birth weight group, and combination of age and birth weight (p < 0.001). The growth parameters at 60 months of age showed a significant correlation with those at 6 months of age especially in extremely low birth weight infants. The incidence of suspected developmental delay was significantly higher in infants with growth below the 10th percentiles than in those with growth above the 10th percentiles. Among 4571 (1.6%) infants with suspected developmental delay results at 60 months of age, birth weight, sex, and poor growth parameters were confirmed as associated factors. This nationwide Korean study shows that poor growth and neurodevelopment outcomes persisted among low-birth-weight infants at 60 months of age. Our findings provide guidance for developing a nationwide follow-up program for infants with perinatal risk factors in Korea.
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Quitmann J, Bloemeke J, Dörr HG, Bullinger M, Witt S, Silva N. First-year predictors of health-related quality of life changes in short-statured children treated with human growth hormone. J Endocrinol Invest 2019; 42:1067-1076. [PMID: 30840207 DOI: 10.1007/s40618-019-01027-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/20/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Little attention has been directed towards examining the impact of predictors on change in health-related quality of life (HRQOL) within the course of growth hormone (GH) treatment in pediatric short stature. We aimed to assess changes in HRQOL and its sociodemographic, clinical and psychosocial predictors in children and adolescents diagnosed with growth hormone deficiency (GHD), and born short for gestational age (SGA) before and 12-month after start of GH treatment from the parents' perspective. Results were compared with an untreated group with idiopathic short stature (ISS). In this prospective multicenter study, 152 parents of children/adolescents (aged 4-18 years) provided data on their children's HRQOL at baseline and at 12-month follow-up. METHOD Repeated-measures multivariate analyses of covariance were performed to examine parent-reported HRQOL changes from baseline to 1-year after treatment and hierarchical linear regressions to identify the predictors of HRQOL changes. RESULTS Results showed that parents of children that were treated with GH report an increase in their children's HRQOL after 1 year. Changes in HRQOL were mostly explained by psychosocial predictors followed by sociodemographic and clinical variables. Specifically, the diagnosis SGA significantly predicted a greater increase in parent-reported HRQOL. Furthermore, a lower caregiving burden significantly predicted a decrease in parent-reported HRQOL. CONCLUSION In conclusion, a substantial percentage of explained variance in HRQOL relates to psychosocial and sociodemographic predictors. However, there appears to be other important factors that are predictors of HRQOL, which need to be determined in large, population-based samples.
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Affiliation(s)
- J Quitmann
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - J Bloemeke
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - H-G Dörr
- Division Paediatric Endocrinology, Hospital for Children and Adolescents, University Erlangen-Nürnberg, Erlangen, Germany
| | - M Bullinger
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - S Witt
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - N Silva
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Faculty of Psychology and Education Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
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Growth Hormone Treatment in Children Born Small for Gestational Age (SGA). ACTA ACUST UNITED AC 2018; 39:143-149. [PMID: 30110258 DOI: 10.2478/prilozi-2018-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Introduction: Growth failure is a common consequence in small for gestational age (SGA) children.
Patients and Methods: The growth patterns and serum insulin like growth factor 1 (IGF1) concentrations before and after the 1st year under growth hormone treatment of 32 short stature SGA born children have been evaluated. In addition, we investigated the insulin like growth factor 1 receptor (IGF1R) exon 2 as a hotspot for IGF1R genetic alterations. It is of note that no dysmorphic features were observed in this group of children.
Results: The tests for pituitary reserve were within normal ranges for all 32 patients. Growth hormone (GH) treatment (0.037 mg/kg/day) was initiated at the mean age of 9.32±3.19 years. Growth velocity increased yearly from −1.80 SDS after the first year to −0.03 SDS in the sixth year of treatment. Their IGF1 serum concentrations before treatment were age and sex appropriate, while during treatment a significant increase was observed fitting in the upper third of the normal range: before the treatment IGF1 SDS was 0.84±1.78 after 1st year the concentrations increased to IGF1 SDS 0.94±2.23. No genetic alterations were found in the IGF1R exon 2 by PCR analysis.
Conclusions: Herein we present 32 short stature SGA children with no dysmorphic features treated with GH. They all had increased growth velocity and entered the normal growth range on their growth charts. No side-effects were observed. GH treatment in children with no genetic alterations on the IGF1R exon 2 is safe and efficient in treating SGA children with short stature.
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Deal C, Kirsch S, Chanoine JP, Lawrence S, Cummings E, Rosolowsky ET, Marks SD, Jia N, Child CJ. Growth hormone treatment of Canadian children: results from the GeNeSIS phase IV prospective observational study. CMAJ Open 2018; 6:E372-E383. [PMID: 30201821 PMCID: PMC6182101 DOI: 10.9778/cmajo.20180020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Country-specific data on outcomes of treatment with recombinant human growth hormone are lacking. We present such data for children treated with growth hormone in Canada. METHODS We describe characteristics and outcomes of 850 children (mean age at baseline 8.5 yr) treated with growth hormone constituting the Canadian cohort of the multinational phase IV prospective observational Genetics and Neuroendocrinology of Short-stature International Study (GeNeSIS). The diagnosis associated with short stature was as determined by the investigator. Auxological data were evaluated yearly until near-adult height. Adverse events were assessed in all growth-hormone-treated patients. RESULTS The diagnosis ascribed as the cause of short stature was growth hormone deficiency in 526 children (61.9%), predominantly organic rather than idiopathic, particularly congenital pituitary abnormalities and intracranial tumours. All diagnostic groups with sufficient patients for analysis had increased height velocity standard deviation score (SDS) and height SDS during growth hormone treatment. For patients who reached near-adult height (n = 293), the mean height SDS was within the normal range for about 80% of patients with organic growth hormone deficiency (n = 131) or idiopathic growth hormone deficiency (n = 50), 50% of patients with idiopathic short stature (n = 10) and 46% of patients with Turner syndrome (n = 79). Eleven deaths were reported, 7 in patients with organic growth hormone deficiency. Serious adverse events considered related to growth hormone treatment (n = 19) were isolated except for medulloblastoma recurrence (n = 2) and adenoidal hypertrophy (n = 2). INTERPRETATION Growth hormone treatment was effective and had a good safety profile in Canadian children. Growth hormone dosages were lower than in the US and global GeNeSIS cohorts, and a greater proportion of treated Canadian children had organic growth hormone deficiency. STUDY REGISTRATION ClinicalTrials.gov, no. NCT01088412.
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Affiliation(s)
- Cheri Deal
- University of Montreal and Centre hospitalier universitaire Sainte-Justine (Deal), Montréal, Que.; Lilly Research Laboratories (Kirsch), Toronto, Ont.; Endocrinology and Diabetes Unit (Chanoine), British Columbia Children's Hospital, Vancouver, BC; Division of Endocrinology and Metabolism (Lawrence), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Endocrinology (Cummings), IWK Health Centre, Dalhousie University, Halifax, NS; Division of Endocrinology (Rosolowsky), Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Department of Pediatrics and Child Health (Marks), Children's Hospital Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Man.; Lilly Research Laboratories (Jia), Indianapolis, Ind.; Eli Lilly and Company (Child), Windlesham, UK
| | - Susan Kirsch
- University of Montreal and Centre hospitalier universitaire Sainte-Justine (Deal), Montréal, Que.; Lilly Research Laboratories (Kirsch), Toronto, Ont.; Endocrinology and Diabetes Unit (Chanoine), British Columbia Children's Hospital, Vancouver, BC; Division of Endocrinology and Metabolism (Lawrence), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Endocrinology (Cummings), IWK Health Centre, Dalhousie University, Halifax, NS; Division of Endocrinology (Rosolowsky), Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Department of Pediatrics and Child Health (Marks), Children's Hospital Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Man.; Lilly Research Laboratories (Jia), Indianapolis, Ind.; Eli Lilly and Company (Child), Windlesham, UK
| | - Jean-Pierre Chanoine
- University of Montreal and Centre hospitalier universitaire Sainte-Justine (Deal), Montréal, Que.; Lilly Research Laboratories (Kirsch), Toronto, Ont.; Endocrinology and Diabetes Unit (Chanoine), British Columbia Children's Hospital, Vancouver, BC; Division of Endocrinology and Metabolism (Lawrence), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Endocrinology (Cummings), IWK Health Centre, Dalhousie University, Halifax, NS; Division of Endocrinology (Rosolowsky), Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Department of Pediatrics and Child Health (Marks), Children's Hospital Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Man.; Lilly Research Laboratories (Jia), Indianapolis, Ind.; Eli Lilly and Company (Child), Windlesham, UK
| | - Sarah Lawrence
- University of Montreal and Centre hospitalier universitaire Sainte-Justine (Deal), Montréal, Que.; Lilly Research Laboratories (Kirsch), Toronto, Ont.; Endocrinology and Diabetes Unit (Chanoine), British Columbia Children's Hospital, Vancouver, BC; Division of Endocrinology and Metabolism (Lawrence), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Endocrinology (Cummings), IWK Health Centre, Dalhousie University, Halifax, NS; Division of Endocrinology (Rosolowsky), Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Department of Pediatrics and Child Health (Marks), Children's Hospital Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Man.; Lilly Research Laboratories (Jia), Indianapolis, Ind.; Eli Lilly and Company (Child), Windlesham, UK
| | - Elizabeth Cummings
- University of Montreal and Centre hospitalier universitaire Sainte-Justine (Deal), Montréal, Que.; Lilly Research Laboratories (Kirsch), Toronto, Ont.; Endocrinology and Diabetes Unit (Chanoine), British Columbia Children's Hospital, Vancouver, BC; Division of Endocrinology and Metabolism (Lawrence), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Endocrinology (Cummings), IWK Health Centre, Dalhousie University, Halifax, NS; Division of Endocrinology (Rosolowsky), Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Department of Pediatrics and Child Health (Marks), Children's Hospital Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Man.; Lilly Research Laboratories (Jia), Indianapolis, Ind.; Eli Lilly and Company (Child), Windlesham, UK
| | - Elizabeth T Rosolowsky
- University of Montreal and Centre hospitalier universitaire Sainte-Justine (Deal), Montréal, Que.; Lilly Research Laboratories (Kirsch), Toronto, Ont.; Endocrinology and Diabetes Unit (Chanoine), British Columbia Children's Hospital, Vancouver, BC; Division of Endocrinology and Metabolism (Lawrence), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Endocrinology (Cummings), IWK Health Centre, Dalhousie University, Halifax, NS; Division of Endocrinology (Rosolowsky), Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Department of Pediatrics and Child Health (Marks), Children's Hospital Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Man.; Lilly Research Laboratories (Jia), Indianapolis, Ind.; Eli Lilly and Company (Child), Windlesham, UK
| | - Seth D Marks
- University of Montreal and Centre hospitalier universitaire Sainte-Justine (Deal), Montréal, Que.; Lilly Research Laboratories (Kirsch), Toronto, Ont.; Endocrinology and Diabetes Unit (Chanoine), British Columbia Children's Hospital, Vancouver, BC; Division of Endocrinology and Metabolism (Lawrence), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Endocrinology (Cummings), IWK Health Centre, Dalhousie University, Halifax, NS; Division of Endocrinology (Rosolowsky), Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Department of Pediatrics and Child Health (Marks), Children's Hospital Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Man.; Lilly Research Laboratories (Jia), Indianapolis, Ind.; Eli Lilly and Company (Child), Windlesham, UK
| | - Nan Jia
- University of Montreal and Centre hospitalier universitaire Sainte-Justine (Deal), Montréal, Que.; Lilly Research Laboratories (Kirsch), Toronto, Ont.; Endocrinology and Diabetes Unit (Chanoine), British Columbia Children's Hospital, Vancouver, BC; Division of Endocrinology and Metabolism (Lawrence), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Endocrinology (Cummings), IWK Health Centre, Dalhousie University, Halifax, NS; Division of Endocrinology (Rosolowsky), Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Department of Pediatrics and Child Health (Marks), Children's Hospital Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Man.; Lilly Research Laboratories (Jia), Indianapolis, Ind.; Eli Lilly and Company (Child), Windlesham, UK
| | - Christopher J Child
- University of Montreal and Centre hospitalier universitaire Sainte-Justine (Deal), Montréal, Que.; Lilly Research Laboratories (Kirsch), Toronto, Ont.; Endocrinology and Diabetes Unit (Chanoine), British Columbia Children's Hospital, Vancouver, BC; Division of Endocrinology and Metabolism (Lawrence), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Division of Endocrinology (Cummings), IWK Health Centre, Dalhousie University, Halifax, NS; Division of Endocrinology (Rosolowsky), Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alta.; Department of Pediatrics and Child Health (Marks), Children's Hospital Health Sciences Centre Winnipeg, University of Manitoba, Winnipeg, Man.; Lilly Research Laboratories (Jia), Indianapolis, Ind.; Eli Lilly and Company (Child), Windlesham, UK
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10
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Kojima-Ishii K, Toda N, Okubo K, Tocan V, Ohyama N, Makimura M, Matsuo T, Ochiai M, Ohga S, Ihara K. Metabolic and immunological assessment of small-for-gestational-age children during one-year treatment with growth hormone: the clinical impact of apolipoproteins. Endocr J 2018; 65:449-459. [PMID: 29459555 DOI: 10.1507/endocrj.ej17-0485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Children born small for gestational age (SGA) are at a higher risk for metabolic disorders later in life. In this study, we aimed to characterize young SGA children without catch-up growth and evaluate the effects of GH treatment on endocrinological, metabolic, and immunological parameters. Study design is a one-year single hospital-based study included prospective observation of SGA patients during 12 months of GH treatment. Clinical and laboratory profiles of SGA children at baseline were compared with controls born appropriate size for age. Twenty-six SGA children (median age, 3.4 years) and 26 control children (median age, 3.8 years) were enrolled. Anthropometric, hematologic, biochemical, immunological, and endocrinological parameters were assessed at baseline and 1, 3, 6, 9, and 12 months after the start of GH treatment. As a result, median height SD score (SDS) of SGA children increased by +0.42 with 12-month GH treatment. Body mass index SDS was lower in SGA children than in controls. Serum apolipoprotein A1 increased, whereas apolipoprotein B decreased during GH treatment. Serum leptin and resistin levels, which were lower in SGA children than in controls at baseline, did not change remarkably with GH treatment. Monocyte counts, which were lower in SGA patients at baseline, increased after GH treatment. Neutrophil counts significantly increased after GH treatment. Natural killer cell ratios, which were higher in SGA patients, decreased after GH treatment. In conclusion, there was no evidence suggesting metabolic abnormalities in SGA children. Serum apolipoprotein changes might predict the beneficial role of GH treatment in lowering cardiometabolic risk.
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Affiliation(s)
- Kanako Kojima-Ishii
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Naoko Toda
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Kazuhiro Okubo
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Noriko Ohyama
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Mika Makimura
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka 802-0077, Japan
| | - Terumichi Matsuo
- Department of Pediatrics, National Hospital Organization Kyushu Medical Center, Fukuoka 810-8563, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Kenji Ihara
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
- Department of Pediatrics, Faculty of Medicine, Oita University, Oita 879-5593, Japan
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11
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Valdes A, Cervantes J, Delgado Y, Valdes M, Granados H. The Short Child. Pediatr Ann 2018; 47:e29-e35. [PMID: 29323694 DOI: 10.3928/19382359-20171215-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Growth is one of the most important characteristics of human development. This process occurs from the moment of conception through the final stages of puberty. There are multiple factors that contribute to growth in humans. Although it may seem complex, a pediatrician should note that growth can be fairly predictable. The advantage to predictable changes in growth is that clinicians should be able to promptly detect any deviation and evaluate it in a timely manner. One of the most helpful tools to assess changes in growth is the use of a growth chart. This article provides the clinician with the necessary tools to identify growth abnormalities, investigate appropriately to arrive at an accurate diagnosis, and either treat or, when indicated, provide a timely referral to a pediatric endocrinologist. [Pediatr Ann. 2018;47(1):e29-e35.].
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12
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Sánchez Zahonero J, López García MJ. Estudio valenciano sobre tratamiento con hormona de crecimiento en pequeños para la edad gestacional. An Pediatr (Barc) 2017; 86:87-93. [DOI: 10.1016/j.anpedi.2016.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022] Open
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13
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Study on growth hormone treatment in small for gestational age children. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Cappa M, Iughetti L, Loche S, Maghnie M, Vottero A. Efficacy and safety of growth hormone treatment in children with short stature: the Italian cohort of the GeNeSIS clinical study. J Endocrinol Invest 2016; 39:667-77. [PMID: 27223400 PMCID: PMC4944121 DOI: 10.1007/s40618-015-0418-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE We examined auxological changes in growth hormone (GH)-treated children in Italy using data from the Italian cohort of the multinational observational Genetics and Neuroendocrinology of Short Stature International Study (GeNeSIS) of pediatric patients requiring GH treatment. METHODS We studied 711 children (median baseline age 9.6 years). Diagnosis associated with short stature was as determined by the investigator. Height standard deviation score (SDS) was evaluated yearly until final or near-final height (n = 78). Adverse events were assessed in all GH-treated patients. RESULTS The diagnosis resulting in GH treatment was GH deficiency (GHD) in 85.5 % of patients, followed by Turner syndrome (TS 6.6 %). Median starting GH dose was higher in patients with TS (0.30 mg/kg/week) than patients with GHD (0.23 mg/kg/week). Median (interquartile range) GH treatment duration was 2.6 (0.6-3.7) years. Mean (95 % confidence interval) final height SDS gain was 2.00 (1.27-2.73) for patients with organic GHD (n = 18) and 1.19 (0.97-1.40) for patients with idiopathic GHD (n = 41), but lower for patients with TS, 0.37 (-0.03 to 0.77, n = 13). Final height SDS was >-2 for 94 % of organic GHD, 88 % of idiopathic GHD and 62 % of TS patients. Mean age at GH start was lower for organic GHD patients, and treatment duration was longer than for other groups, resulting in greater mean final height gain. GH-related adverse events occurred mainly in patients diagnosed with idiopathic GHD. CONCLUSIONS Data from the Italian cohort of GeNeSIS showed auxological changes and safety of GH therapy consistent with results from international surveillance databases.
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Affiliation(s)
- M Cappa
- Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - L Iughetti
- Pediatric Unit, University of Modena and Reggio, Modena, Italy
| | - S Loche
- Pediatric Endocrinology, Ospedale Microcitemico ASL Cagliari, Cagliari, Italy
| | - M Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, University of Genova, Genoa, Italy
| | - A Vottero
- Medical Diabetes Group, Eli Lilly and Company, 50019, Sesto Fiorentino, Italy.
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Two-Year Data from a Long-Term Phase IV Study of Recombinant Human Growth Hormone in Short Children Born Small for Gestational Age. Adv Ther 2016; 33:423-34. [PMID: 26886776 PMCID: PMC4833801 DOI: 10.1007/s12325-016-0301-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 11/25/2022]
Abstract
Introduction This ongoing, prospective, open-label, non-comparative, multicenter phase IV study is evaluating the safety and efficacy of recombinant human growth hormone (rhGH; Omnitrope®, Sandoz GmbH) in short children born small for gestational age (SGA). Here we report data from patients who have completed 2 years’ treatment. Methods Eligibility criteria included prepubertal children born SGA with growth disturbances defined as current height standard deviation score (HSDS) <−2.5 and parental adjusted SDS <−1; birth weight and/or length <−2 SDS; and failure of catch-up growth [height velocity (HV) SDS <0 during the last year] by 4 years of age or later. The primary study objective is to assess the long-term effect of Omnitrope treatment on the development of diabetes in short children born SGA. Secondary objectives include evaluation of efficacy, incidence and severity of adverse events (AEs), occurrence of malignancies during treatment, and detection of anti-rhGH antibodies during treatment. Results In total, 278 children have been enrolled and received study medication; 249 have completed 2 years of treatment. No child has developed diabetes mellitus during the first 2 years; no fasting glucose or 2-h oral glucose tolerance test value exceeded the pre-defined limits of >126 or >200 mg/dL, respectively. No adverse alterations in body mass were noted. Treatment-emergent AEs were experienced by 211 (76.2%) children; most of these were of mild-to-moderate intensity (99.3%) and considered unrelated to study medication (97.6%). Treatment with Omnitrope was effective; mean HSDS was −3.39 at baseline, −2.57 at 1 year and −2.15 at 2 years of treatment. Mean HVSDS (peak-centered) also improved, from −2.13 at baseline to +4.16 at 1 year and +2.23 at 2 years. Conclusion In this second interim analysis, short children born SGA were safely and effectively treated with rhGH (Omnitrope), and 2 years’ treatment had no major adverse impact on carbohydrate metabolism or body mass. Funding Sandoz. Electronic supplementary material The online version of this article (doi:10.1007/s12325-016-0301-1) contains supplementary material, which is available to authorized users.
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Luzuriaga Tomás C, Oyarzabal Irigoyen M, Caveda Cepas E, Vázquez Salvi LA, García-Pérez LE. [Safety and efficacy of growth hormone treatment: GeNeSIS study in Spain]. An Pediatr (Barc) 2015; 84:139-47. [PMID: 26139238 DOI: 10.1016/j.anpedi.2015.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/21/2015] [Accepted: 05/04/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Country-specific information on pediatric GH therapy is available from multi-national studies. METHODS A total of 1294 children in Spain enrolled in the observational Genetics and Neuroendocrinology of Short-stature International Study (GeNeSIS). Adverse events were assessed in all GH-treated patients (n=1267) and effectiveness in those with GH deficiency (GHD, 78%). RESULTS Mean age at time of entry to the study was 9.8 years. GH was initiated at a median (Q1-Q3) 0.22 (0.20-0.25) mg/kg/week and administered for 2.8 (1.6-4.4) years. For 262 patients with GHD and 4-year data, mean (95% CI) height velocity was 4.3 (4.1 - 4.6) cm/year at baseline, 9.0 (8.7 to 9.4) cm/year at 1-year, and 5.5 (5.2 to 5.8) cm/year at 4-years. Height standard deviation score (SDS) was -2.48 (-2.58 to -2.38) at baseline and -1.18 (-1.28 to -1.08) at 4 years. Final height SDS minus target height SDS (n=241) was -0.09 (-0.20 to 0.02). In 1143 GH-treated patients with ≥1 year follow-up, 93 (8.1%) reported treatment-emergent adverse events. Serious events were reported for 7 children, with 2 considered GH-related. CONCLUSION These data confirm the benefit of GH replacement therapy on height gain for the patients in Spain. The safety profile was consistent with that already known for GH therapy.
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Affiliation(s)
- C Luzuriaga Tomás
- Unidad de Endocrinología Pediátrica, Hospital Marqués de Valdecilla, Santander, Cantabria, España
| | - M Oyarzabal Irigoyen
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - E Caveda Cepas
- Global Scientific Communications, Eli Lilly and Company, Alcobendas Madrid, España
| | - L A Vázquez Salvi
- Departamento Médico, Eli Lilly and Company, Alcobendas Madrid, España
| | - L E García-Pérez
- Global Medical Affairs, Eli Lilly and Company, Indianapolis, USA.
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Oberbauer AM. Developmental programming: the role of growth hormone. J Anim Sci Biotechnol 2015; 6:8. [PMID: 25774292 PMCID: PMC4358872 DOI: 10.1186/s40104-015-0001-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/20/2015] [Indexed: 12/30/2022] Open
Abstract
Developmental programming of the fetus has consequences for physiologic responses in the offspring as an adult and, more recently, is implicated in the expression of altered phenotypes of future generations. Some phenotypes, such as fertility, bone strength, and adiposity are highly relevant to food animal production and in utero factors that impinge on those traits are vital to understand. A key systemic regulatory hormone is growth hormone (GH), which has a developmental role in virtually all tissues and organs. This review catalogs the impact of GH on tissue programming and how perturbations early in development influence GH function.
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Affiliation(s)
- Anita M Oberbauer
- Department of Animal Science, University of California, One Shields Ave, Davis, CA 95616 USA
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Jung H, Land C, Blum WF, Schöenau E. Early differentiation between good and poor response to growth hormone therapy in short children born small for gestational age (SGA) to improve the outcome of poor responders. J Pediatr Endocrinol Metab 2014; 27:229-35. [PMID: 24150198 DOI: 10.1515/jpem-2013-0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 09/09/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine height-gain response in relation to predicted good or poor response during first-year low or high growth hormone (GH) dose in short prepubertal children born small for gestational age. PATIENTS AND METHODS The OPTIMA (Optimization of GH Treatment in Short Children Born Small for Gestational Age Based on a Growth Prediction Model) randomised study evaluated 12-month height standard deviation score (SDS) changes in patients receiving GH dose: fixed high (FH; 0.067 mg/kg/day) or 0.035 mg/kg/day individually adjusted (IA) after 3 months according to the Cologne early growth prediction. RESULTS Predicted 12-month height SDS gain was <0.75 for 21/89 FH-dose patients, considered poor responders; 11/21 reached a 12-month height SDS gain of ≥0.75. In IA-dose poor responders, increasing GH dose at 3 months maintained mean height velocity (HV), with 73.7% reaching a 12-month height SDS gain of ≥0.75 vs. 73.8% in IA-dose good responders who continued on low GH dose, where mean HV decreased after the initial 3-month period. CONCLUSION GH dose increase at 3 months in patients with predicted poor response maintained catch-up growth. Even when on FH dose, some patients did not achieve a good response.
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One-Year Data from a Long-Term Phase IV Study of Recombinant Human Growth Hormone in Short Children Born Small for Gestational Age. BIOLOGICS IN THERAPY 2014; 4:1-13. [PMID: 24676989 PMCID: PMC4254863 DOI: 10.1007/s13554-014-0014-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Indexed: 11/26/2022]
Abstract
Background This prospective, open-label, non-comparative, multicentre, long-term phase IV study is examining the efficacy and safety of somatropin [recombinant human growth hormone (rhGH)] in short children born small for gestational age (SGA) and its impact on the incidence of diabetes. This report is the first interim analysis of patients who have completed 1 year of treatment. Methods A total of 278 pre-pubertal patients were enrolled. Key eligibility criteria included height standard deviation score (HSDS) <−2.5; parental adjusted SDS <−1; birth weight and/or length <−2 SD and failure to show catch-up growth by ≥4 years of age. Patients were treated with rhGH 0.035 mg/kg/day. The primary objective was to evaluate the long-term effect of rhGH on carbohydrate metabolism [including fasting glucose, stimulated glucose (2-h oral glucose tolerance test, OGTT) and glycated haemoglobin (HbA1c)]. Secondary objectives included evaluation of height parameters [body height, HSDS, height velocity (HV), HVSDS]; insulin-like growth factor 1 (IGF-I) and insulin-like growth factor-binding protein 3 (IGFBP-3) serum levels during treatment; and incidence and severity of adverse events (AEs). Results None of the children developed diabetes mellitus within the first year of treatment. Mean levels of fasting glucose, HbA1c and 2-h OGTT values remained stable during the study period. Treatment with rhGH was effective, as documented by all height parameters. Mean HSDS improved from −3.39 at baseline to −2.57 at Year 1. Mean HV increased markedly from 4.25 cm/year at baseline to 8.99 cm/year during the first year. Similarly, mean peak-centred HVSDS increased from −2.13 at baseline to +4.16 at Year 1. Mean IGF-I SDS and IGFBP-3 SDS also increased within the first year (by +1.80 and +0.41, respectively). 13 patients (4.7%) did not respond adequately to treatment (HVSDS <1); they were withdrawn from the study. In total, 192 children (69.3%) experienced treatment-emergent AEs; most (98.7%) were mild-to-moderate, and the majority (96.5%) were unrelated to study treatment. Conclusion This interim analysis shows that short children born SGA can be effectively and safely treated with rhGH and that rhGH treatment has no major impact on carbohydrate metabolism after the first year of treatment. Electronic supplementary material The online version of this article (doi:10.1007/s13554-014-0014-4) contains supplementary material, which is available to authorized users.
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The Influence of Growth Hormone on Bone and Adipose Programming. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 814:169-76. [DOI: 10.1007/978-1-4939-1031-1_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Houk CP, Lee PA. Early diagnosis and treatment referral of children born small for gestational age without catch-up growth are critical for optimal growth outcomes. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2012; 2012:11. [PMID: 22559301 PMCID: PMC3441279 DOI: 10.1186/1687-9856-2012-11] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/25/2012] [Indexed: 05/17/2023]
Abstract
Approximately 10% of children born small for their gestational age (SGA) fail to show catch-up growth and may remain short-statured as adults. Despite treatment guidelines for children born SGA that recommend referral for growth hormone (GH) therapy evaluation and initiation by ages 2 to 4 years, the average age of GH treatment initiation is typically much later, at ages 7 to 9 years. Delayed referral for GH treatment is problematic as studies show younger age at GH treatment initiation in children born SGA is an independent predictor for responses such as optimal growth acceleration, normalization of prepubertal height, and most importantly, adult height (AH). This review discusses the importance and associated challenges of early diagnosis of children born SGA who fail to show catch-up growth, contrasts the recommended age of referral for these patients and the average age of GH treatment initiation, and discusses studies showing the significant positive effects of early referral and treatment with GH on AHs in short-statured children born SGA. To optimize the eventual height in short-statured SGA children who fail to manifest catch-up growth, a lowering of the average age of referral for GH therapy evaluation is needed to better align with consensus recommendations for SGA management. The importance of increasing parental and physician awareness that most children born SGA will do well developmentally and will optimally benefit from early initiation of GH treatment when short-statured is addressed, as is the need to shift the age of referral to better align with consensus recommendations.
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Affiliation(s)
- Christopher P Houk
- Penn State College of Medicine, Milton S, Hershey Medical Center, PO Box 850, Hershey, PA, 17033-0850, USA.
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