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Smyczyńska J, Hilczer M, Smyczyńska U, Lewiński A, Stawerska R. Transient Isolated, Idiopathic Growth Hormone Deficiency-A Self-Limiting Pediatric Disease with Male Predominance or a Diagnosis Based on Uncertain Criteria? Lesson from 20 Years' Real-World Experience with Retesting at One Center. Int J Mol Sci 2024; 25:5739. [PMID: 38891927 PMCID: PMC11171613 DOI: 10.3390/ijms25115739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
In the majority of children with growth hormone (GH) deficiency (GHD), normal GH secretion may occur before the attainment of final height. The aim of the study was to assess the incidence of persistent and transient GHD and the effectiveness of recombined human GH (rhGH) therapy in children with isolated, idiopathic GHD with respect to the moment of therapy withdrawal and according to different diagnostic criteria of GHD. The analysis included 260 patients (173 boys, 87 girls) with isolated, idiopathic GHD who had completed rhGH therapy and who had been reassessed for GH and IGF-1 secretion. The incidence of transient GHD with respect to different pre- and post-treatment criteria was compared together with the assessment of GH therapy effectiveness. The incidence of transient GHD, even with respect to pediatric criteria, was very high. Normal GH secretion occurred before the attainment of near-final height. Application of more restricted criteria decreased the number of children diagnosed with GHD but not the incidence of transient GHD among them. Poor response to GH therapy was observed mainly in the patients with normal IGF-1 before treatment, suggesting that their diagnosis of GHD may have been a false positive. Further efforts should be made to avoid the overdiagnosis GHD and the overtreatment of patients.
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Affiliation(s)
- Joanna Smyczyńska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Maciej Hilczer
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland; (M.H.); (A.L.); (R.S.)
| | - Urszula Smyczyńska
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland; (M.H.); (A.L.); (R.S.)
- Department of Pediatric Endocrinology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Renata Stawerska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital–Research Institute, 93-338 Lodz, Poland; (M.H.); (A.L.); (R.S.)
- Department of Pediatric Endocrinology, Medical University of Lodz, 90-419 Lodz, Poland
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Lonero A, Giotta M, Guerrini G, Calcaterra V, Galazzi E, Iughetti L, Cassio A, Wasniewska GM, Mameli C, Tornese G, Salerno M, Cherubini V, Caruso Nicoletti M, Street ME, Grandone A, Giacomozzi C, Faienza MF, Guzzetti C, Bellone S, Parpagnoli M, Musolino G, Maggio MC, Bozzola M, Trerotoli P, Delvecchio M. Isolated childhood growth hormone deficiency: a 30-year experience on final height and a new prediction model. J Endocrinol Invest 2022; 45:1709-1717. [PMID: 35567736 DOI: 10.1007/s40618-022-01808-4] [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: 02/16/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to evaluate the near-final height (nFHt) in a large cohort of pediatricpatients with growth hormone deficiency (GHD) and to elaborate a new predictive method of nFHt. METHODS We recruited GHD patients diagnosed between 1987 and 2014 and followed-up until nFHt. To predict the values of nFHt, each predictor was run in a univariable spline. RESULTS We enrolled 1051 patients. Pre-treatment height was -2.43 SDS, lower than parental height (THt) (-1.09 SDS, p < 0.001). The dose of recombinant human GH (rhGH) was 0.21mg/kg/week at start of treatment. nFHt was -1.08 SDS (height gain 1.27 SDS), higher than pre-treatment height (p < 0.001) and comparable to THt. 1.6% of the patients were shorter than -2 SDS from THt. The rhGH dose at nFHt was 0.19 mg/kg/week, lower than at the start (p < 0.001). The polynomial regression showed that nFHt was affected by gender, THt, age at puberty, height at puberty, age at the end of treatment (F = 325.37, p < 0.0001, R2 87.2%). CONCLUSION This large national study shows that GHD children can reach their THt. The rhGH/kg/day dose significantly decreased from the start to the end of the treatment. Our model suggests the importance of a timely diagnosis, possibly before puberty, the beneficial effect of long-term treatment with rhGH, and the key-role of THt. Our prediction model has a very acceptable error compared to the majority of other published studies.
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Affiliation(s)
- Antonella Lonero
- Giovanni XXIII Children's Hospital, AOU Policlinico di Bari, piazza G.Cesare 11, Bari, Italy
| | - Massimo Giotta
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Giulia Guerrini
- Specialty School of Paediatrics - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - Elena Galazzi
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Cassio
- Department of Pediatric Endocrinology, Unit of Pediatrics, University of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Chiara Mameli
- Pediatric Department, "V. Buzzi" Children's Hospital, University of Milan, Milan, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Mariacarolina Salerno
- Department of Translational Medical Sciences, Paediatric Endocrinology Unit, University of Naples 'Federico II', Naples, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Maria Elisabeth Street
- Department of Mother and Child, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Anna Grandone
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Giacomozzi
- Unit of Pediatrics, Department of Maternal and Child Health, Carlo Poma Hospital, ASST-Mantova, Mantua, Italy
| | - Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, Paediatric Unit, University of Bari "A. Moro", Bari, Italy
| | - Chiara Guzzetti
- SSD Endocrinologia Pediatrica e Centro Screening Neonatale, Ospedale Pediatrico Microcitemico "A. Cao", ASSL Cagliari, Novara, Italy
| | - Simonetta Bellone
- SCDU of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Gianluca Musolino
- Ambulatorio di Auxologia ed Endocrinologia pediatrica, S.C. Pediatria, Ospedale Pediatrico "Filippo Del Ponte", ASST Sette Laghi, Varese, Italy
| | - Maria Cristina Maggio
- Department of Health Promotion, Maternal and Infantile Care, Department of Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Paolo Trerotoli
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Maurizio Delvecchio
- Giovanni XXIII Children's Hospital, AOU Policlinico di Bari, piazza G.Cesare 11, Bari, Italy.
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Di Luigi L, Pigozzi F, Sgrò P, Frati L, Di Gianfrancesco A, Cappa M. The use of prohibited substances for therapeutic reasons in athletes affected by endocrine diseases and disorders: the therapeutic use exemption (TUE) in clinical endocrinology. J Endocrinol Invest 2020; 43:563-573. [PMID: 31734891 DOI: 10.1007/s40618-019-01145-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023]
Abstract
To protect sporting ethics and athletes' health, the World Anti-Doping Agency (WADA) produced the World Anti-Doping Code and The Prohibited List of substances and methods forbidden in sports. In accordance with the International Standards for Therapeutic Use Exemption (ISTUE), to avoid rule violations and sanctions, athletes affected by different endocrine diseases and disorders (e.g., adrenal insufficiency, diabetes, male hypogonadisms, pituitary deficit, thyroid diseases, etc.) who need to use a prohibited substance for therapeutic reasons (e.g., medical treatments, surgical procedures, clinical diagnostic investigations) must apply to their respective Anti-Doping Organizations (ADOs) to obtain a Therapeutic Use Exemption (TUE), if specific criteria are respected. The physicians who treat these athletes (i.e., endocrinologists, andrologists and diabetologists) are highly involved in these procedures and should be aware of their specific role and responsibility in applying for a TUE, and in adequately monitoring unhealthy athletes treated with prohibited substances. In this paper, the prohibited substances commonly used for therapeutic reasons in endocrine diseases and disorders (e.g., corticotropins, beta-blockers, glucocorticoids, hCG, insulin, GnRH, rhGH, testosterone, etc.), the role of physicians in the TUE application process and the general criteria used by ADO-Therapeutic Use Exemption Committees (TUECs) for granting a TUE are described.
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Affiliation(s)
- L Di Luigi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy.
- National Anti-Doping Organization Italia (NADO-Italia), Rome, Italy.
| | - F Pigozzi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy
| | - P Sgrò
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy
| | - L Frati
- National Anti-Doping Organization Italia (NADO-Italia), Rome, Italy
- Mediterranean Neurology Institute (NEUROMED)-I.R.C.C.S, Pozzilli, Isernia, Italy
| | - A Di Gianfrancesco
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy
- National Anti-Doping Organization Italia (NADO-Italia), Rome, Italy
| | - M Cappa
- National Anti-Doping Organization Italia (NADO-Italia), Rome, Italy
- Unit of Endocrinology, Bambino Gesù Children's Hospital, Rome, Italy
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Centonze C, Guzzetti C, Orlando G, Loche S. Adherence to growth hormone (GH) therapy in naïve to treatment GH-deficient children: data of the Italian Cohort from the Easypod Connect Observational Study (ECOS). J Endocrinol Invest 2019; 42:1241-1244. [PMID: 30968283 PMCID: PMC6751271 DOI: 10.1007/s40618-019-01046-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the use of non-objective measurement, adherence to growth hormone (GH) therapy has been reported suboptimal in a large proportion of patients, and poor adherence has been shown to affect short-term growth response in patients receiving GH treatment. OBJECTIVE The Easypod™ electronic device allows objective measurement of adherence. In this study, we report 3-year prospective adherence data of the Italian cohort of naïve GH deficient (GHD) children extrapolated from the Easypod Connect Observational Study (ECOS) database. PATIENTS AND METHODS Seventy-three GHD children naïve to GH treatment were included in the analysis. 22 Italian centers participated in the study. RESULTS Mean adherence rate was consistently above 85% across the 3-year observation period. Particularly, mean adherence was 88.5%, 86.6%, and 85.7% after 1, 2 and 3 years, respectively. Mean (± SD) height-SDS increase after the first year was 0.41 (± 0.38). CONCLUSIONS The majority of naïve GHD children starting GH treatment with Easypod maintained an adherence rate > 85% up to 3 years. Easypod is a useful tool to follow-up patients' adherence allowing timely intervention to improve optimal treatment for these patients.
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Affiliation(s)
- C Centonze
- Medical Affairs Department, Merck Serono S.p.A., Rome, Italy
| | - C Guzzetti
- SSD di Endocrinologia Pediatrica e, Centro Screening Neonatale, Ospedale Pediatrico Miccrocitemico "A. Cao", AO Brotzu, Via Jenner, 09121, Cagliari, Italy
| | - G Orlando
- Medical Affairs Department, Merck Serono S.p.A., Rome, Italy
| | - S Loche
- SSD di Endocrinologia Pediatrica e, Centro Screening Neonatale, Ospedale Pediatrico Miccrocitemico "A. Cao", AO Brotzu, Via Jenner, 09121, Cagliari, Italy.
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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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