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Miller BS, Kelepouris N, Tenenbaum H, Di Carlo S, Backeljauw P. Pediatric growth hormone deficiency: Understanding the patient and caregiver perspectives. Growth Horm IGF Res 2024; 76:101592. [PMID: 38640825 DOI: 10.1016/j.ghir.2024.101592] [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: 01/26/2024] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
Childhood growth hormone deficiency (GHD) is a rare disorder associated with significant burden on both patients and caregivers. Although previous reports have detailed aspects of the burden experienced by patients and their caregivers, there is a paucity of first-hand information on the patient and caregiver journeys from their respective voices. To address this need, an advisory board meeting was conducted on September 30, 2022, with 4 pediatric patients with GHD and their caregivers to discuss their experiences prior to GHD diagnosis, during the diagnostic process, and during ongoing treatment with recombinant growth hormone. Feedback from patients and caregivers was reviewed by pediatric endocrinologists, who provided their own perspectives on the patient and caregiver journeys based on the information reported. Despite the small sample size, important insights were obtained: patients and caregivers reported remarkable growth benefits achieved with treatment, which provided strong motivation to remain adherent to daily injection regimens. Patient and caregiver accounts reflected wide variability between families in time from suspicion to diagnosis and in treatment challenges faced, ranging from practical issues such as handling and administration of medication to broader concerns about treatment access and continuity, as well as key knowledge gaps among patients, caregivers, and clinicians. Recommendations are provided to enhance the patient and caregiver journeys, including increasing development and availability of educational materials, providing opportunities for patient advocacy by clinicians and health care providers, and encouraging institutional improvements to ensure that patients continue to receive uninterrupted treatment during their critical period of growth.
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Affiliation(s)
- Bradley S Miller
- M Health Fairview Masonic Children's Hospital, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | | | | | | | - Philippe Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
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Miller BS, Loftus J, Kelkar M, Shrestha S, Parzynski C, Benjumea D, Wogen J, Jhingran P, Alvir J, Gupta A, Wajnrajch M. Impact of Daily Growth Hormone Adherence on Height Velocity among Children with Growth Hormone Deficiency (GHD). Endocr Pract 2024:S1530-891X(24)00545-7. [PMID: 38821179 DOI: 10.1016/j.eprac.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE To describe adherence to daily somatropin treatment and impact on height velocity within one year of treatment start among patients with pediatric growth hormone deficiency (pGHD) in a real-world US population. METHODS This retrospective cohort study included pediatric patients ages ≥3 years to <16 years old with pGHD prescribed somatropin by a pediatric endocrinologist at a US-based center of excellence between 01/01/2015 and 12/31/2020. Patient data was collected using hospital electronic health records linked to a specialty pharmacy patient prescription records. Adherence, evaluated over 12 months, was measured using the proportion of days covered (PDC) metric and patients were categorized as adherent if their PDC≥80%. Height velocity was annualized to compare across adherent and non-adherent patients. RESULTS 181 patients were identified and included in this study, of which 70.2% were male,73.5% were white and mean age (standard deviation [SD]) at index was 12.1 (2.8). In the height velocity analysis, 174 patients were included and the mean (SD) annualized change in height was 10.2 (5.7) cm/year in the adherent group (n=108) and 9.8 (7.6) in the non-adherent group (n=66). The difference in HV between the groups was not statistically significant. CONCLUSIONS Minor improvements in average HV were observed in the patient group who were adherent to somatropin therapy, although not statistically significant. Lack of observed significance may be due to small sample sizes, short observation period, a likely heterogenous population in terms of growth hormone prescribing, data bias due to single-center origin or potential patient misclassification.
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Affiliation(s)
- Bradley S Miller
- University of Minnesota Medical School, M Health Fairview Masonic Children's Hospital, Minneapolis, MN, USA
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Attia N, Moussa K, Altwaim A, Al-Agha AE, Amir AA, Almuhareb A. Tackling access and payer barriers for growth hormone therapy in Saudi Arabia: a consensus statement for the Saudi Working Group for Pediatric Endocrinology. J Pediatr Endocrinol Metab 2024; 37:387-399. [PMID: 38547465 DOI: 10.1515/jpem-2024-0021] [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: 01/10/2024] [Accepted: 03/13/2024] [Indexed: 05/05/2024]
Abstract
Prompt diagnosis and early treatment are key goals to optimize the outcomes of children with growth hormone deficiency (GHD) and attain the genetically expected adult height. Nonetheless, several barriers can hinder prompt diagnosis and treatment of GHD, including payer-related issues. In Saudi Arabia, moderate-to-severe short stature was reported in 13.1 and 11.7 % of healthy boys and girls, respectively. Several access and payer barriers can face pediatric endocrinologists during the diagnosis and treatment of GHD in Saudi Arabia. Insurance coverage policies can restrict access to diagnostic tests for GHD and recombinant human growth hormone (rhGH) due to their high costs and lack of gold-standard criteria. Some insurance policies may limit the duration of treatment with rhGH or the amount of medication covered per month. This consensus article gathered the insights of pediatric endocrinologists from Saudi Arabia to reflect the access and payer barriers to the diagnostic tests and treatment options of children with short stature. We also discussed the current payer-related challenges endocrinologists face during the investigations of children with short stature. The consensus identified potential strategies to overcome these challenges and optimize patient management.
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Affiliation(s)
- Najya Attia
- Department of Pediatric Endocrinology, 4917 King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences/King Abdullah International Medical Research Center , Jeddah, Saudi Arabia
| | | | - Abdulaziz Altwaim
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- International Diabetes Care Center, Jeddah, Saudi Arabia
| | - Abdulmoein Eid Al-Agha
- Pediatric Department, Pediatric Endocrinology & Diabetes Section, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Chimatapu SN, Sethuram S, Samuels JG, Klomhaus A, Mintz C, Savage MO, Rapaport R. Evolving growth hormone deficiency: proof of concept. Front Endocrinol (Lausanne) 2024; 15:1398171. [PMID: 38752175 PMCID: PMC11095394 DOI: 10.3389/fendo.2024.1398171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction We present the evolution of GHD in adolescent males with persistent growth failure, in whom the diagnosis was established after a second GH stimulation test (GST). Methods We performed a retrospective chart review of children who presented for short stature (height less < 2SD for mean/mid-parental height) and/or growth failure (sustained growth velocity < 0 SD) to pediatric endocrinology at Mount Sinai Kravis Children's Hospital, New York and who had 2 GSTs. Data collected from electronic medical records were analyzed using SPSS v28.0. Results Of 53 patients included, 42 were males. Average GH peak on initial GST was 15.48 ± 4.92 ng/ml, at 10.07 ± 2.65 years, mean height -1.68 ± 0.56SD(28% had <2SD), IGF-1 -1.00 ± 0.88SD. After 2.23 ± 1.22 years, at 12.04 ± 2.41years, height SDs decreased to -1.82 ± 0.63SD and IGF-1 was -1.08 ± 0.84SD. At repeat GST, average GH peak was 7.59 ± 2.12 ng/dL, with 36% ≤7 ng/dl and 32% in puberty. 12 males reached adult height of 0.08 ± 0.69 SD with a mean height gain of 1.83 ± 0.56SD(p<0.005), IGF-1 of -1.15 ± 0.81SD after 4.64 ± 1.4 years of GH. Conclusion We offer evidence for Evolving Growth Hormone Deficiency (EGHD) through repeat GST in children with persistent growth slowdown, even with pubertal progression; emphasizing the need for careful longitudinal follow-up to make accurate diagnosis.
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Affiliation(s)
- Sri Nikhita Chimatapu
- Division of Pediatric Endocrinology, University of California, Los Angeles (UCLA) Mattel Children’s Hospital, Los Angeles, CA, United States
| | - Swathi Sethuram
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, United States
| | - Julie G. Samuels
- Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Cassie Mintz
- Division of Medical Genetics & Genomics, Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Martin O. Savage
- William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, University of London, Queen Mary, United Kingdom
| | - Robert Rapaport
- Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Sachani P, Dhande R, Parihar P, Bothara SS, Kasat PR. Multisystem Involvement in a Pediatric Patient With Suspected Mucopolysaccharidosis: A Case Report. Cureus 2024; 16:e60593. [PMID: 38894766 PMCID: PMC11184629 DOI: 10.7759/cureus.60593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Mucopolysaccharidoses (MPS) are a group of inherited metabolic disorders characterized by the deficiency or malfunction of lysosomal enzymes responsible for glycosaminoglycan (GAG) degradation. We present the case of an 11-year-old male with a history of calcified mitral valve, rheumatic heart disease, and growth hormone deficiency who presented with dyspnea on exertion. Physical examination revealed dysmorphic facial features, short stature, and suboptimal weight and height parameters. Magnetic resonance imaging (MRI) of the brain showed cystic lesions in the white matter and corpus callosum, hydrocephalus, and cerebral atrophy, suggestive of MPS. This case highlights the importance of considering MPS in the differential diagnosis of patients with multisystemic involvement and the utility of advanced imaging techniques like MRI in guiding diagnosis and management. A multidisciplinary approach involving cardiology, endocrinology, genetics, and neurology is crucial for comprehensive management and improving patient outcomes. Early diagnosis and intervention are essential in optimizing the quality of life for patients with MPS.
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Affiliation(s)
- Pratiksha Sachani
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajasbala Dhande
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivani S Bothara
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Paschyanti R Kasat
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Altobaishat O, Abouzid M, Moawad MHED, Sharaf A, Al-Ajlouni Y, Umar TP, Bani-Salameh A, Tanashat M, Bataineh OA, Nashwan AJ. Efficacy, safety, and patient satisfaction of norditropin and sogroya in patients with growth hormone deficiency: a systematic review and meta-analysis of randomized controlled trials. Endocrine 2024:10.1007/s12020-024-03834-z. [PMID: 38658475 DOI: 10.1007/s12020-024-03834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Growth hormone deficiency occurs when the pituitary gland does not produce enough growth hormone. Norditropin®, a recombinant human growth hormone, and Sogroya®, an albumin-binding growth hormone derivative, are prescribed for patients with growth hormone deficiency. This systematic review assesses the efficacy, safety, and patient satisfaction associated with Norditropin and Sogroya. METHODS We systematically searched PubMed, Web of Science, and Scopus databases to identify eligible comparative studies. All studies published until June 2023 were included in our analysis. Our outcomes for children included height velocity and height velocity standard deviation score. In contrast, adult outcomes included adverse events, insulin-like growth factor 1-standard deviation score (IGF-1 SDS), and the Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9). Results are reported as odds ratio (OR) and mean difference (MD) with a 95% confidence interval (95% CI). RESULTS Ten studies involving 1058 participants (665 children and 393 adults) were included in the meta-analysis. In children, Norditropin at doses of 0.034 and 0.067 mg/kg/day was compared to Sogroya at doses of 0.04, 0.08, 0.16, and 0.24 mg/kg/week. The results showed that 0.034 mg/kg/day Norditropin had a favorable impact on height velocity (MD -2.01, 95% CI -3.7 to -2.12, p < 0.00001) and height velocity standard deviation score (Mean Difference -3.61, 95% CI -5.06 to -2.16, p < 0.00001) when compared to Sogroya 0.04 mg/kg/day. Other doses showed comparable results. In adults, the only significant side effect noted was rash, which favored Sogroya (OR 0.1, 95% CI 0.04-0.27, p < 0.00001). Additionally, IGF-1 SDS was significantly higher in the Sogroya group than in the Norditropin group (MD 0.25, 95% CI 0.02-0.48, p = 0.03). Furthermore, the overall score of the TSQM-9 questionnaire, which includes three domains: convenience, effectiveness, and satisfaction, was significantly higher in the Sogroya group compared to the Norditropin group (OR 6.36, 95% CI 3.92-8.8, p < 0.00001). CONCLUSION Norditropin and Sogroya showed comparable efficacy and safety profiles, except for the prevalence of rash in the Norditropin group, and Sogroya has higher satisfaction among adults. More high-quality studies with more patients are required to confirm these results.
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Affiliation(s)
- Obieda Altobaishat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St., 60-806, Poznan, Poland.
- Doctoral School, Poznan University of Medical Sciences, 60-812, Poznan, Poland.
| | - Mostafa Hossam El Din Moawad
- Faculty of Pharmacy, Clinical Department Alexandria University, Alexandria, Egypt
- Faculty of Medicine, Suez Canal University, Isamailia, Egypt
| | - Abdulrahman Sharaf
- Department of Clinical Pharmacy, Salmaniya Medical Complex, Government Hospital, Manama, Bahrain
| | | | - Tungki Pratama Umar
- Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Gujral J, Kidd BA, Becker C, Golden E, Lee HC, Kim-Schulze S, Yau M, Dudley J, Rapaport R. Acute Effects of Growth Hormone on the Cellular Immunologic Landscape in Pediatric Patients. Cureus 2024; 16:e57383. [PMID: 38566781 PMCID: PMC10984134 DOI: 10.7759/cureus.57383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Growth hormone (GH) and the immune system have multiple bidirectional interactions. Data about the acute effects of GH on the immune system are lacking. The objective of our study was to evaluate the acute effects of GH on the immune system using time-of-flight mass cytometry. METHODS This was a prospective study of pediatric patients who were being evaluated for short stature and underwent a GH stimulation test at a tertiary care center. Blood samples for immunologic markers, i.e., complete blood count (CBC) and time of flight mass cytometry (CyTOF), were collected at baseline (T0) and over the course of three hours (T3) of the test. Differences in immune profiling in patients by timepoint (T0, T3) and GH response (growth hormone sufficient (GHS) versus growth hormone deficient (GHD)) were calculated using a two-way ANOVA test. Results: A total of 54 patients (39 boys and 15 girls) aged five to 18 years were recruited. Twenty-two participants tested GHD (peak GH <10 ng/ml). The CyTOF analysis showed a significant increase from T0 to T3 in granulocyte percentage, monocyte count, and dendritic cell (DC) count; in contrast, a significant decrease was seen in T lymphocytes (helper and cytotoxic) and IgD+ B lymphocytes. The CBC analysis supported these findings: an increase in total white blood cell count, absolute neutrophil count, and neutrophil percentage; a decrease in absolute lymphocyte count, lymphocyte percentage, absolute eosinophil count, and absolute monocyte count. No significant differences were found between CBC/CyTOF measurements and GH status at either time. CONCLUSIONS This study provides the first high-resolution map of acute changes in the immune system with GH stimulation. This implies a key role for GH in immunomodulatory function.
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Affiliation(s)
- Jasmine Gujral
- Pediatric Endocrinology, Yale School of Medicine, New Haven, USA
| | - Brian A Kidd
- Genetics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Christine Becker
- Genetics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Eddye Golden
- Genetics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hao-Chih Lee
- Genetics, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Seunghee Kim-Schulze
- Immunology and Immunotherapy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mabel Yau
- Pediatric Endocrinology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Joel Dudley
- Genetics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert Rapaport
- Pediatric Endocrinology, Icahn School of Medicine at Mount Sinai, New York, USA
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Zaffanello M, Pietrobelli A, Cavarzere P, Guzzo A, Antoniazzi F. Complex relationship between growth hormone and sleep in children: insights, discrepancies, and implications. Front Endocrinol (Lausanne) 2024; 14:1332114. [PMID: 38327902 PMCID: PMC10847528 DOI: 10.3389/fendo.2023.1332114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024] Open
Abstract
Growth hormone (GH) is crucial to growth and development. GH secretion is regulated by a complex feedback system involving the pituitary gland, hypothalamus, and other organs, and predominantly occurs during deep sleep. Isolated and idiopathic growth hormone deficiency (GHD) is a condition characterized by GHD without any other signs or symptoms associated with a specific syndrome or disease. The aim of this narrative review was to evaluate the relationship between GH and sleep in children using published data. Various databases (Medline/PubMed, Scopus, and Web of Science) were systematically searched for relevant English language articles published up to April 2023. Search strategies included the terms 'children/pediatric', 'growth hormone', 'growth hormone deficiency' and 'sleep'. Data were extracted by two independent reviewers; 185 papers were identified of which 58 were duplicates and 118 were excluded (unrelated n=83, syndromic/genetic GHD n=17, non-English n=13, abstract n=1, case report n=1). Overall, nine studies (six clinical studies, two case series, and one survey) were included. GHD appears to have an adverse effect on sleep in children, and GH therapy has only been shown to have a beneficial effect on sleep parameters in some individuals. Notably, identified data were limited, old/poor quality, and heterogenous/inconsistent. Further research of GHD in pediatric populations is necessary to improve the understanding of GHD impact on sleep and its underlying mechanisms, and to determine the specific impacts of GH therapy on sleep in children.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Alessandra Guzzo
- Department of Pathology and Diagnostics, School of Medicine, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
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Khan MQ, Hassan S, Lizaola-Mayo BC, Bhat M, Watt KD. Navigating the "specific etiology" steatohepatitis category: Evaluation and management of nonalcoholic/nonmetabolic dysfunction-associated steatohepatitis. Hepatology 2023:01515467-990000000-00637. [PMID: 37939197 DOI: 10.1097/hep.0000000000000674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Mohammad Qasim Khan
- Department of Internal Medicine, Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada
| | - Sara Hassan
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Blanca C Lizaola-Mayo
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA
| | - Mamatha Bhat
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | - Kymberly D Watt
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Santos LA, Sullivan B, Kvist O, Jambawalikar S, Mostoufi-Moab S, Raya JM, Nguyen J, Marin D, Delgado J, Tokaria R, Nelson RR, Kammen B, Jaramillo D. Diffusion tensor imaging of the physis: the ABC's. Pediatr Radiol 2023; 53:2355-2368. [PMID: 37658251 DOI: 10.1007/s00247-023-05753-z] [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: 05/09/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
The physis, or growth plate, is the primary structure responsible for longitudinal growth of the long bones. Diffusion tensor imaging (DTI) is a technique that depicts the anisotropic motion of water molecules, or diffusion. When diffusion is limited by cellular membranes, information on tissue microstructure can be acquired. Tractography, the visual display of the direction and magnitude of water diffusion, provides qualitative visualization of complex cellular architecture as well as quantitative diffusion metrics that appear to indirectly reflect physeal activity. In the growing bones, DTI depicts the columns of cartilage and new bone in the physeal-metaphyseal complex. In this "How I do It", we will highlight the value of DTI as a clinical tool by presenting DTI tractography of the physeal-metaphyseal complex of children and adolescents during normal growth, illustrating variation in qualitative and quantitative tractography metrics with age and skeletal location. In addition, we will present tractography from patients with physeal dysfunction caused by growth hormone deficiency and physeal injury due to trauma, chemotherapy, and radiation therapy. Furthermore, we will delineate our process, or "DTI pipeline," from image acquisition to data interpretation.
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Affiliation(s)
- Laura A Santos
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA.
| | - Brendan Sullivan
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | - Ola Kvist
- Pediatric Radiology Department, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | | | - Jose M Raya
- New York University Langone Health, New York, NY, USA
| | - Jie Nguyen
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Marin
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | - Jorge Delgado
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rumana Tokaria
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | - Ronald R Nelson
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
| | - Bamidele Kammen
- University of California San Francisco, San Francisco, CA, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Irvine Medical Center, New York, NY, USA
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Donbaloğlu Z, Singin B, Acar S, Bedel A, Barsal Çetiner E, Aydın Behram B, Parlak M, Tuhan H. Evaluation of the growth response of children with growth hormone deficiency according to the peak growth hormone levels in provocation tests. Arch Pediatr 2023; 30:573-579. [PMID: 37802668 DOI: 10.1016/j.arcped.2023.08.005] [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: 10/20/2022] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND We aimed to evaluate the relation between the peak growth hormone (GH) levels in provocation tests and response to recombinant human GH (rhGH) therapy in patients with GH deficiency (GHD). METHODS This was a cross-sectional, single-center, and retrospective study. A total of 135 patients under the age of 16 years who were diagnosed with GHD through insulin tolerance tests and L-DOPA stimulation tests and who received rhGH therapy for at least 2 years in the Pediatric Endocrinology Clinic of Akdeniz University Hospital between 1997 and 2021 were included in the study. RESULTS The patients were divided into two groups: idiopathic GHD (group I, n = 119) and multiple pituitary hormone deficiencies or organic pathology on magnetic resonance imaging (group II, n = 16). The patients in group I were classified into three subgroups according to the peak GH values in the provocation tests (group Ia: peak GH <3 μg/L, n = 34; group Ib: peak GH between 3 and 7 μg/L, n = 71; group Ic: peak GH between 7 and 10 μg/L, n = 34). The median age was 11.5 years in group I (8.8 in group Ia, 12.1 in group Ib, 12.3 in group Ib) and 8.8 years in group II. The height standard deviation score (SDS) was -2.93 in group I (-2.85 in group Ia, -2.99 in group Ib, -2.94 in group Ic) and -3.79 in group II. The median Δheight SDS was 0.61 in group I and 1.05 in group II at the end of the first year of treatment and 0.31 in group I and 0.45 in group II at the end of the second year (p = 0.005 and p = 0.074, respectively). When the subgroups of group I were compared, height SDS, Δheight SDS, and height velocity (HV) SDS were all higher in group Ia at the end of the first year of rhGH therapy (p = 0.040, p = 0.029, and p = 0.005, respectively). The height SDS was still significantly higher in group Ia (p = 0.033) while the HV SDS and Δheight SDS were similar between the groups at the end of the second year of therapy (p = 0.164 and p = 0.522, respectively). There was a statistically significant association between the first-year HV SDS and the peak GH value in provocation tests in multiple regression analyses (p<0.001). In addition, the final model revealed that height SDS and weight SDS at the start of the treatment and the first-year HV SDS are the factors with a statistically significant effect on the second-year HV SDS (p = 0.022, p = 0.001, and p<0.001, respectively). CONCLUSION Our findings show that the lower the GH peak in provocation tests, the better the response to treatment. The best HV was observed in the first year of rhGH therapy, and the diagnosis should be checked in those patients who had a low first-year HV and did not have a severely low GH peak in provocation tests.
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Affiliation(s)
- Zeynep Donbaloğlu
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Berna Singin
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Sezer Acar
- Department of Pediatric Endocrinology, Manisa City Hospital, Manisa, Turkey
| | - Aynur Bedel
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Ebru Barsal Çetiner
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Bilge Aydın Behram
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Mesut Parlak
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Hale Tuhan
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey.
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Gomez R, Lamoureux R, Turner-Bowker DM, Loftus J, Maghnie M, Miller BS, Polak M, Yaworsky A. Physician experience with once-weekly somatrogon versus once-daily rhGH regimen in pediatric patients with growth hormone deficiency: a cross-sectional survey of physicians from the global phase 3 study. Front Endocrinol (Lausanne) 2023; 14:1254424. [PMID: 37955005 PMCID: PMC10634585 DOI: 10.3389/fendo.2023.1254424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/18/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction The standard of care for pediatric growth hormone deficiency (pGHD) is once-daily recombinant human growth hormone (rhGH). Somatrogon, a long-acting rhGH, requires less frequent, once-weekly, dosing. We describe physicians' preference for, experiences, and satisfaction with once-weekly somatrogon vs once-daily rhGH. Methods English-speaking investigators from somatrogon's global phase III study (NCT02968004) with prior experience using once-daily rhGH were included. Participants answered an online survey containing 14 closed- and open-ended items. Results Twenty-four pediatric endocrinologists (41.7% men; 79.2% practiced at public/private hospitals) from 12 countries with 25.8 ± 12.0 years' experience treating pGHD completed the survey. In terms of the time and effort required to explain device instructions, injection regimen, procedure for missed injection, and address patients'/caregivers' concerns, a similar proportion of physicians chose once-weekly somatrogon and once-daily rhGH; 62.5% physicians indicated that once-daily rhGH required greater effort to monitor adherence. Overall, 75% preferred once-weekly somatrogon over once-daily rhGH, 79.2% considered once-weekly somatrogon to be more convenient and less burdensome, and 83.3% were likely to prescribe somatrogon in the future. Overall, 50% felt that once-weekly somatrogon was more beneficial to patients, while 50% chose "No difference". Most physicians (62.5%) felt both regimens were equally likely to support positive long-term growth outcomes and reduce healthcare utilization. More physicians were "very satisfied" with once-weekly somatrogon (62.5%) than with once-daily rhGH (16.7%). Reduced injection frequency, patient and caregiver burden, increased convenience, and improved adherence were reasons for these choices. Conclusion Physicians had a positive experience with, and perception of, treating pGHD with once-weekly somatrogon.
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Affiliation(s)
- Roy Gomez
- Global Medical Affairs, Pfizer Pte Limited, Singapore, Singapore
| | - Roger Lamoureux
- Adelphi Values, Patient-Centered Outcomes, Boston, MA, United States
| | | | - Jane Loftus
- Outcomes Research, Pfizer Ltd, Walton Oaks, Tadworth, United Kingdom
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Bradley S. Miller
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, M Health Fairview Masonic Children’s Hospital, Minneapolis, MN, United States
| | - Michel Polak
- D’endocrinologie, Gynécologie et Diabétologie Pédiatriques, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Andrew Yaworsky
- Adelphi Values, Patient-Centered Outcomes, Boston, MA, United States
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13
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Grillo MS, Frank J, Saenger P. Long acting growth hormone (LAGH), an update. Front Pediatr 2023; 11:1254231. [PMID: 37842029 PMCID: PMC10569466 DOI: 10.3389/fped.2023.1254231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
In 1957, Maurice Raben at Yale was able to isolate and purify growth hormone from cadaveric pituitary glands. Pituitary growth hormone was the only way to treat children with growth hormone (GH) deficiency, until 1985 when recombinant GH became available for daily subcutaneous injection. For many years, the pediatric endocrine community longed for a long-acting recombinant GH formulation that would decrease the inconvenience of daily injections. Several mechanisms were employed to develop a GH that is rapidly absorbed into the blood stream after subcutaneous injection, but provides slow removal from the circulatory system to potentially optimize patient adherence to GH therapy. Four long-acting growth hormones are currently available in the world, or are close to regulatory approval. They are: (1) Pegylated formulations, (2) Prodrug formulations which are converted into active drug, (3) Nonvalent transient albumin binding GH compounds and (4) GH fusion proteins where a protein si fused with GH. All four formulations have undergone detailed phase 3 studies and were found to show non-inferiority in these clinical studies. All four demonstrate a safety and tolerability profile that is comparable to that of daily somatropin with an excellent adherence profile.
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14
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Fatani TH. Diagnostic Value of IGF-1 in Growth Hormone-Deficient Children: Is a Second Growth Hormone Stimulation Test Necessary? J Endocr Soc 2023; 7:bvad018. [PMID: 36846213 PMCID: PMC9954969 DOI: 10.1210/jendso/bvad018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
Objective we assessed the diagnostic accuracy of insulin-like growth factor (IGF) 1 measurements with 1 growth hormone stimulation test (GHST) vs performing 2 GHSTs as the standard test to confirm the diagnosis of growth hormone deficiency (GHD) in children. Methods We retrospectively analyzed the baseline characteristics, anthropometric measurements, and laboratory data of 703 children with short stature, aged 4-14 years (mean age, 8.46 ± 2.7 years), who had undergone 2 GHSTs. We compared the diagnostic values of IGF-1 levels by using a cut-off value of ≤0 SD score, along with results of a single clonidine stimulation test (CST). We evaluated the false-positive rate, specificity, likelihood ratio, and area under the curve (AUC) of the 2 diagnostic methods. GHD was diagnosed if the peak growth hormone level was <7 ng/mL on 2 GHSTs. Results Of the 724 children, 577 (79.7%) had a low IGF-1 level (mean 104.9 ± 61.4 ng/mL), and 147 (20.3%) had a normal IGF-1 level (mean 145.9 ± 86.9 ng/mL). GHD was diagnosed in 187 patients (25.8%), of whom 146 (25.3%) had a low IGF-1 level. An IGF-1 level reflecting ≤0 SDs in combination with results of a single CST had a specificity of 92.6%, a false-positive rate of 5.5%, and an AUC of 0.6088. Using an IFG-1 cut-off level of ≤-2 SDs did not alter the diagnostic accuracy. Conclusion Low IGF-1 values of ≤0 SDs or ≤-2 SDs in combination with results of a single CST had poor diagnostic accuracy for GHD.
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Affiliation(s)
- Tarah H Fatani
- Correspondence: Tarah H. Fatani, MBBS, FRCPC, FAAP, Department of Pediatrics, Pediatric Endocrinology, King Abdulaziz University, P.O. BOX 80215, Jeddah 21589, Saudi Arabia.
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15
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Hou L, Huang K, Gong C, Luo F, Wei H, Liang L, Du H, Zhang J, Zhong Y, Chen R, Chen X, Pan J, Jin X, Zeng T, Liao W, Liu D, Lan D, Zhu S, Dong Z, Ma H, Yang Y, Xiong F, Mb PL, Cheng S, Gu X, Jin R, Liu Y, Wu J, Xu X, Chen L, Dong Q, Pan H, Su Z, Liu L, Luo X, Ni S, Chen Z, Hu Y, Wang C, Liu J, Liu L, Lu B, Wang X, Wang Y, Yang F, Zhang M, Cao L, Liu G, Yao H, Zhang Y, Dai M, Li G, Li L, Liu Y, Wang K, Xiao Y, Zhang X, Dong J, Gu Z, Ying L, Huang F, Liu Y, Liu Z, Ye J, Zhao D, Hu X, Jiang Z, Ye K, Zhu H, Chen S, Chen X, Wan N, Xu Z, Yin Q, Zhang H, Huang X, Yin J, Zhang H, Li P, Yin P, Fu J, Luo X. Long-term pegylated growth hormone for children with growth hormone deficiency: a large, prospective, real-world study. J Clin Endocrinol Metab 2023:6994549. [PMID: 36669772 DOI: 10.1210/clinem/dgad039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
CONTEXT The evidence of long-term polyethylene glycol recombinant human growth hormone (PEG-rhGH) in pediatric growth hormone deficiency (GHD) is limited. OBJECTIVE This study aimed to examine the effectiveness and safety of long-term PEG-rhGH in children with GHD in real world, as well as to examine the effects of dose on patient outcomes. DESIGN A prospective, observational, post-trial study (NCT03290235). SETTING, PARTICIPANTS AND INTERVENTION Children with GHD were enrolled from 81 centers in China in four individual clinical trials, and received weekly 0.2 mg/kg/week (high-dose) or 0.1-<0.2 mg/kg/week (low-dose) PEG-rhGH for 30 months. MAIN OUTCOMES MEASURES Height standard deviation score (Ht SDS) at 12, 24, and 36 months. RESULTS A total of 1170 children were enrolled in this post-trial study, with 642 patients in the high-dose subgroup and 528 in the low-dose subgroup, respectively. The Ht SDS improved significantly after treatment in the total population (P < 0.0001), with a mean change of 0.53 ± 0.30, 0.89 ± 0.48, 1.35 ± 0.63, 1.63 ± 0.75 at 6 months, 12 months, 24 months, and 36 months, respectively. Besides, the changes in Ht SDS from baseline was significantly improved in the high-dose subgroup than in the low-dose subgroup at 6, 12, 24 and 36 months after treatment (all P < 0.05). A total of 12 (1.03%) patients developed serious AEs. There was no serious AE related to the treatment, and no AEs leading to treatment discontinuation or death occurred. CONCLUSIONS PEG-rhGH showed long-term effectiveness and safety in treating children with GHD. Both dose subgroups showed promising outcomes, while PEG-rhGH 0.2 mg/kg/week might show additional benefit.
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Affiliation(s)
- Ling Hou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ke Huang
- Department of Endocrinology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Chunxiu Gong
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing 100045, China
| | - Feihong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Haiyan Wei
- Department of Endocrinology and Metabolism, Genetics, Henan Children's Hospital (Children's Hospital Affiliated to Zhengzhou University), Zhengzhou 450018, China
| | - Liyang Liang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Hongwei Du
- Department of Paediatrics, First Hospital of Jilin University, Changchun 130021, China
| | - Jianping Zhang
- Department of Pediatrics, Ningbo Women & Children's Hospital, Ningbo 315012, China
| | - Yan Zhong
- Department of Child Health Care, Hunan Children's Hospital, Changsha 410007, China
| | - Ruimin Chen
- Department of Endocrinology, Genetics and Metabolism, Fuzhou Children's Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Xinran Chen
- Department of Pediatric Endocrine Genetics and Metabolism, Chengdu Women's and Children's Center Hospital, Chengdu 610074, China
| | - Jiayan Pan
- Department of Pediatrics, Wuhu First People's Hospital, Wuhu 241000, China
| | - Xianjiang Jin
- Department of Genetics and Endocrinology, The Second Affiliated Hospital &Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Ting Zeng
- Department of Child Health Care, Liuzhou Maternilty and Child Heulthcare Hospital, Liuzhou, Guangxi 545001, China
| | - Wei Liao
- Department of Pediatrics, First Affiliated Hospital of Army Medical University (Thrid Military Medical University), Chongqing 400038, China
| | - Deyun Liu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Dan Lan
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Shunye Zhu
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China
| | - Zhiya Dong
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao-Tong University, School of Medicine, Shanghai 200025, China
| | - Huamei Ma
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yu Yang
- Department of Endocrinology and Genetics, Jiangxi Provincial Children's Hospital, Affiliated Children's Hospital of Nanchang University, Nanchang 330006, China
| | - Feng Xiong
- Department of Endocrinology, Children's Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ping Lu Mb
- Department of Pediatrics, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Shengquan Cheng
- Department of Pediatrics, First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - Xuefan Gu
- Department of Pediatric Endocrinology and Genetic Metabolism, Xinhua Hospital, Shanghai Institute for Pediatric Research, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Runming Jin
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Liu
- Department of Endocrine and Genetic Metabolism, Maternal and Child Health-Care Hospital in Guiyang, Guiyang 550003, China
| | - Jinzhun Wu
- Department of Pediatrics, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Xu Xu
- Department of Endocrinology, Wuxi Children's Hospital, Wuxi 214023, China
| | - Linqi Chen
- Depatment of Endocrinology, Children's Hospital of Soochow University, Suzhou 215025, China
| | - Qin Dong
- Department of Pediatrics, Zhejiang Hospital of Traditional Chinese Medicine, Hangzhou 310000, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zhe Su
- Department of Endocrinology, Shenzhen Children's Hospital, No. 7019, Yitian Road, Shenzhen 518038, China
| | - Lijun Liu
- Department of Endocrinology, Genetics and Metabolism, Hebei Children's Hospital, Shijiazhuang 050031, China
| | - Xiaoming Luo
- Department of Pediatrics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Shining Ni
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Zhihong Chen
- Department of Pediatric Endocrinology, Metabolism & Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Yuhua Hu
- Department of Pediatrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Chunlin Wang
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jing Liu
- Department of Pediatrics, Changchun Children's Hospital, Changchun, Jilin 130000, China
| | - Li Liu
- Department of Genetics and Endocrinology, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
| | - Biao Lu
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan 750004, China
| | - Xinli Wang
- Department of Pediatric, Peking University Third Hospital, No.49, Huayuanbei Road, Haidian District, Beijing 100191, China
| | - Yunfeng Wang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fan Yang
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, China
| | - Manyan Zhang
- Department of Pediatrics, Shaoxing Second Hospital, Shaoxing 312000, China
| | - Lizhi Cao
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - GeLi Liu
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hui Yao
- Department of Endocrinology and Metabolism, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Yaqin Zhang
- Department of Child Health, Maternal and Child Health Care Hospital of Hainan Province, Haikou 570206, China
| | - Mingjuan Dai
- Department of Pediatrics, Hangzhou First People's Hospital, Hangzhou 310022, China
| | - Guimei Li
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Li Li
- Department of Pediatrics, The 1st People's Hospital of Yunnan Province, Kunming 650032, China
| | - Yanjie Liu
- Department of Pediatrics, Inner Mongolia People's Hospital, Hohhot Inner Mongolia 010017, China
| | - Kan Wang
- Department of Pediatrics, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
| | - Yanfeng Xiao
- Department of Pediatrics, The 2nd Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an 710004, China
| | - Xingxing Zhang
- Department of Pediatrics, the Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Junhua Dong
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Zaiyan Gu
- Department of Pediatrics, Jiaxing First Hospital, Jiaxing 314000, China
| | - Lirong Ying
- Department of Pediatrics, Cixi People's Hospital, Cixi 315300, China
| | - Feng Huang
- Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong 226000, China
| | - Yanling Liu
- Department of Pediatrics, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Zheng Liu
- Department of Pediatrics, Tai'an Maternal and Child Health Care Hospital, Tai'an, Shandong 271000, China
| | - Jin Ye
- Department of Pediatrics, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China
| | - Dongmei Zhao
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Jinan, Shandong 250022, China
| | - Xu Hu
- Department of Pediatrics, Lu'an People's Hospital, Lu'an 237000, China
| | - Zhihong Jiang
- Department of Pediatric, The First Affiliated Hospital of He'nan University of Science and Technology, Luoyang 471003, China
| | - Kan Ye
- Department of Child Health, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215002, China
| | - Hong Zhu
- Department of Pediatrics, The First People's Hospital of Changzhou, Changzhou 213000, China
| | - Shaoke Chen
- The Second Affiliated Hospital of Guangxi Medical University, Nanning 530005, China
| | - Xiaobo Chen
- Department of Endocrinology, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - Naijun Wan
- Department of Pediatrics, Jishuitan Hospital, Beijing 100035, China
| | - Zhuangjian Xu
- Department of Pediatrics, Affiliated Hospital of Jiangnan University, Wuxi 214122, China
| | - Qingjin Yin
- Ward 1, Department of Internal Medicine, Chengdu Children's Specialized Hospital, Chengdu 610015, China
| | - Hongxiao Zhang
- Department of Pediatric, Second Hospital of Lanzhou University, Lanzhou 730030, China
| | - Xiaodong Huang
- Department of Endocrinology and Genetics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Jianying Yin
- Department of Pediatrics, Hebei General Hospital, Shijiazhuang 050051, China
| | - Huifeng Zhang
- Department of Pediatrics, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Pin Li
- Department of Endocrinology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200333, China
| | - Ping Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Junfen Fu
- Department of Endocrinology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - XiaoPing Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Feng YD, Wang J, Tao ZB, Jiang HK. Development and validation of a nomogram to predict poor short-term response to recombinant human growth hormone treatment in children with growth disorders. J Endocrinol Invest 2022:10.1007/s40618-022-01979-0. [PMID: 36480094 DOI: 10.1007/s40618-022-01979-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to develop and validate a clinical predictive model for predicting the likelihood of a poor therapeutic response during the first year of recombinant human growth hormone (rhGH) treatment in children with growth disorders. METHODS A total of 627 pediatric patients with growth disorders (GHD, ISS, TS, SGA) from The LG Growth Study cohort were evaluated. Restricted cubic splines (RCS) were utilized to investigate the association between predictors and the risk of poor rhGH response. Variables were selected using LASSO regression, and multivariate logistics regression models were established. Receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC) were used to assess the predictive model's accuracy and clinical value. The predictive accuracy of the model was validated on the testing set. RESULTS Two predictive models containing 8 baseline predictors (diagnosis, age, height SDS, bone age minus chronological age, rhGH dosage, distance from mid-parental height in SDS, weight SDS, IGF-1 SDS) and 1 post-treatment predictor (height SDS gain at 6 months) were constructed by multivariate logistic regression analyses. The nomogram was built based on the multivariate predictive model and showed good discrimination and model fit effects in both the training set and the testing set. DCA and CIC analyses presented good clinical usability. CONCLUSION The clinical predictive model for predicting the probability of poor short-term response of rhGH treatment in pediatric patients with growth disorders is useful and can assist physicians in making clinical decisions.
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Affiliation(s)
- Y D Feng
- Department of Pediatrics, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110000, Liaoning Province, China
| | - J Wang
- Gansu University of Chinese Medicine, Lanzhou, China
- Department of Neonatology, Lanzhou Maternity and Child Health Care Hospital, Lanzhou, China
| | - Z B Tao
- Department of Pediatrics, The First Hospital of Lanzhou University, Lanzhou, China
| | - H K Jiang
- Department of Pediatrics, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110000, Liaoning Province, China.
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Owada Y, Okazaki M, Ikeda T, Yamamoto R, Minami K, Takahashi K, Hirato T, Mita Y, Yamamoto T, Tanizawa K, Sonoda H, Sato Y. Pharmacokinetics and pharmacodynamics of once-weekly administration of JR-142, a long-acting albumin-fused human growth hormone: A rondemized, placebo-controlled phase 1 study. Growth Horm IGF Res 2022; 67:101500. [PMID: 36113378 DOI: 10.1016/j.ghir.2022.101500] [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: 04/14/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Under clinical development for patients with growth hormone deficiency, JR-142 is a long-acting growth hormone with a half-life extended by fusion with modified serum albumin. We conducted a Phase 1 study to investigate the safety, tolerability, and pharmacokinetic (PK) and pharmacodynamic (PD) profiles of once-weekly subcutaneous administrations of JR-142. The study consisted of two parts: an open-label single ascending dosing study (Part 1), and a randomized, placebo-controlled, assessor-blinded multiple ascending dosing study (Part 2). DESIGN A total of 31 healthy Japanese male participants were enrolled. In Part 1, seven of them received a single subcutaneous injection of JR-142 each at dosages of 0.15 mg/kg (n = 1), 0.25 mg/kg (n = 2), 0.5 mg/kg (n = 2), or 1.0 mg/kg (n = 2). In Part 2, one weekly subcutaneous injection of JR-142 at 0.25 mg/kg, 0.5 mg/kg, 1.0 mg/kg or a placebo were given for four weeks to each of the other 24 participants (six in each group). Plasma JR-142 and serum insulin-like growth factor-1 (IGF-1) concentrations were measured for PK and PD assessments. Safety was evaluated on the basis of adverse events (AEs), laboratory tests, and other measures. RESULTS JR-142 induced dose-dependent increases in the maximum plasma JR-142 concentration (Cmax) and the area under the plasma concentration-time curve from time 0 to τ (AUC0-τ). A similar dose-response relationship was observed in serum IGF-1 concentrations. All trough IGF-1 levels were well sustained one week after the final administrations of JR-142 at the three dosages, while the peak concentrations of IGF-1 remained mildly elevated. No serious AEs were observed, and laboratory tests, including assessment of anti-drug antibodies, uncovered no significant safety issues. CONCLUSIONS Once-weekly subcutaneous injections of JR-142 produced positive dose-dependent PK and PD profiles over the dosage range. Drug accumulation was observed after the four-week administration period but did not raise safety concerns, indicating that JR-142 is well-tolerated in healthy participants. The PD profiles observed in terms of IGF-1 concentrations were also positive, and we believe the encouraging results of this study warrant substantiation in further clinical trials in patients with GHD. ETHICS This clinical study was conducted at one investigational site in Osaka, Japan, where the clinical study and the non-clinical data of JR-142 were reviewed and approved by its Institutional Review Board on 9th May 2019. The study was conducted in compliance with the approved study protocol, the Declaration of Helsinki, 1964, as revised in 2013, and Good Clinical Practice.
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Affiliation(s)
- Yasuko Owada
- Medical Corporation Heishinkai OPHAC Hospital, Osaka, Japan
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Susilo AFP, Tjandraprawira KD, Rachmawati A. Isolated growth hormone deficiency and amenorrhea - Case report. Ann Med Surg (Lond) 2022; 84:104909. [PMID: 36582894 PMCID: PMC9793238 DOI: 10.1016/j.amsu.2022.104909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Growth hormone (GH) deficiency is the most common hypopituitarism disorder. We highlight the challenges to its diagnosis and management in the setting of a developing country. Case description A 14-year-old came with a chief complaint of inability to menstruate. Menarche was at 12-years old, lasted 7 days, soaking 2 pads/day which discontinued shortly after. Thelarche was at 12-years-old and her breast is at Tanner stage 3. Her axillary and pubic hair are at Tanner stage 1. Height was 120 cm, weight 34.8 kg, height for age z-score < -3. Her lab results were normal for estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin. Bone age was suitable for age. Magnetic resonance imaging revealed pituitary gland hypoplasia (5.3 mm). A hormonal panel 3 years prior showed abnormally low GH level but normal cortisol and thyroid hormone levels. She was diagnosed with isolated growth hormone deficiency (IGHD) with delayed puberty. She was treated with medroxyprogesterone tablets once daily, after which her menstruation restarted. However, due to her economic background, she declined genetic tests, discontinued her medication and amenorrhea recurred. Clinical discussion Amenorrhea present after a brief menarche should alert gynaecologists of a possible multi-hormone disorder with an underlying structural abnormality. IGHD may be due to a structural abnormality, such as pituitary gland hypoplasia. Unfortunately, economic reasons prevented the patient from receiving optimal treatment. Conclusion IGHD rarely presents with a gynaecological complaint. Hormonal and genetic tests along with imaging should be undertaken. Growth hormone supplementation is the treatment of choice.
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Harju S, Saari A, Sund R, Sankilampi U. Epidemiology of Disorders Associated with Short Stature in Childhood: A 20-Year Birth Cohort Study in Finland. Clin Epidemiol 2022; 14:1205-1214. [PMID: 36320440 PMCID: PMC9618248 DOI: 10.2147/clep.s372870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many primary and secondary disorders disturb growth and cause short stature (height below −2 SDS) in childhood. Growth monitoring programs aim at their early detection but are not evidence-based: epidemiology of childhood growth disorders is poorly characterized, and no consensus exists on priority target conditions. Herein, we describe population-based epidemiological data on several primary and secondary growth disorders associated with short stature in childhood. Materials and Methods This retrospective population-based 20-year birth cohort study examined 1 144 503 children (51% boys) born in Finland between 1998 and 2017, with 16.5 million care notifications including medical diagnoses. The first occurrences of key primary or secondary growth disorders were identified in multiple registers. Median ages at diagnosis (MAD), and age- and sex-specific cumulative incidences (CMI) from birth until 16 years of age were determined. Results Turner syndrome was the most common primary growth disorder (CMI 52 per 100 000 at 16 years, MAD 4.0 years). Most primary growth disorders were diagnosed before the age of 4 years, and thereafter, secondary growth disorders increased in number. MAD of growth hormone deficiency (GHD) was 8.7 (boys) and 7.2 years (girls). At 16 years, the CMI of GHD was higher in boys than in girls (127 versus 93 per 100 000, respectively), whereas the CMI of hypothyroidism was higher in girls (569 versus 306 per 100 000). Celiac disease was the most common secondary growth disorder and more common in girls than in boys (988 versus 546 per 100 000 at 16 years, respectively). Conclusion These population-based epidemiological data indicate that childhood growth monitoring should be age- and sex-specific. In the early childhood, the focus should be on primary growth disorders, and from preschool age also on secondary growth disorders. These results provide evidence for improving growth monitoring programs and diagnostic practices targeting on Turner syndrome, GHD, hypothyroidism, and celiac disease.
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Affiliation(s)
- Samuli Harju
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland,Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland,Correspondence: Samuli Harju, Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, PO Box 1627, Kuopio, 70211, Finland, Email
| | - Antti Saari
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland,Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Reijo Sund
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ulla Sankilampi
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland,Department of Paediatrics, Kuopio University Hospital, Kuopio, Finland
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In vivo and in vitro evidence for growth hormone-like bioactivity of Rhizoma Anemarrhenae extract. Biomed Pharmacother 2022; 153:113489. [DOI: 10.1016/j.biopha.2022.113489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
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Park M, Kim YJ, Oh KE, Kang E, Nam HK, Rhie YJ, Lee KH. The association between idiopathic scoliosis and growth hormone treatment in short children. Ann Pediatr Endocrinol Metab 2022; 27:207-213. [PMID: 35592900 PMCID: PMC9537675 DOI: 10.6065/apem.2142186.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Idiopathic scoliosis is the most common form of scoliosis, and the risk of onset and progression has been found to correlate with growth spurts. Therefore, treatment with recombinant human growth hormone (GH) treatment in short children may initiate and/or aggravate scoliosis. The aim of this study was to investigate the relationship between idiopathic scoliosis and GH treatment in short children. METHODS The medical records of 113 subjects seen at the participating institution between January 2010 and December 2020 and who were diagnosed with GH deficiency and small for gestational age, had idiopathic short stature, and were treated with GH for at least one year were reviewed. Scoliosis was defined as a Cobb angle greater than 10 degrees as assessed using a spine x-ray. Clinical data and laboratory findings before and 12 months after GH treatment were compared. RESULTS There was significant increase in height, height-standard deviation score, insulin-like growth factor 1, and insulin-like growth factor binding protein 3 (p<0.001) with GH treatment. However, there were no significant differences in the average Cobb angle (6.2°±3.3° vs. 6.1°±3.5°, p=0.842) and the prevalence of scoliosis (9.7% vs. 13.3%, p=0.481) before and after one year of GH treatment. A comparative analysis of both initial Cobb angle and change in Cobb angle during GH treatment showed no relationship with other factors. CONCLUSION Although GH treatment in short children increased height and growth velocity, it was not associated with development or aggravation of idiopathic scoliosis.
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Affiliation(s)
- Mijin Park
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Yu Jin Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Kyeong Eun Oh
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Eungu Kang
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Hyo-Kyoung Nam
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea,Address for correspondence: Young-Jun Rhie Department of Pediatrics, Korea University College of Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 15355, Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
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22
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Lee T, Song K, Sohn B, Eom J, Ahn SS, Kim HS, Lee SK. A Radiomics-Based Model with the Potential to Differentiate Growth Hormone Deficiency and Idiopathic Short Stature on Sella MRI. Yonsei Med J 2022; 63:856-863. [PMID: 36031786 PMCID: PMC9424774 DOI: 10.3349/ymj.2022.63.9.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/21/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We hypothesized that a radiomics approach could be employed to classify children with growth hormone deficiency (GHD) and idiopathic short stature (ISS) on sella magnetic resonance imaging (MRI). Accordingly, we aimed to develop a radiomics prediction model for differentiating GHD from ISS and to evaluate the diagnostic performance thereof. MATERIALS AND METHODS Short stature pediatric patients diagnosed with GHD or ISS from March 2011 to July 2020 at our institution were recruited. We enrolled 312 patients (GHD 210, ISS 102) with normal sella MRI and temporally split them into training and test sets (7:3). Pituitary glands were semi-automatically segmented, and 110 radiomic features were extracted from the coronal T2-weighted images. Feature selection and model development were conducted by applying mutual information (MI) and a light gradient boosting machine, respectively. After training, the model's performance was validated in the test set. We calculated mean absolute Shapley values for each of the selected input features using the Shapley additive explanations (SHAP) algorithm. Volumetric comparison was performed for GHD and ISS groups. RESULTS Ten radiomic features were selected by MI. The receiver operating characteristics curve of the developed model in the test set was 0.705, with an accuracy of 70.6%. When analyzing SHAP plots, root mean squared values had the highest impact in the model, followed by various texture features. In volumetric analysis, sagittal height showed a significant difference between GHD and ISS groups. CONCLUSION Radiomic analysis of sella MRI may be able to differentiate between GHD and ISS in clinical practice for short-statured children.
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Affiliation(s)
- Taeyoun Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungchul Song
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Beomseok Sohn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Jihwan Eom
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Computer Science, Yonsei University, Seoul, Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
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Chen J, Zhong Y, Wei H, Chen S, Su Z, Liu L, Liang L, Lu P, Chen L, Chen R, Ni S, Wang X, Li L, Wang Y, Xu X, Xiao Y, Yao H, Liu G, Jin R, Cao B, Wu D, Su C, Li W, Qin M, Li X, Luo X, Gong C. Polyethylene glycol recombinant human growth hormone in Chinese prepubertal slow-growing short children: doses reported in a multicenter real-world study. BMC Endocr Disord 2022; 22:201. [PMID: 35945517 PMCID: PMC9364582 DOI: 10.1186/s12902-022-01101-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of individualized-dose polyethylene glycol recombinant human growth hormone (PEG-rhGH) for short stature. METHODS This real-world study enrolled children with short stature in 19 hospitals throughout China. They were treated with PEG-rhGH for 6 months. The starting dosage ranged from 0.10 to 0.20 mg/kg/week. The primary outcome was the change in height standard deviation score (ΔHt SDS). RESULTS Five hundred and ten patients were included and grouped based on dosage as A (0.10-0.14 mg/kg/week), B (0.15-0.16 mg/kg/week), C (0.17-0.19 mg/kg/week), and D (0.20 mg/kg/week). The mean 6-month ΔHt SDS for the total cohort was 0.49 ± 0.27, and the means differed among the four dose groups (P = 0.002). The ΔHt SDS was lower in group A than in groups B (LSM difference [95%CI], -0.09 [-0.17, -0.01]), C (LSM difference [95%CI], -0.10 [-0.18, -0.02]), and D (LSM difference [95%CI], -0.13 [-0.21, -0.05]) after adjusting baseline covariates. There were no significant differences among groups B, C, and D. When the baseline IGF-1 was < -2 SDS or > 0 SDS, the △Ht SDS was not different among the four groups (P = 0.931 and P = 0.400). In children with baseline IGF-1 SDS of -2 ~ 0 SDS, a higher dosage was associated with a better treatment effect (P = 0.003), and the △Ht SDS was lower in older children than in younger ones (P < 0.001). CONCLUSIONS PEG-rhGH could effectively increase height in prepubertal short children. When the baseline IGF-1 was < -2 SDS, 0.10 mg/kg/week could be a starting dose. In other IGF-1 statuses, 0.15-0.20 mg/kg/week might be preferred. TRIAL REGISTRATION ClinicalTrials.gov: NCT03249480 , retrospectively registered.
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Affiliation(s)
- Jiajia Chen
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, No.56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Yan Zhong
- Department of Child Health Care, Hunan Children's Hospital, Changsha, 410007, China
| | - Haiyan Wei
- Department of Endocrinology and Metabolism, Genetics, Henan Children's Hospital (Children's Hospital Affiliated to Zhengzhou University), Changsha, 450018, China
| | - Shaoke Chen
- Department of Genetics and Metabolism, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530005, China
| | - Zhe Su
- Department of Endocrinology, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Lijun Liu
- Department of Endocrinology, Genetics, and Metabolism, Hebei Children's Hospital, Shijiazhuang, 050031, China
| | - Liyang Liang
- Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Ping Lu
- Department of Pediatrics, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Linqi Chen
- Depatment of Endocrinology, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Ruimin Chen
- Department of Endocrinology, Geneticsand Metabolism, Fuzhou Children's Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Shining Ni
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xinli Wang
- Department of Pediatrics, Peking University Third Hospital, Beijing, 100191, China
| | - Li Li
- Department of Pediatrics, The First People's Hospital of Yunnan Province, Kunming, 650032, China
| | - Yunfeng Wang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xu Xu
- Department of Endocrinology, Wuxi Children's Hospital, Wuxi, 214023, China
| | - Yanfeng Xiao
- Department of Pediatrics, The 2nd Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Hui Yao
- Department of Endocrinology and Metabolism, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430015, China
| | - Geli Liu
- Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Runming Jin
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bingyan Cao
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, No.56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Di Wu
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, No.56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Chang Su
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, No.56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Wenjing Li
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, No.56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Miao Qin
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, No.56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Xiaoqiao Li
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, No.56 Nanlishi Road, Xicheng District, 100045, Beijing, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Chunxiu Gong
- Department of Endocrine and Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, No.56 Nanlishi Road, Xicheng District, 100045, Beijing, China.
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Berta E, Zsíros N, Bodor M, Balogh I, Lőrincz H, Paragh G, Harangi M. Clinical Aspects of Genetic and Non-Genetic Cardiovascular Risk Factors in Familial Hypercholesterolemia. Genes (Basel) 2022; 13:genes13071158. [PMID: 35885941 PMCID: PMC9321861 DOI: 10.3390/genes13071158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
Familial hypercholesterolemia (FH) is the most common monogenic metabolic disorder characterized by considerably elevated low-density lipoprotein cholesterol (LDL-C) levels leading to enhanced atherogenesis, early cardiovascular disease (CVD), and premature death. However, the wide phenotypic heterogeneity in FH makes the cardiovascular risk prediction challenging in clinical practice to determine optimal therapeutic strategy. Beyond the lifetime LDL-C vascular accumulation, other genetic and non-genetic risk factors might exacerbate CVD development. Besides the most frequent variants of three genes (LDL-R, APOB, and PCSK9) in some proband variants of other genes implicated in lipid metabolism and atherogenesis are responsible for FH phenotype. Furthermore, non-genetic factors, including traditional cardiovascular risk factors, metabolic and endocrine disorders might also worsen risk profile. Although some were extensively studied previously, others, such as common endocrine disorders including thyroid disorders or polycystic ovary syndrome are not widely evaluated in FH. In this review, we summarize the most important genetic and non-genetic factors that might affect the risk prediction and therapeutic strategy in FH through the eyes of clinicians focusing on disorders that might not be in the center of FH research. The review highlights the complexity of FH care and the need of an interdisciplinary attitude to find the best therapeutic approach in FH patients.
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Affiliation(s)
- Eszter Berta
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (E.B.); (N.Z.); (H.L.); (G.P.)
| | - Noémi Zsíros
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (E.B.); (N.Z.); (H.L.); (G.P.)
| | - Miklós Bodor
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary;
| | - István Balogh
- Division of Clinical Genetics, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Hajnalka Lőrincz
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (E.B.); (N.Z.); (H.L.); (G.P.)
| | - György Paragh
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (E.B.); (N.Z.); (H.L.); (G.P.)
| | - Mariann Harangi
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (E.B.); (N.Z.); (H.L.); (G.P.)
- Correspondence: ; Tel./Fax: +36-52-442-101
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Hawkins J, Hires C, Dunne E, Keenan L. Prevalence of endocrine disorders among children exposed to Lavender Essential Oil and Tea Tree Essential Oils. Int J Pediatr Adolesc Med 2022; 9:117-124. [PMID: 35663791 PMCID: PMC9152575 DOI: 10.1016/j.ijpam.2021.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/15/2021] [Accepted: 10/03/2021] [Indexed: 12/01/2022]
Abstract
Background Lavender essential oil and tea tree essential oil have become popular ingredients in personal care and household products in recent decades. Questions regarding the safety of these oils in pediatric populations have been raised, proposing a link between these essential oils and endocrine disruption in children, specifically prepubertal gynecomastia. To date, no epidemiological studies have been conducted to evaluate this proposed link. Methods This is a cross sectional study conducted among parents of children in the United States to identify the prevalence of endocrine disruption in children aged 2-15 years old. This study also evaluates the potential for a relationship between the exposure of lavender essential oil and tea tree essential oil products and endocrine disrupting outcomes. Results In 556 children with a mean age of 6.33 (SD = 3.92), prevalence of endocrine disruption was .016 (SD = 0.13). No cases of prepubertal gynecomastia were identified in either group, and prevalence of precocious puberty, delayed puberty, growth hormone deficiency, and hypothyroidism were all consistent with population norms. Total risk of endocrine disorders among those exposed (0.0194) did not differ from the risk of those unexposed (0.0069). The risk ratio was 2.796 (95% CI: 0.352, 22.163, P = .458). Conclusion Children who were regularly exposed to lavender or tea tree essential oils experienced the same risk of endocrine disorders as those who were not exposed.
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Affiliation(s)
- Jessie Hawkins
- Franklin Health Research Center, 1650 Murfreesboro Rd., Suite 156, Franklin, TN, 37067, USA
| | - Christy Hires
- Franklin Health Research Center, 1650 Murfreesboro Rd., Suite 156, Franklin, TN, 37067, USA
| | - Elizabeth Dunne
- Franklin Health Research Center, 1650 Murfreesboro Rd., Suite 156, Franklin, TN, 37067, USA
| | - Lindsey Keenan
- Franklin Health Research Center, 1650 Murfreesboro Rd., Suite 156, Franklin, TN, 37067, USA
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Csákváry V, Ammer N, Bagci EB, Bolshova OV, Damholt BB, Katanic D, Mikhailova E, Muzsnai Á, Raduk D, Senatorova G, Szalecki M, Teifel M, Vajda Z, Zelinska N, Chaychenko T. Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of Macimorelin in Children with Suspected Growth Hormone Deficiency: An Open-Label, Group Comparison, Dose-Escalation Trial. Horm Res Paediatr 2022; 94:239-250. [PMID: 34438400 DOI: 10.1159/000519232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Diagnosis of growth hormone deficiency (GHD) in children requires the use of provocative growth hormone (GH) stimulation tests, which can have limited reliability and are potentially contraindicated in some patients. This is the first paediatric study to test the safety, tolerability, and pharmacokinetics (PK)/pharmacodynamics (PD) of macimorelin, an oral GH secretagogue, approved for diagnosis of adult GHD. METHODS In this open-label, group comparison, single-dose escalation trial (EudraCT 2018-001988-23), sequential cohorts of patients (C1-C3) received ascending single doses of macimorelin: 0.25 (C1), 0.5 (C2), and 1.0 (C3) mg/kg. Primary endpoints were safety and tolerability, and secondary endpoints were PK/PD. RESULTS Twenty-four patients aged between 2 and <18 with suspected GHD participated in the study. No macimorelin-related adverse events were reported, and macimorelin was well tolerated. Plasma macimorelin concentrations increased with dose: mean areas under the curve were 6.69 (C1), 18.02 (C2), and 30.92 (C3) h × ng/mL; mean maximum concentrations were 3.46 (C1), 8.13 (C2), and 12.87 (C3) ng/mL. GH concentration increased following macimorelin administration: mean times of maximum measured concentration were 52.5 (C1), 37.5 (C2), and 37.5 (C3) min. CONCLUSION All 3 doses of macimorelin had excellent safety and tolerability with PK/PD profiles in expected ranges. These results support the use of 1.0 mg/mL macimorelin in a Phase 3 test validation trial in children.
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Affiliation(s)
- Violetta Csákváry
- Department of Paediatrics, Markusovszky Teaching Hospital, Szombathely, Hungary
| | - Nicola Ammer
- Aeterna Zentaris GmbH, Frankfurt am Main, Germany
| | | | - Olena V Bolshova
- Komisarenko Institute of Endocrinology and Metabolism of the NAMS of Ukraine, Kyiv, Ukraine
| | | | - Dragan Katanic
- Institute for Child and Youth Health Care, Vojvodina, Novi Sad, Serbia
| | | | - Ágota Muzsnai
- Division of North Buda Center, Buda Children's Hospital, Budapest, Hungary
| | - Dmitri Raduk
- HCI 2nd Children's City Clinical Hospital, BelMAPO, Minsk, Belarus
| | - Ganna Senatorova
- Department of Paediatrics No. 1 and Neonatology, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Mieczysław Szalecki
- Department of Paediatric Endocrinology and Diabetology, The Children's Memorial Health Institute, Warsaw, Poland.,Collegium Medicum UJK, Kielce, Poland
| | | | - Zsolt Vajda
- Pál Heim National Pediatric Institute, Budapest, Hungary
| | - Nataliya Zelinska
- Ukrainian Scientifically Practical Center of Endocrine Surgery and Transplantation of Endocrine Organs and Tissues, MoH, Kyiv, Ukraine
| | - Tetyana Chaychenko
- Department of Paediatrics No. 1 and Neonatology, Kharkiv National Medical University, Kharkiv, Ukraine
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Almaghraby A, Jaju A, Ryan ME, Rychlik K, Habiby RL, Brickman WJ. Is Gadolinium Contrast Necessary for Pituitary MRI in the Evaluation of Pediatric Short Stature and Growth Hormone Deficiency? Horm Res Paediatr 2022; 94:201-210. [PMID: 34425574 DOI: 10.1159/000519031] [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: 01/09/2021] [Accepted: 08/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Short stature is a common concern that necessitates pediatric endocrinology evaluation. Growth hormone deficiency (GHD) is a commonly considered etiology. Brain and pituitary magnetic resonance imaging (MRI) with gadolinium-based contrast agents (GBCAs) is the most widely used imaging in assessing patients with GHD. Given the significant strides made in MRI technology, the need for contrast material should be reassessed. METHOD We performed a retrospective review of healthy patients with short stature and/or GHD who underwent brain and pituitary MRI with and without contrast to assess the added value of contrast administration. RESULTS 227/318 identified patients underwent growth hormone (GH) stimulation testing; 28 (12.3%) with normal GH response and 62 (27.3%) with severe GHD. We found a low incidence of sellar and suprasellar pathologies. When comparing noncontrast and contrast MRI, we found perfect agreement in detecting abnormal posterior pituitary bright spots (kappa:1.0) and substantial agreement in detecting pars intermedia cysts and posterior superior sellar cysts (kappa: 0.74 and 0.71, respectively). Initially, only moderate agreement was found in detecting infundibular abnormalities (kappa: 0.51), although a revised noncontrast MRI protocol with high-resolution 3D images enabled visualization of the infundibulum. CONCLUSION The MRI evaluation of healthy patients with short stature and/or isolated GHD may be completed without the use of GBCAs. The slight overestimation of pituitary stalk interruption by noncontrast images can be overcome by adding newer high-resolution sequences.
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Affiliation(s)
- Abdullah Almaghraby
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alok Jaju
- Division of Neuroradiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Maura E Ryan
- Division of Neuroradiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Karen Rychlik
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.,Stanley Manne Children's Research Institute, Biostatistics Research Core, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Reema L Habiby
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Wendy J Brickman
- Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Lim HH, Kim YM, Lee GM, Yu J, Han HS, Yu J. Growth Responses During 3 Years of Growth Hormone Treatment in Children and Adolescents With Growth Hormone Deficiency: Comparison Between Idiopathic, Organic and Isolated Growth Hormone Deficiency, and Multiple Pituitary Hormone Deficiency. J Korean Med Sci 2022; 37:e90. [PMID: 35315601 PMCID: PMC8938607 DOI: 10.3346/jkms.2022.37.e90] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/20/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The study aimed to compare the growth responses to 3 years of growth hormone (GH) treatment in children and adolescents with GH deficiency (GHD) according to idiopathic, organic, isolated (IGHD), and multiple pituitary hormone deficiency (MPHD). METHODS Total 163 patients aged 2-18 years (100 males and 63 females; 131 idiopathic and 32 organic GHD; 129 IGHD and 34 MPHD) were included from data obtained from the LG Growth Study. Parameters of growth responses and biochemical results were compared during the 3-year GH treatment. RESULTS The baseline age, bone age (BA), height (Ht) standard deviation score (SDS), weight SDS, mid-parental Ht SDS, predicted adult Ht (PAH) SDS, and insulin like growth factor-1 (IGF-1) SDS were significantly higher in the organic GHD patients than in the idiopathic GHD patients, but peak GH on the GH-stimulation test, baseline GH dose, and mean 3-year-GH dosage were higher in the idiopathic GHD patients than in the organic GHD patients. The prevalence of MPHD was higher in the organic GHD patients than in the idiopathic GHD patients. Idiopathic MPHD subgroup showed the largest increase for the ΔHt SDS and ΔPAH SDS during GH treatment, and organic MPHD subgroup had the smallest mean increase after GH treatment, depending on ΔIGF-1 SDS and ΔIGF binding protein-3 (IGFBP-3) SDS. The growth velocity and the parental-adjusted Ht gain were greater in the idiopathic GHD patients than the organic GHD patients during the 3-year GH treatment, which may have been related to the different GH dose, ΔIGF-1 SDS, and ΔIGFBP-3 SDS between two groups. Multiple linear regression analysis revealed that baseline IGF-1 SDS, BA, and MPH SDS in idiopathic group and baseline HT SDS in organic group are the most predictable parameters for favorable 3-year-GH treatment. CONCLUSION The 3-year-GH treatment was effective in both idiopathic and organic GHD patients regardless of the presence of MPHD or underlying causes, but their growth outcomes were not constant with each other. Close monitoring along with appropriate dosage of GH and annual growth responses, not specific at baseline, are more important in children and adolescents with GHD for long-term treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01604395.
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Affiliation(s)
- Han Hyuk Lim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yoo Mi Kim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | | | - Jaehong Yu
- Joey Children's Hospital, Daejeon, Korea
| | - Heon-Seok Han
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jeesuk Yu
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea.
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29
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Loftus J, Chen Y, Alvir JMJ, Chi L, Dasgupta S, Gupta A, Wajnrajch MP. Suboptimal adherence to daily growth hormone in a US real-world study: an unmet need in the treatment of pediatric growth hormone deficiency. Curr Med Res Opin 2021; 37:2141-2150. [PMID: 34569388 DOI: 10.1080/03007995.2021.1982682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate adherence to, and discontinuation of, somatropin treatment over 4 years in a US population-based study of children with pediatric growth hormone deficiency (pGHD). METHODS A retrospective cohort analysis of commercially insured patients ≥3 and <16 years, diagnosed with pGHD, newly treated with somatropin was conducted using Optum De-identified Clinformatics Data Mart. Index date was defined as the first prescription for somatropin between 01 July 2002 and 30 September 2019. Five non-exclusive patient cohorts were identified (>3, 12, 24, 36, and 48 months of post-index continuous enrollment). Suboptimal adherence was defined as medication possession ratio <80%. Discontinuation was defined as the date at which a gap of >60 days between somatropin fills first occurred. Cox proportional hazards regression was used to evaluate time to discontinuation. RESULTS In the 12-month cohort (n = 3091), mean age was 11.3 ± 2.9 years, 75.9% were male, 70.9% white, 9.4% Hispanic, 3.6% Asian, and 3.1% black. The proportion with suboptimal adherence at months 12 and 48 was 19.6% and 35.9%, respectively. Discontinuation occurred in 42.2% of patients. The rate of discontinuation (HR [95% CI]) was higher for age ≥10 (1.74 [1.53-1.98]), females (1.35 [1.21-1.50]), black and Hispanic race/ethnicity (1.50 [1.18-1.90] and 1.27 [1.09-1.49] compared to White) and obesity (1.69 [1.19-2.40]). CONCLUSION Suboptimal adherence increases with treatment duration, and risk of discontinuation is associated with age, female gender, black or Hispanic race/ethnicity, and obesity. Strategies that facilitate adherence among children at risk of discontinuation may improve clinical outcomes.
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Affiliation(s)
| | | | | | - Lei Chi
- Pfizer Inc, New York, NY, USA
| | | | | | - Michael P Wajnrajch
- Pfizer Inc, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
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30
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Huang J, Sarma A, Gupta N, Little S, Pruthi S. Noncontrast MRI Protocol for Selected Pediatric Pituitary Endocrinopathies: A Procedure with High Diagnostic Yield and Potential to Reduce Anesthesia and Gadolinium-Based Contrast Exposure. AJNR Am J Neuroradiol 2021; 42:1884-1890. [PMID: 34475192 PMCID: PMC8562761 DOI: 10.3174/ajnr.a7228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although many pediatric neuroradiology practices empirically use noncontrast brain and pituitary MR imaging for evaluation of growth hormone deficiency, central precocious puberty, and short stature, there are currently insufficient published data to support this practice in an evidence-based fashion. Therefore, the use of contrast-enhanced MR imaging for all pediatric pituitary endocrinopathies remains widespread. We evaluated whether noncontrast MR imaging has adequate diagnostic yield for the evaluation of pediatric growth hormone deficiency, central precocious puberty, and short stature. MATERIALS AND METHODS Pituitary MR imaging studies obtained for growth hormone deficiency, central precocious puberty, or short stature in patients 0-18 years of age from 2010 to 2019 were analyzed. Separate blinded review of noncontrast images in cases with abnormalities on the original radiology report was performed by 2 subspecialty-trained pediatric neuroradiologists, with discrepancies resolved by consensus. RESULTS Of the 134/442 MR imaging studies obtained for growth hormone deficiency, central precocious puberty, or short stature with hypothalamic-pituitary region abnormalities, there was 70% concordance with the original reports on blinded review of noncontrast images. Twenty-two of 40 discrepancies were deemed unrelated to the indication, and 9 cases originally interpreted as possible microadenoma were read as having normal findings on blinded review. Only 9 of 40 discrepancies required contrast for further characterization. CONCLUSIONS In our study, most relevant radiologic findings in patients with growth hormone deficiency, central precocious puberty, and short stature were detectable without contrast, providing evidence that contrast can be avoided in routine MR imaging evaluation of these indications. We propose a "rapid noncontrast pituitary" MR imaging protocol for pediatric patients presenting with growth hormone deficiency, central precocious puberty, or short stature, which may increase efficiency and decrease contrast and anesthesia exposure.
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Affiliation(s)
- J Huang
- From the Department of Radiology (J.H., A.S., S.L., S.P.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - A Sarma
- From the Department of Radiology (J.H., A.S., S.L., S.P.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - N Gupta
- Division of Pediatric Endocrinology and Diabetes (N.G.), Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S Little
- From the Department of Radiology (J.H., A.S., S.L., S.P.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - S Pruthi
- From the Department of Radiology (J.H., A.S., S.L., S.P.), Vanderbilt University Medical Center, Nashville, Tennessee
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31
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Hwang IT, Kim M, Kim NY, Yoon JS, Lee HJ, Jeong HR, Shim YS, Kang MJ. Gene polymorphisms in leptin and its receptor and the response to growth hormone treatment in patients with idiopathic growth hormone deficiency. Endocr J 2021; 68:889-895. [PMID: 33762520 DOI: 10.1507/endocrj.ej20-0788] [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] [Indexed: 11/23/2022] Open
Abstract
This study aimed to investigate the relationships between genetic polymorphisms of leptin/receptor genes and clinical/biochemical characteristics in children with growth hormone deficiency (GHD). Ninety-three GHD children and 69 age-matched normal controls were enrolled. Anthropometric measurements, bone age, and laboratory test results were obtained. Polymorphisms in the LEP gene promoter locus (LEP-2548, rs7799039) and LEPR genes (K109R, rs1137100 and Q223R, rs1137101) were analyzed using PCR-RFLP. The serum leptin levels were measured using an ELISA kit. The median height and BMI z-scores of all GHD subjects were -2.20 and -0.26, respectively, and those of normal controls were -0.30 and -0.13, respectively. The serum leptin levels were similar between GHD subjects and normal controls (p = 0.537), but those were different between the complete GHD (6.97 ng/mL) and partial GHD (4.22 ng/mL) groups (p = 0.047). There were no differences in the genotypic distributions of LEP-2548, LEPR K109R, and Q223R between GHD subjects and normal controls. However, GHD subjects with the G allele at LEP-2548 showed higher IGF-1 (p = 0.047) and IGFBP-3 SDSs (p = 0.027) than GHD subjects with the A allele. GHD subjects with the G allele at LEPR Q223R showed lower stimulated GH levels (p = 0.023) and greater height gain after 1 year of GH treatment (p = 0.034) than GHD subjects with the A allele. In conclusion, leptin/leptin receptor genes are suggested to have the role of growth-related factors, which can affect various growth responses in children who share the same disease entity.
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Affiliation(s)
- Il Tae Hwang
- Department of Pediatrics, Hallym University College of Medicine, 1, Hallymdaehak-gil, Chuncheon-si, Gangwon-do, 24252, Republic of Korea
| | - Mijin Kim
- Department of Pediatrics, Hallym University College of Medicine, 1, Hallymdaehak-gil, Chuncheon-si, Gangwon-do, 24252, Republic of Korea
| | - Nan Young Kim
- Hallym Institute of Translational Genomics & Bioinformatics, Hallym University Medical Center, 11, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14066, Republic of Korea
| | - Jong Seo Yoon
- Department of Pediatrics, Hallym University College of Medicine, 1, Hallymdaehak-gil, Chuncheon-si, Gangwon-do, 24252, Republic of Korea
| | - Hye Jin Lee
- Department of Pediatrics, Hallym University College of Medicine, 1, Hallymdaehak-gil, Chuncheon-si, Gangwon-do, 24252, Republic of Korea
| | - Hwal Rim Jeong
- Department of Pediatrics, Soonchunhyang University College of Medicine, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31151, Republic of Korea
| | - Young Suk Shim
- Department of Pediatrics, Ajou University College of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Min Jae Kang
- Department of Pediatrics, Hallym University College of Medicine, 1, Hallymdaehak-gil, Chuncheon-si, Gangwon-do, 24252, Republic of Korea
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Drummond JB, Soares BS, Pedrosa W, Ribeiro-Oliveira A. Revisiting peak serum cortisol response to insulin-induced hypoglycemia in children. J Endocrinol Invest 2021; 44:1291-1299. [PMID: 32959333 DOI: 10.1007/s40618-020-01427-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/14/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE To evaluate factors that could potentially affect the hypothalamic-pituitary adrenal (HPA) axis response to insulin-induced hypoglycemia in children without history or symptoms of adrenal insufficiency and to propose a cut-off value to define a normal response in this population. METHODS Exploratory single-center study involving 78 children that prospectively underwent insulin tolerance test (ITT) for suspected growth hormone (GH) deficiency. METHODS Glucose, cortisol, GH, adrenocorticotrophic hormone (ACTH), epinephrine and norepinephrine levels were measured at baseline and after insulin-induced hypoglycemia. Serum cortisol was measured using Access automated immunoassay. RESULTS Mean (range) basal morning serum cortisol of 8 (2.2-19.5) µg/dL/222 (61-542) nmol/L increased after hypoglycemia to 20.5 (14.6-29.5) µg/dL/570 nmol/L (405-819) nmol/L. Peak serum cortisol levels of 14.6 µg/dL (405 nmol/L) and 15.4 µg/dL (428 nmol/L) corresponded to the 2.5th and 5th percentiles, respectively. Peak serum cortisol correlated with peak plasma epinephrine (r = 0.367; P = 0.0014) but did not correlate with age, BMI-SD or peak serum GH. Children with intact and abnormal GH responses presented similar mean peak serum cortisol levels (20.0 vs. 20.6 µg/dL/555 vs. 572 nmol/L; P = 0.21). CONCLUSION Our data indicate that the current cut-off to define normal HPA axis response in children after insulin-induced hypoglycemia warrants reevaluation to avoid over-diagnosis of adrenal insufficiency. Our results suggest that peak serum cortisol levels ≥ 15.4 µg/dL (428 nmol/L) in children undergoing ITT might represent a normal cortisol response to stress, regardless of age, BMI or GH secretory capacity.
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Affiliation(s)
- J B Drummond
- Laboratory of Endocrinology, Federal University of Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, Minas Gerais, 30130-100, Brazil
- Hermes Pardini Institute, Belo Horizonte, Minas Gerais, Brazil
| | - B S Soares
- Laboratory of Endocrinology, Federal University of Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - W Pedrosa
- Hermes Pardini Institute, Belo Horizonte, Minas Gerais, Brazil
| | - A Ribeiro-Oliveira
- Laboratory of Endocrinology, Federal University of Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte, Minas Gerais, 30130-100, Brazil.
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Baird K, McCroskey J, Arynchyna A, Abdullatif H, Ashraf AP, Simpson L, Rocque BG. Incidental Pituitary Cysts in Children: Does Growth Hormone Treatment Affect Cyst Size? Endocr Pract 2021; 27:1128-1132. [PMID: 33965583 DOI: 10.1016/j.eprac.2021.04.887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the response of incidentally discovered pituitary cysts to growth hormone (GH) treatment. METHODS A retrospective chart review was performed of children with pituitary cysts on magnetic resonance imaging (MRI) over a 5-year period. Records and images were reviewed, and the results were analyzed using descriptive statistics. Children with pituitary cysts who received GH treatment were compared with those without. RESULTS We identified 109 children with pituitary cysts, 24 were treated with GH therapy. The average age was 8.5 ± 5.1 years. Children whose initial MRI scan was to evaluate growth hormone deficiency were more commonly male and non-Hispanic White compared with those with scans for other indications (male, 18 of 24 vs 35 of 85, P = .003; White, 23 of 24 vs 58 of 85, P = .004). Among patients who received GH treatment, 12 had follow-up MRI. Six had no change in cyst size and 6 had a decrease in cyst size. We observed no difference in the likelihood of cyst growth between those who received GH and those who did not (0 of 12 cysts with GH vs 1 of 15 cysts without GH showed growth at follow-up). No patient had neurologic deficits attributable to the pituitary cyst at any time. CONCLUSION In a single-institution, retrospective study, we find no evidence of growth in pituitary cysts in response to GH therapy.
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Affiliation(s)
- Katelin Baird
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Lauren Simpson
- University of Alabama at Birmingham, Birmingham, Alabama
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Henry RK. When They're Done Growing, Don't Forget They May Still Need Growth Hormone. Metab Syndr Relat Disord 2021; 19:257-263. [PMID: 33596132 DOI: 10.1089/met.2020.0130] [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: 11/12/2022] Open
Abstract
The effect of the growth hormone (GH) in promoting linear growth is well known; however, less recognized by practitioners especially pediatric, are its metabolic properties. This may be because the deleterious effects of improperly treated or untreated growth hormone deficiency (GHD) can present beyond the pediatric years. In addition, clinicians may lack familiarity with the potential issues that can arise due to inadequately treated GHD. Considering information from both the basic sciences research and clinical medicine, pediatric practitioners should be cognizant about the metabolic effects of GH. They should also be equipped to provide anticipatory guidance to patients regarding the importance of adherence to therapy in GHD and be prepared to transition patients with permanent GHD from pediatric GH supplementation to adult GH dosing. With a lack of proper transitioning, adverse outcomes may present beyond childhood.
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Affiliation(s)
- Rohan K Henry
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
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35
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Yuen KCJ, Alter CA, Miller BS, Gannon AW, Tritos NA, Samson SL, Dobri G, Kurtz K, Strobl F, Kelepouris N. Adult growth hormone deficiency: Optimizing transition of care from pediatric to adult services. Growth Horm IGF Res 2021; 56:101375. [PMID: 33341524 DOI: 10.1016/j.ghir.2020.101375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/23/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Most patients with childhood-onset growth hormone deficiency (CO-GHD) receive treatment with exogenous growth hormone (GH) to facilitate the attainment of their full potential adult height. Recent evidence suggests that continuing GH administration during the transition period between the end of linear growth and full adult maturity is necessary for proper body composition and bone and muscle health, and may also have beneficial effects on metabolic parameters, bone mineral density, and quality of life. The timing of this transition period coincides with the transfer of care from a pediatric to an adult endocrinologist, creating the potential for a care gap as a consequence of losing the patient to follow-up. DESIGN An advisory board comprising both pediatric and adult endocrinologists was assembled to address current clinical unmet needs and to collaborate on a structured transitional plan for optimal management of patients with CO-GHD. INSIGHTS/CONCLUSION The advisors suggest collaborative, multidisciplinary approaches to ensure continuity of care; ongoing testing and monitoring of GHD status into adulthood; and a clearly structured protocol that includes practical guidance for clinicians to establish best practices for transitioning older adolescents with persistent CO-GHD to adult care.
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Affiliation(s)
- Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine, Creighton School of Medicine, Phoenix, AZ, United States of America
| | - Craig A Alter
- Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Bradley S Miller
- Pediatric Endocrinology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States of America
| | - Anthony W Gannon
- Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, United States of America
| | - Nicholas A Tritos
- Massachusetts General Hospital, Neuroendocrine Unit, Harvard Medical School, Boston, MA, United States of America
| | - Susan L Samson
- Pituitary Center, Baylor St. Luke's Medical Center, Baylor College of Medicine, Houston, TX, United States of America
| | - Georgiana Dobri
- Neurological Surgery and Endocrinology Departments, Weill Cornell Medicine, New York, NY, United States of America
| | - Kristine Kurtz
- Novo Nordisk Inc., Plainsboro, NJ, United States of America
| | - Frank Strobl
- Novo Nordisk Inc., Plainsboro, NJ, United States of America
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Abstract
PURPOSE OF REVIEW Williams syndrome is a multisystem disorder caused by a microdeletion on chromosome 7q. Throughout infancy, childhood, and adulthood, abnormalities in body composition and in multiple endocrine axes may arise for individuals with Williams syndrome. This review describes the current literature regarding growth, body composition, and endocrine issues in Williams syndrome with recommendations for surveillance and management by the endocrinologist, geneticist, or primary care physician. RECENT FINDINGS In addition to known abnormalities in stature, calcium metabolism, and thyroid function, individuals with Williams syndrome are increasingly recognized to have low bone mineral density, increased body fat, and decreased muscle mass. Furthermore, recent literature identifies a high prevalence of diabetes and obesity starting in adolescence, and, less commonly, a lipedema phenotype in both male and female individuals. Understanding of the mechanisms by which haploinsufficiency of genes in the Williams syndrome-deleted region contributes to the multisystem phenotype of Williams syndrome continues to evolve. SUMMARY Multiple abnormalities in growth, body composition, and endocrine axes may manifest in individuals with Williams syndrome. Individuals with Williams syndrome should have routine surveillance for these issues in either the primary care setting or by an endocrinologist or geneticist.
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Affiliation(s)
- Takara L. Stanley
- Pediatric Endocrine Division, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
- Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Aaron Leong
- Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Barbara R. Pober
- Genetics Division, Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
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Choi YJ, Lee YJ, Lee NY, Lee SH, Kim SK, Ahn MB, Kim SH, Cho WK, Cho KS, Jung MH, Suh BK. Discriminatory performance of insulin-like growth factor 1 and insulin-like growth factor binding protein-3 by correlating values to chronological age, bone age, and pubertal status for diagnosis of isolated growth hormone deficiency. Ann Pediatr Endocrinol Metab 2020; 25:240-247. [PMID: 32871649 PMCID: PMC7788340 DOI: 10.6065/apem.2040018.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The discriminatory performance of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) was investigated by correlating their values with chronological age (CA), bone age (BA), and pubertal status (PS) for diagnosis of isolated growth hormone deficiency (IGHD). METHODS We evaluated IGF-1 and IGFBP-3 levels in 310 short-stature subjects subdivided into 2 groups: IGHD (n=31) and non-IGHD (n=279). IGF-1 and IGFBP-3 were assayed using immune-radiometric assay and transformed into standard deviation score (SDS) according to CA, BA, and PS. RESULTS The highest sensitivity was found in IGF-1-SDS for CA and IGFBP-3-SDS for CA (22.6% and 30.0%, respectively). The highest specificity was found in IGF-1-SDS for PS and IGFBP-3-SDS for PS (98.2% and 94.4%, respectively). Groups with the highest positive predictive values were IGF-1-SDS for BA and IGFBP-3-SDS for BA (10.9% and 5.1%, respectively). Highest negative predictive values were seen in IGF-1-SDS for CA and IGFBP-3-SDS for CA (98.4% and 98.4%, respectively). CONCLUSION IGF-1-SDS for CA, instead of IGF-1-SDS for BA or PS, could be used as a standard variable for IGHD screening. The sufficiently high specificity of IGF-1-SDS for PS suggests that this value is a useful tool for identification of IGHD.
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Affiliation(s)
- Yu jung Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Ji Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na Yeong Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seon-Hwa Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seul-Ki Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon-Bae Ahn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shin-Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Kyoung Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung-Soon Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ho Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea,Address for correspondence: Min Ho Jung, MD Department of Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1063(yuksam)-ro, Yeongdeungpogu, Seoul 07345, Korea Tel: +82-2-3779-1131 Fax: +82-2-783-2589 E-mail:
| | - Byung-Kyu Suh
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Measuring IGF-1 and IGFBP-3 Profiles in Women Seeking Assisted Reproduction; Relationship to Clinical Parameters (Study 1). J Pers Med 2020; 10:jpm10030122. [PMID: 32933040 PMCID: PMC7565441 DOI: 10.3390/jpm10030122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
This study examines the IGF serum profile (IGF-1, IGFBP-3 and the IGF Ratio) from 1633 women who undertook an Assessment Cycle prior to any treatment by assisted reproduction. The idea is to progressively study the IGF profile with a view to identify those women who may be classified as having adult growth hormone deficiency (AGHD) and who may benefit from specific dynamic endocrinological testing to identify a potential benefit from growth hormone adjuvant treatment. This first study evaluates the IGF profile on clinical parameters, namely age, body mass index (BMI) and stature. The study shows a significant linear reduction in IGF-1 levels across the four age groups (<35 years, 35–39 years, 40–44 years and ≥45 years; p < 0.001). However, there was no variation in IGFBP-3 levels but the IGF Ratio showed a progressive linear elevation with advancing age (p < 0.001). With respect to both BMI and stature, none of the IGF profile parameters showed any variation. We conclude that further studies are warranted to examine the notion of underlying AGHD in the causation of the well-known feature of age-related poor prognosis in assisted reproduction.
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Kim JH, Chae HW, Chin SO, Ku CR, Park KH, Lim DJ, Kim KJ, Lim JS, Kim G, Choi YM, Ahn SH, Jeon MJ, Hwangbo Y, Lee JH, Kim BK, Choi YJ, Lee KA, Moon SS, Ahn HY, Choi HS, Hong SM, Shin DY, Seo JA, Kim SH, Oh S, Yu SH, Kim BJ, Shin CH, Kim SW, Kim CH, Lee EJ. Diagnosis and Treatment of Growth Hormone Deficiency: A Position Statement from Korean Endocrine Society and Korean Society of Pediatric Endocrinology. Endocrinol Metab (Seoul) 2020; 35:272-287. [PMID: 32615711 PMCID: PMC7386113 DOI: 10.3803/enm.2020.35.2.272] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022] Open
Abstract
Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.
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Affiliation(s)
- Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Yonsei University College of Medicine, Seoul,
Korea
| | - Sang Ouk Chin
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Cheol Ryong Ku
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Kyeong Hye Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Dong Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Jung Soo Lim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Yun Mi Choi
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong,
Korea
| | - Seong Hee Ahn
- Department of Endocrinology, Inha University School of Medicine, Incheon,
Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Yul Hwangbo
- Department of Internal Medicine, National Cancer Center, Goyang,
Korea
| | - Ju Hee Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Bu Kyung Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan,
Korea
| | - Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon,
Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
Korea
| | - Seong-Su Moon
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju,
Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon,
Korea
| | - Sang Mo Hong
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong,
Korea
| | - Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Ji A Seo
- Division of Endocrinology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan,
Korea
| | - Se Hwa Kim
- Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon,
Korea
| | - Seungjoon Oh
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Sung Hoon Yu
- Department of Endocrinology and Metabolism, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri,
Korea
| | - Byung Joon Kim
- Division of Endocrinology, Department of Internal Medicine, Gachon University College of Medicine, Incheon,
Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul,
Korea
| | - Sung-Woon Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul,
Korea
| | - Chong Hwa Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon,
Korea
| | - Eun Jig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
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Demiral M, Salih Karaca M, Unal E, Baysal B, Taner Baran R, Demirbilek H, Nuri Ozbek M. A novel diagnostic tool for the evaluation of hypothalamic-pituitary region and diagnosis of growth hormone deficiency: pons ratio. J Pediatr Endocrinol Metab 2020; 33:735-742. [PMID: 32436858 DOI: 10.1515/jpem-2019-0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/21/2020] [Indexed: 11/15/2022]
Abstract
Backgrounds Limitations in the evaluation of the pituitary size and changes according to pubertal status make its validity questionable. Recently, in a small-scale study, pons ratio (PR) has been suggested as a more sensitive tool for diagnosis and etiological evaluation of growth hormone deficiency (GHD). The aim of the study is to evaluate the diagnostic value of PR in the diagnosis of GHD. Methods We retrospectively evaluated the pituitary magnetic resonance imaging (MRI) of 133 patients with a diagnosis of GHD. Primary axis (PA) was assigned as a line crossing the mid-sagittal dorsum sella and fourth ventricle. PR was defined as the pons height above the PA divided by total pons height. The PR of patients with GHD was compared to subjects without GHD. Results Study included 133 patients with GHD and 47 controls. In total, 121 (91%) patients had isolated GHD and 12 (9%) patients had multiple pituitary hormone deficiency. The PR of the patient group (mean: 0.32 ± 0.89; range: 0.14-0.63) was significantly higher than controls (mean: 0.26 ± 0.067; range 0.19-0.44) (p: 0.000). The optimal cut-off value of PR for GHD diagnosis was 0.27 (sensitivity 71% specificity 56%). There was a negative correlation between anterior pituitary height (APH)-SDS and PR (p: 0.002; r: -0.27). APH was increased, but PR remained unchanged in pubertal patients (p: 0.089). Conclusions PR measurement is a noninvasive, practical method with a cost-benefit clinical value. As it is not affected by pubertal status, PR is potentially a more sensitive tool for evaluation of pituitary gland in GHD patients compared to APH.
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Affiliation(s)
- Meliha Demiral
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Mehmet Salih Karaca
- Gazi Yasargil Training and Research Hospital Clinics of Radiology, Diyarbakir, Turkey
| | - Edip Unal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
| | - Birsen Baysal
- Gazi Yasargil Training and Research Hospital Clinics of Paediatrics, Diyarbakır, Turkey
| | - Rıza Taner Baran
- Antalya Training and Research Hospital Clinics of Paediatric Endocrinology, Antalya, Turkey
| | - Huseyin Demirbilek
- Hacettepe University, Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey
| | - Mehmet Nuri Ozbek
- Gazi Yasargil Training and Research Hospital Clinics of Paediatric Endocrinology, Diyarbakır, Turkey
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Early Recovery of Height Velocity in Prepubertal Children With Acute Lymphoblastic Leukemia Treated by a Short Intensive Phase Without Cranial Radiation Therapy. J Pediatr Hematol Oncol 2020; 42:271-274. [PMID: 31842181 DOI: 10.1097/mph.0000000000001695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE There have been few reports on height disturbance in childhood acute lymphoblastic leukemia (ALL) patients treated without cranial radiation therapy (CRT). Our study aimed to clarify the critical period of growth in pediatric patients who were treated by the Japan Childhood Leukemia Study (JACLS) ALL-02 protocol, which involved short-term intensive treatment without CRT. PATIENTS AND METHODS A retrospective, cohort study was conducted for prepubertal children with B-precursor ALL who were diagnosed from July 2002 to November 2011 and treated by the JACLS ALL-02 protocol at Oita University Hospital. The heights were chronologically measured at pretreatment, after the intensive phase (INT), at the end of treatment (END), and at 1 to 5 year(s) posttreatment (POST 1 to 5). RESULTS Nine boys and 4 girls were enrolled. Z score of the height was reduced at INT and END. Delta Z scores of the height and Z score of height velocity were reduced from pretreatment to INT, and they demonstrated an early recovery during maintenance treatment in INT to END. CONCLUSIONS Early recovery of delta Z scores of the height and Z score of height velocity was observed during the INT to END period. The shortened intensive phase without CRT may result in an adequate height in prepubertal ALL patients.
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Yau M, Chacko E, Regelmann MO, Annunziato R, Wallach EJ, Chia D, Rapaport R. Peak Growth Hormone Response to Combined Stimulation Test in 315 Children and Correlations with Metabolic Parameters. Horm Res Paediatr 2020; 92:36-44. [PMID: 31461713 DOI: 10.1159/000502308] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Studies are lacking regarding the timing of peak growth hormone (PGH) response. We aim to elucidate the timing of PGH response to arginine and levodopa (A-LD) and evaluate the influence of body mass index (BMI) and other metabolic parameters on PGH. METHODS During growth hormone (GH) stimulation testing (ST) with A-LD, serum GH was measured at baseline and every 30 min up to 180 min. The PGH cut-off was defined as &#x3c;10 ng/mL. IGF-1, IGF BP3, BMI, and metabolic parameters were obtained in a fasting state at baseline. RESULTS In the 315 tested children, stimulated PGH levels occurred at or before 120 min in 97.8% and at 180 min in 2.2%. GH area under the curve (AUC) positively correlated with PGH in all patients and with IGF-1 in pubertal males and females. BMI negatively correlated with PGH in all subjects. GH AUC negatively correlated with HOMA-IR and total cholesterol. CONCLUSION We propose termination of the GH ST with A-LD at 120 min since omission of GH measurement at 180 min did not alter the diagnosis of GH deficiency based on a cut-off of &#x3c; 10 ng/mL. BMI should be considered in the interpretation of GH ST with A-LD. The relationships between GH AUC and metabolic parameters need further study.
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Affiliation(s)
- Mabel Yau
- Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York, New York, USA,
| | - Elizabeth Chacko
- Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Molly O Regelmann
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital at Montefiore, Bronx, New York, USA
| | | | - Elizabeth J Wallach
- Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dennis Chia
- Division of Pediatric Endocrinology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Robert Rapaport
- Division of Pediatric Endocrinology and Diabetes, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Fujimoto M, Khoury JC, Khoury PR, Kalra B, Kumar A, Sluss P, Oxvig C, Hwa V, Dauber A. Anthropometric and biochemical correlates of PAPP-A2, free IGF-I, and IGFBP-3 in childhood. Eur J Endocrinol 2020; 182:363-374. [PMID: 31961798 PMCID: PMC7238294 DOI: 10.1530/eje-19-0859] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Pregnancy-associated plasma protein-A2 (PAPP-A2) is a metalloproteinase that cleaves IGFBP-3 and IGFBP-5. Human mutations in PAPPA2 result in short stature with a low percentage of free IGF-I. Little is known about PAPP-A2 levels and the regulation of free IGF-I throughout childhood. We examined PAPP-A2 and intact IGFBP-3 levels in childhood and explored associations between PAPP-A2, free and total IGF-I, and total and intact IGFBP-3 and their relationship to the percentage of free to total IGF-I and anthropometric factors. DESIGN Cross-sectional study at a single center. METHODS PAPP-A2, free IGF-I, and intact IGFBP-3 levels were measured in childhood (3-18 years old) and an evaluation of the relationship between these proteins and anthropometric factors. RESULTS In 838 children, PAPP-A2 consistently decreased throughout childhood. In contrast, free IGF-I increased. A pubertal peak in free IGF-I was present in females but was less evident in males. Intact and total IGFBP-3 increased throughout childhood; however, intact IGFBP-3 had a more marked rise than total IGFBP-3. Percent free IGF-I decreased with no distinct pubertal peak. PAPP-A2 levels positively correlated with the percent free IGF-I (Male, Female; r = 0.18, 0.38; P < 0.001) and negatively with intact IGFBP-3 (Male, Female; r = -0.58, -0.65; P < 0.0001). CONCLUSIONS This is the first study to describe serum PAPP-A2 and intact IGFBP-3 in children between 3 and 18 years of age. Our correlative findings suggest that PAPP-A2 is an important regulator of the percent free IGF-I which can be a marker of perturbations in the GH/IGF-I axis.
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Affiliation(s)
- Masanobu Fujimoto
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatrics and Perinatology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Jane C Khoury
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Philip R Khoury
- Heart Institute Research Core, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | | | - Claus Oxvig
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus C, Denmark
| | - Vivian Hwa
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew Dauber
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Mulamreddy R, Lubell WD. Constrained Glu‐Gly and Gln‐Gly dipeptide surrogates from γ‐substituted α‐amino‐δ‐lactam synthesis. Pept Sci (Hoboken) 2020. [DOI: 10.1002/pep2.24149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Tas E, Garibaldi L, Muzumdar R. Glucose Homeostasis in Newborns: An Endocrinology Perspective. Neoreviews 2020; 21:e14-e29. [PMID: 31894079 DOI: 10.1542/neo.21-1-e14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Physiologic adaptations in the postnatal period, along with gradual establishment of enteral feeding, help maintain plasma glucose concentrations in the neonatal period. The definition of normal plasma glucose in the neonatal period has been a subject of debate because of a lack of evidence linking a set plasma or blood glucose concentration to clinical symptoms or predictors of short- and long-term outcomes. However, there is consensus that maintaining plasma glucose in the normal range for age is important to prevent immediate and long-term neurodevelopmental consequences of hypoglycemia or hyperglycemia. The specific management strategy for abnormal glucose levels in neonates depends on the underlying etiology, and interventions could include nutritional changes, medications, hormone therapy, or even surgery. Here, we will review the physiological processes that help maintain plasma glucose in newborns and discuss the approach to a newborn with disordered glucose homeostasis, with an emphasis on the endocrine basis of abnormal glucose homeostasis.
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Affiliation(s)
- Emir Tas
- Division of Endocrinology and Diabetes, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
| | - Luigi Garibaldi
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Radhika Muzumdar
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
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Pozzobon G, Partenope C, Mora S, Garbetta G, Weber G, Barera G. Growth hormone therapy in children: predictive factors and short-term and long-term response criteria. Endocrine 2019; 66:614-621. [PMID: 31423546 DOI: 10.1007/s12020-019-02057-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The definition of growth response in growth hormone (GH)-treated children is controversial. This study aims at: (1) evaluating short-term and long-term efficacy of GH treatment in a cohort of short children with GH deficiency (GHD); (2) assessing and compare various poor response criteria; (3) identifying predictive factors of growth response. METHODS Our study included 94 children, affected by isolated GHD and treated with GH until they reached final height. Criteria used for calculating the proportion of poor responders to GH for the first year were gain in height (ΔHt) SDS < 0.5 ("Bang criterion"), <0.3 or <0.4 SDS for less-severe and severe GHD, respectively ("Ranke criterion"), height velocity (HV) < mean -1 SDS ("Bakker criterion"); for adult height "Cianfarani criterion" was total ΔHt < 1 SDS. RESULTS After 1 year of treatment we defined "poor responders" 55.3% of patients according to Bang criterion, 40.9% according to Bakker criterion and 23.4% according to Ranke criterion. At the end of the treatment, poor responders according to Cianfarani criterion were 22.34%; almost everyone in our population (97.9%) achieved mMid-parental height (MPH). Median final Ht was -1.11 SDS. Our analysis revealed a significant negative association between ΔHt and age at diagnosis. CONCLUSIONS Bang criterion generated the highest number of poor responders, but had a low negative predictive value (67.5%); Ranke and Cianfarani criteria displayed similar rate of poor response. There is no reliable predictive factor of growth hormone response. However, almost all children treated reached MPH, suggesting good treatment efficacy.
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Affiliation(s)
- Gabriella Pozzobon
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Partenope
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Gisella Garbetta
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanna Weber
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Graziano Barera
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Kautsar A, Wit JM, Pulungan A. Isolated Growth Hormone Deficiency Type 2 due to a novel GH1 Mutation: A Case Report. J Clin Res Pediatr Endocrinol 2019; 11:426-431. [PMID: 30678423 PMCID: PMC6878336 DOI: 10.4274/jcrpe.galenos.2019.2018.0305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/11/2019] [Indexed: 12/01/2022] Open
Abstract
Isolated growth hormone (GH) deficiency (IGHD) type 2 is a rare autosomal dominant disorder characterized by severe short stature with low GH level. Timely diagnosis is important for optimal results of recombinant human GH (rhGH) treatment and detection of additional pituitary deficiencies in affected relatives. A male child presented at the age of one year with severe, proportionate short stature [-4.9 standard deviation score (SDS)] and with a normal body mass index (-1.1 SDS). Physical examination revealed frontal bossing, midfacial hypoplasia, normal external genitalia and no dysmorphic features. Paternal and maternal heights were -6.1 and -1.9 SDS. Serum insulin-like growth factor-1 (IGF-1) and IGF-binding protein-3 were undetectable and the peak GH concentration by clonidine stimulation test was extremely low (0.18 ng/mL). Brain magnetic resonance imaging showed anterior pituitary hypoplasia. Genetic analysis identified a novel heterozygous mutation (c.291+2T>G) expected to lead to splicing out exon 3 of GH1. rhGH from age 2.4 years led to appropriate catch-up. In conclusion, we identified a novel GH1 gene mutation in an infant with classical IGHD type 2 presentation.
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Affiliation(s)
- Ahmad Kautsar
- University of Indonesia, Cipto Mangunkusumo Hospital, Department of Child Health, Jakarta, Indonesia
| | - Jan M. Wit
- Leiden University Medical Center, Department of Paediatrics, Leiden, The Netherlands
| | - Aman Pulungan
- University of Indonesia, Cipto Mangunkusumo Hospital, Department of Child Health, Jakarta, Indonesia
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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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Abstract
PURPOSE OF REVIEW This review summarizes pituitary function, and the clinical presentation and treatment of hypopituitarism. RECENT FINDINGS Updates in the field include new guidelines and meta-analyses on the diagnosis and treatment of select hormone deficiencies, novel treatment options, and advances in next generation sequencing technology. SUMMARY Hypopituitarism is defined as partial or complete loss of a single or multiple pituitary hormones. The clinical presentation of hypopituitarism varies depending on the number and severity of hormone deficiencies. Treatment involves the physiologic replacement of the individual end-organ hormone deficiencies and requires close lifelong monitoring.
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Affiliation(s)
- Olga Yeliosof
- Pediatric Endocrinology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Georeli I, Triantafyllou P, Dimitriadou M, Slavakis A, Christoforidis A. TIMING OF GH PEAK IN BOTH GLUCAGON AND CLONIDINE TESTS IS OF MAJOR CLINICAL IMPORTANCE. Endocr Pract 2019; 25:800-808. [PMID: 31013159 DOI: 10.4158/ep-2019-0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To detect a possible correlation between timing of the peak value of growth hormone (GH) during stimulatory tests (STs) and the effectiveness of treatment with recombinant human growth hormone (rhGH) in children with idiopathic GH deficiency (iGHD). Methods: We retrospectively studied 92 patients with iGHD (57 boys; mean age at diagnosis: 9.93 years). Diagnosis was confirmed by 2 different STs, glucagon stimulation test (GST), and clonidine stimulation test (CST). Auxologic parameters were recorded, while observed and predicted (according to KIGS Prediction Model) height velocity during the first year of treatment and the index of responsiveness (IoR) were calculated for the prepubertal children (n = 65). Results: Atypical GST was defined as that with peak GH value at time 0 minutes, 30 minutes, 60 minutes, or 180 minutes, whereas atypical CST was defined as that with peak timing at 0 minutes, 30 minutes, or 120 minutes. Atypical GST was detected in 18 patients (19.57%). IoR was lower in the prepubertal children with atypical GST (-1.81 ± 0.67 versus -1.34 ± 0.85; P = .051). In the CST, the 18 children who had atypical timing, had significantly lower IoR (-1.86 ± 0.66 versus -1.35 ± 0.84; P = .047). When the patients were categorized according to the number of atypical tests, significant differences in the IoR were detected (-2.09 ± 0.68 with 2 atypical STs [n = 6], -1.64 ± 0.61 with 1 atypical ST [n = 16], and -1.29 ± 0.87 with no atypical ST [n = 43], P = .045). Conclusion: The presence of atypical peak GH timing during ST may be a factor that predicts lower growth hormone velocity during the first year of rhGH treatment in prepubertal children with iGHD. Abbreviations: CST = clonidine stimulation test; GH = growth hormone; GHD = growth hormone deficiency; GST = glucagon stimulation test; iGHD = idiopathic growth hormone deficiency; IoR = index of responsiveness; rhGH = recombinant human growth hormone; SDS = standard deviation scores; ST = stimulatory test.
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