Human growth hormone and hypopituitargrowth retardation

The dosage dependency of growth and maturity in growth hormone deficiency treated with human growth hormone

A group of 11 pre-pubertal growth hormone deficient patients were treated with human growth hormone over a period of 4 years. In 6 of the patients the dosage was 4 IU 3 times a week and in 5, 8 IU 3 times a week. Changes in height demonstrated that the "catch up" was significantly greater and of longer duration in the second group. In spite of a more rapid increase of bone age in the second group, the prognosis of final height had improved significantly at the end of the study period. A comparative study of the plasma concentrations significantly at the end of the study period. A comparative study of the plasma concentrations of T4, TSH, gonadotrophins and steroids, to see if the greater velocity of bone maturity in the second group could be due to contamination of the preparation by other could be due to contamination of the preparation by other hypophysary hormones, did not demonstrate significant differences between the groups.

Roentgen cephalometric studies on skull development in rats. III. Gigantism versus acromegaly: age differences in response to prolonged growth hormone administration

Experimental conditions simulating the induction of clinical pituitary gigantism and acromegaly were established by prolonged administration of growth hormone in high dosage to adult male rats starting at two different ages: 6 months (growth still active) and 14 1/2 months (growth virtually arrested). Treatment continued for 14 1/2 months, control receiving saline injections. Each group numbered eight at onset. Standardized x-rays of skull were made in ventro-dorsal and lateral planes, at onset, mid-period, and end of the study. Representative dimensions of cranial and facial segments were measured, including lengths, widths, palate dimensions, gnathic and interzygomatic angles, and incisor curvature. Some related indices were calculated. Means and standard errors were computed, usually on five to eight rats (oldest controls: three only). The response pattern of overall skull length was most illustrative. Younger adult controls grew actively until 14 months of age (5%) while injected rats grew still faster (8%); thereafter, controls grew negligibly (1%) and injected rats only slightly (2%). Older controls showed negligible skull elongation from 14 1/2 to 29 months of age, and growth hormone stimulated no gain. In the younger group, skull length gains were almost entirely in the facial region; cranium gained no length and widened only slightly. Cranial index increased slightly with the hormone. Facial (bizygomatic) width increased in both injected groups--proportionately in younger rats(to giganntism) and disproportionately in older rats. Palatal and dental growth followed facial patterns in both groups. Cranial vault bones thickened and, in older rats, developed surface irregularities, giving them a more massive, acromegaloid structure.

Long-term response to human growth hormone in 36 children with idiopathic growth hormone deficiency

The results of long term treatment with human growth hormone (Crescormon, 12.4 IU/m2/week) in 36 patients with idiopathic growth hormone deficiency are given. Birth trauma--in particular assisted breech delivery (30%)--is the major aetiological cause. Twelve patients had isolated growth hormone deficiency (IGHD), 24 had multiple pituitary hormone deficiencies (MPHD) of which 19 were treated with additional thyroid hormones. The results were judged by the criteria of height velocity, total height gain and change of height prediction (TW2, age based). It is concluded that the growth hormone dose chosen in many cases is insufficient to maintain high growth rates after the first year of treatment, when "catch-up" no loner takes place. The tendency of patients supplemented with thyroid hormone to grow better--without additional bone-age advancement--calls for careful search for hypothyroidism and suggests the use of thyroxin in cases of doubt.

Effect of human growth hormone treatment for 1 to 7 years on growth of 100 children, with growth hormone deficiency, low birthweight, inherited smallness, Turner's syndrome, and other complaints

(1) Human growth hormone (HGH) has been given for one whole year or longer to 100 patients, aged 1·5 to 19 years, participating in the Medical Research Council Clinical Trial of HGH. Each patient was measured 3-monthly for a control year before treatment, and the majority for a control year after the first treatment year. All measurements were made by one anthropometrist. Radiographic measurements of widths of bone, muscle, and fat in calf and upper arm were made. Methods and standards for assessing the significance of a given height acceleration are presented. (2) The characteristics at diagnosis are given of 35 patients with isolated GH deficiency or hyposomatotrophism (HS), 18 with craniopharyngiomas and other CNS lesions, 3 with multiple trophic hormone deficiency, 18 with low birthweight short stature, 4 with hereditary smallness and/or delay in growth, 4 with psychosocial short stature, 1 with high resting HGH and low somatomedin, 6 with Turner's syndrome, and 11 with other diagnoses. (3) 29 of the 35 HS patients were boys and 13 had an abnormally small penis and ill-developed scrotum. Only 2 were sibs. Parents averaged 40th centile for height. 4 children developed growth-suppressing antibodies, and had to cease treatment. The mean standard deviation score (SDS) for height at diagnosis was -4·7, range -2·6 to -7·3. Bone age SDS averaged -3·2, range -0·8 to -5·7. Skinfold SDS averaged +0·91. Limb muscle width SDS averaged about -3·0. GH peak in insulin hypoglycaemia averaged 4·7 ± 0·7 μU/ml, range 1 to 13. (4) A category of partial growth hormone deficiency is defined as patients with GH peaks of 7-20 μU/ml inclusive and height velocity SDS in the year before treatment between -1 and -2. Total HS patients have GH peaks of 1 to 6 μU/ml inclusive and height velocity SDS of < -2. Partial HS patients are accelerated by HGH and should be treated; but their average acceleration is below that of total HS patients. (5) There was a highly significant relation (r = -0·64) between blood GH peak level and pretreatment height velocity in the HS patients. (6) The LBW patients were 10 boys and 7 girls; all the boys had normal genitalia. The average height SDS at diagnosis was -3·7; parents' height centile averaged 50th, bone age SDS -1·8, skinfold SDS -0·9. GH peaks were all above 30