1
|
Del Pino M, Fano V. Growth in puberty in girls with hypochondroplasia, p.Asn540Lys-related mutations. Am J Med Genet A 2024; 194:394-396. [PMID: 37789665 DOI: 10.1002/ajmg.a.63423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Mariana Del Pino
- Growth and Development, Hospital Garrahan, Buenos Aires, Argentina
| | - Virginia Fano
- Growth and Development, Hospital Garrahan, Buenos Aires, Argentina
| |
Collapse
|
2
|
Cheung MS, Cole TJ, Arundel P, Bridges N, Burren CP, Cole T, Davies JH, Hagenäs L, Högler W, Hulse A, Mason A, McDonnell C, Merker A, Mohnike K, Sabir A, Skae M, Rothenbuhler A, Warner J, Irving M. Growth reference charts for children with hypochondroplasia. Am J Med Genet A 2024; 194:243-252. [PMID: 37814549 DOI: 10.1002/ajmg.a.63431] [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: 09/04/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
Hypochondroplasia (HCH) is a rare skeletal dysplasia causing mild short stature. There is a paucity of growth reference charts for this population. Anthropometric data were collected to generate height, weight, and head circumference (HC) growth reference charts for children with a diagnosis of HCH. Mixed longitudinal anthropometric data and genetic analysis results were collected from 14 European specialized skeletal dysplasia centers. Growth charts were generated using Generalized Additive Models for Location, Scale, and Shape. Measurements for height (983), weight (896), and HC (389) were collected from 188 (79 female) children with a diagnosis of HCH aged 0-18 years. Of the 84 children who underwent genetic testing, a pathogenic variant in FGFR3 was identified in 92% (77). The data were used to generate growth references for height, weight, and HC, plotted as charts with seven centiles from 2nd to 98th, for ages 0-4 and 0-16 years. HCH-specific growth charts are important in the clinical care of these children. They help to identify if other comorbidities are present that affect growth and development and serve as an important benchmark for any prospective interventional research studies and trials.
Collapse
Affiliation(s)
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Paul Arundel
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Nicola Bridges
- Department of Paediatric Endocrinology, Chelsea and Westminster Hospital, London, UK
| | - Christine P Burren
- Paediatric Endocrinology and Diabetes Department, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Trevor Cole
- Birmingham Health Partners, West Midlands Regional Genetics Service, Birmingham Women's and Children's National Health Service (NHS) Foundation Trust, Birmingham, UK
| | - Justin Huw Davies
- Regional Centre for Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton Children's Hospital, University of Southampton, Southampton, UK
| | - Lars Hagenäs
- Paediatric Endocrine Unit, Paediatric Clinic, Karolinska Hospital, Stockholm, Sweden
| | - Wolfgang Högler
- Institute of Metabolism & Systems Research, University of Birmingham, Birmingham, UK
| | - Anthony Hulse
- Evelina Children's Hospital, St. Thomas' Hospital, London, UK
| | - Avril Mason
- Department of Endocrinology (E.M.F.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Ciara McDonnell
- Department of Paediatric Endocrinology & Diabetes, Children's Health Ireland, Dublin, Ireland
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Andrea Merker
- Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden
| | - Klaus Mohnike
- Department of Paediatrics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Ataf Sabir
- Birmingham Health Partners, West Midlands Regional Genetics Service, Birmingham Women's and Children's National Health Service (NHS) Foundation Trust, Birmingham, UK
| | - Mars Skae
- Department of Pediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Anya Rothenbuhler
- Department of Endocrinology and Diabetology for Children, Bicetre Paris-Saclay University Hospital, Le Kremlin Bicetre, France
| | - Justin Warner
- Noah's Ark Children's Hospital for Wales, University Hospital of Wales, Cardiff, UK
| | - Melita Irving
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Moy N, Flynn D, Henriquez J, Connelly LB, Vale L, Paolucci F. Interventions for improving clinical outcomes and health-related quality-of-life for people living with skeletal dysplasias: an evidence gap map. Qual Life Res 2023; 32:2751-2762. [PMID: 37294397 PMCID: PMC10474209 DOI: 10.1007/s11136-023-03431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Skeletal dysplasias are rare genetic disorders that are characterized by abnormal development of bone and cartilage. There are multiple medical and non-medical treatments for specific symptoms of skeletal dysplasias e.g. pain, as well as corrective surgical procedures to improve physical functioning. The aim of this paper was to develop an evidence-gap map of treatment options for skeletal dysplasias, and their impact on patient outcomes. METHODS We conducted an evidence-gap map to identify the available evidence on the impact of treatment options on people with skeletal dysplasias on clinical outcomes (such as increase in height), and dimensions of health-related quality of life. A structured search strategy was applied to five databases. Two reviewers independently assessed articles for inclusion in two stages: titles and abstracts (stage 1), and full text of studies retained at stage 2. RESULTS 58 studies fulfilled our inclusion criteria. The included studies covered 12 types of skeletal dysplasia that are non-lethal with severe limb deformities that could result in significant pain and numerous orthopaedic interventions. Most studies reported on the effect of surgical interventions (n = 40, 69%), followed by the effect of treatments on dimensions of health quality-of-life (n = 4, 6.8%) and psychosocial functioning (n = 8, 13.8%). CONCLUSION Most studies reported on clinical outcomes from surgery for people living with Achondroplasia. Consequently, there are gaps in the literature on the full range of treatment options (including no active treatment), outcomes and the lived experience of people living with other skeletal dysplasias. More research is warranted to examine the impact of treatments on health-related quality-of-life of people living with skeletal dysplasias, including their relatives to enable them to make preference- and valued based decisions about treatment.
Collapse
Affiliation(s)
- Naomi Moy
- Department of Sociology and Business Law, University of Bologna, Bologna, Italy
| | - Darren Flynn
- Department of Midwifery, Nursing and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Josefa Henriquez
- Department of Sociology and Business Law, University of Bologna, Bologna, Italy
| | - Luke B Connelly
- Department of Sociology and Business Law, University of Bologna, Bologna, Italy
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Francesco Paolucci
- Department of Sociology and Business Law, University of Bologna, Bologna, Italy.
- Newcastle Business School, Faculty of Business and Law, University of Newcastle, Callaghan, Australia.
| |
Collapse
|
4
|
Kim HY, Lee YA, Shin CH, Cho TJ, Ko JM. Clinical Manifestations and Outcomes of 20 Korean Hypochondroplasia Patients with the FGFR3 N540K variant. Exp Clin Endocrinol Diabetes 2023; 131:123-131. [PMID: 36442838 DOI: 10.1055/a-1988-9734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hypochondroplasia is a skeletal dysplasia caused by activating pathologic variants of FGFR3. The N540K variant accounts for 60-70% of reported cases and is associated with severe manifestations. Here, we analyze the clinical manifestations and outcomes of Korean patients with hypochondroplasia harboring the FGFR3 N540K variant. METHODS Medical records of 20 unrelated patients with genetically confirmed N540K-related hypochondroplasia were retrospectively reviewed. All individuals were diagnosed with hypochondroplasia by Sanger sequencing for FGFR3, or target-panel sequencing for skeletal dysplasia. The effectiveness of growth hormone therapy was analyzed in 16 patients treated with growth hormones. RESULTS Among 20 patients (7 men, 13 women), the mean age at first visit was 3.5±1.0 years, and the mean follow-up duration was 6.8±0.6 years. The patients presented with a short stature and/or short limbs. Genu varum, macrocephaly, and developmental delay were observed in 11 (55.0%), 9 (45.0%), and 5 (25.0%) patients, respectively. Of the 12 patients who underwent neuroimaging, five (41.7%) showed abnormal findings (one required operation for obstructive hydrocephalus). Among 16 growth-hormone-treated patients (two were growth-hormone deficient), the increase in height standard deviation scores was significant after a mean 5.4±0.7 years of treatment (+0.6 and+1.8 using growth references for healthy controls and achondroplasia children, respectively). Four patients underwent surgical limb lengthening at a mean age of 8.8±3.3 years. CONCLUSIONS Neurodevelopmental abnormalities are frequently observed in patients with N540K-related hypochondroplasia. Close monitoring of skeletal manifestations and neurodevelopmental status is necessary for hypochondroplasia.
Collapse
Affiliation(s)
- Hwa Young Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Joon Cho
- Department of Orthopaedics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
5
|
Çetin T, Şıklar Z, Kocaay P, Berberoğlu M. Evaluation of Efficacy of Long-term Growth Hormone Therapy in Patients with Hypochondroplasia. J Clin Res Pediatr Endocrinol 2018; 10:373-376. [PMID: 29739731 PMCID: PMC6280321 DOI: 10.4274/jcrpe.0043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Hypochondroplasia is a cause of disproportionate short stature and characterized by minor clinical manifestations. The aim of this study was to evaluate the efficacy of long-term growth hormone (GH) therapy in hypochondroplastic cases with inadequate response to GH stimulation tests. In this study, six patients who had a height standard deviation score of -3.43 before the treatment and a mean age of 7.42 years and who had received GH treatment at a dose of 0.2 mg/kg/week for a mean period of 4.45 years were evaluated. A good response was found in the first year of treatment, but this increase was not found to be sufficient for the patients to achieve an adequate final height.
Collapse
Affiliation(s)
- Tuğba Çetin
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey Phone: +90 537 408 83 10 E-mail:
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Pınar Kocaay
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| |
Collapse
|
6
|
Arenas MA, Del Pino M, Fano V. FGFR3-related hypochondroplasia: longitudinal growth in 57 children with the p.Asn540Lys mutation. J Pediatr Endocrinol Metab 2018; 31:1279-1284. [PMID: 30335613 DOI: 10.1515/jpem-2018-0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/19/2018] [Indexed: 11/15/2022]
Abstract
Background Children with hypochondroplasia (HCH), who have FGFR3 mutations c.1620C>A or c.1620C>G (p.Asn540Lys) appear to have a more severe phenotype than those with HCH without these mutations. We describe the change in height, leg length and body proportions in a retrospective cohort of children with HCH related-p.Asn540Lys mutation and we compared them with Argentine population. Methods Anthropometric measurements were initially taken and followed up by the same observer, with standardized techniques. Sitting height/height and head circumference/height ratio were calculated as a body disproportion indicator. In order to make a comparison with the Argentine population height average, centiles of height, leg length and body proportions were estimated by the LMS method. Results The sample consisted of 57 HCH children (29 males and 28 females) between the ages of 0-18 years. The median (interquartile range) number of measurements per child was 8 (4.3, 13) for height, 7 (4, 12) for sitting height and 7.5 (4, 12.8) for head circumference. Leg length increased from 17 cm at birth to approximately 54 cm in adolescents, 25 cm shorter than the leg length in non-HCH populations. Sitting height increased from 39 cm at birth to 81 cm in adolescents, 7 cm below mean in non-HCH adolescents. Mean (range) adult height were 143.6 cm (131-154.5) and 130.8 cm (124-138) for males and females, respectively. Conclusions The disharmonic growth between the less affected trunk and the severely affected limbs determine body disproportion in HCH.
Collapse
Affiliation(s)
- María Alejandra Arenas
- Department of Growth and Development, Garrahan Hospital, Combate de los Pozos 1881 (1245), Buenos Aires, Argentina, Phone: 0054 11 4122 6221, Fax: 0054 11 43085325
| | - Mariana Del Pino
- Department of Growth and Development, Garrahan Hospital, Buenos Aires, Argentina
| | - Virginia Fano
- Department of Growth and Development, Garrahan Hospital, Buenos Aires, Argentina
| |
Collapse
|
7
|
González-del Angel A, Caro-Contreras A, Alcántara-Ortigoza MA, Ramos S, Cruz-Alcívar R, Moyers-Pérez P. Unique association of hypochondroplasia with craniosynostosis and cleft palate in a Mexican family. Am J Med Genet A 2017; 176:161-166. [DOI: 10.1002/ajmg.a.38526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 09/18/2017] [Accepted: 10/08/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Ariadna González-del Angel
- Laboratorio de Biología Molecular, Departamento de Genética Humana; Instituto Nacional de Pediatría; Ciudad de México México
| | - Alan Caro-Contreras
- Médico Residente de Genética Médica, Departamento de Genética Humana; Instituto Nacional de Pediatría; Ciudad de México México
| | - Miguel Angel Alcántara-Ortigoza
- Laboratorio de Biología Molecular, Departamento de Genética Humana; Instituto Nacional de Pediatría; Ciudad de México México
| | - Sandra Ramos
- Laboratorio de Citogenética, Departamento de Genética Humana; Instituto Nacional de Pediatría; Ciudad de México México
| | - Roberto Cruz-Alcívar
- Laboratorio de Genética y Cáncer, Departamento de Genética Humana; Instituto Nacional de Pediatría; Ciudad de México México
| | | |
Collapse
|
8
|
|
9
|
Nagahara K, Harada Y, Futami T, Takagi M, Nishimura G, Hasegawa Y. A Japanese familial case of hypochondroplasia with a novel mutation in FGFR3. Clin Pediatr Endocrinol 2016; 25:103-6. [PMID: 27507911 PMCID: PMC4965510 DOI: 10.1297/cpe.25.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/22/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Keiko Nagahara
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Yuki Harada
- Department of Orthopedic Surgery, Shiga Medical Center for Children, Shiga, Japan
| | - Tohru Futami
- Department of Orthopedic Surgery, Shiga Medical Center for Children, Shiga, Japan
| | - Masaki Takagi
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Gen Nishimura
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yukihiro Hasegawa
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| |
Collapse
|
10
|
Krstevska-Konstantinova M, Stamatova A, Gucev Z. Favorable Growth Hormone Treatment Response in a Young Boy with Achondroplasia. Med Arch 2016; 70:148-50. [PMID: 27147792 PMCID: PMC4851542 DOI: 10.5455/medarh.2016.70.148-150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/15/2016] [Indexed: 11/17/2022] Open
Abstract
Background: Achondroplasia is a skeletal dysplasia, the most common cause of rhizomelic dwarfism. Case presentation: This is a ten year old boy who was first diagnosed prenatally. He had a mutation c1138G>A in the gene FGFR3 in a heterozygotic constellation. His IGF1 and IGFBP3 levels were normal. Two stimulation tests for growth hormone were performed with values within the reference range. His psychomotor development was adequate for his age except for speech difficulty. He started with recombinant hGH (r-hGH) at the age of 3.4 years in a dose of 0.06 mg/kg. His mean Height SDS (HtSDS) was -2.2. Results: The growth increased to 10 cm/year in the first year of therapy (HtSDS -1.1). It decreased during the second year to 4 cm (HtSDS -1.7) and again increased during the third year to 8 cm/year (HtSDS–1.3). In the next years the growth was constant (6.5, 2.3, 3.5 cm / year). He is still growing in the 3rd percentile of the growth curve (HtSDS – 1.2) under GH treatment. The body disproportion remained the same. Conclusion: The growth response on GH treatment was satisfactory in the first 4 years of treatment, and the boy still continued to grow. The young age at the start of treatment was also of importance. Our other patients with achondroplasia who started treatment older had a poor response to growth hormone.
Collapse
Affiliation(s)
| | - Ana Stamatova
- University Paediatrics Clinic, Medical Faculty Skopje, Macedonia
| | - Zoran Gucev
- University Paediatrics Clinic, Medical Faculty Skopje, Macedonia
| |
Collapse
|
11
|
Criteria for radiologic diagnosis of hypochondroplasia in neonates. Pediatr Radiol 2016; 46:513-8. [PMID: 26867606 DOI: 10.1007/s00247-015-3518-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 10/20/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND A radiologic diagnosis of hypochondroplasia is hampered by the absence of age-dependent radiologic criteria, particularly in the neonatal period. OBJECTIVE To establish radiologic criteria and scoring system for identifying neonates with fibroblast growth factor receptor 3 (FGFR3)-associated hypochondroplasia. MATERIALS AND METHODS This retrospective study included 7 hypochondroplastic neonates and 30 controls. All subjects underwent radiologic examination within 28 days after birth. We evaluated parameters reflecting the presence of (1) short ilia, (2) squared ilia, (3) short greater sciatic notch, (4) horizontal acetabula, (5) short femora, (6) broad femora, (7) metaphyseal flaring, (8) lumbosacral interpedicular distance narrowing and (9) ovoid radiolucency of the proximal femora. RESULTS Only parameters 1, 3, 4, 5 and 6 were statistically different between the two groups. Parameters 3, 5 and 6 did not overlap between the groups, while parameters 1 and 4 did. Based on these results, we propose a scoring system for hypochondroplasia. Two major criteria (parameters 3 and 6) were assigned scores of 2, whereas 4 minor criteria (parameters 1, 4, 5 and 9) were assigned scores of 1. All neonates with hypochondroplasia in our material scored ≥6. CONCLUSION Our set of diagnostic radiologic criteria might be useful for early identification of hypochondroplastic neonates.
Collapse
|
12
|
Massart F, Miccoli M, Baggiani A, Bertelloni S. Height outcome of short children with hypochondroplasia after recombinant human growth hormone treatment: a meta-analysis. Pharmacogenomics 2015; 16:1965-73. [PMID: 26555758 DOI: 10.2217/pgs.15.129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypochondroplasia (HCH) is a genetic skeletal dysplasia, characterized by rhizomelic short height (Ht) with facial dysmorphology and lumbar hyperlordosis. Albeit there are concerns that HCH children may not achieve optimal long-term outcome in response to recombinant human growth hormone (rhGH), anecdotal experiences suggested at least short-term Ht improvement. After thorough search of published studies, meta-analysis of rhGH use in HCH children was performed. In 113 HCH children, rhGH administration (median 0.25 mg/kg/week) progressively improved Ht pattern with 12 months catch-up growth (p < 0.0001). Then, Ht improvement resulted constant until 36 months (p < 0.0001), but stature remained subnormal. While bone age chronologically progressed, no serious adverse events were reported. In conclusion, our meta-analysis indicates that rhGH treatment progressively improved Ht outcome of HCH subjects.
Collapse
Affiliation(s)
- Francesco Massart
- Pediatric Unit, Maternal & Infant Department, St. Chiara University Hospital of Pisa, Pisa, Italy
| | - Mario Miccoli
- Epidemiology Unit, Department of Experimental Pathology M.B.I.E., University of Pisa, 56126 Pisa PI, Italy
| | - Angelo Baggiani
- Epidemiology Unit, Department of Experimental Pathology M.B.I.E., University of Pisa, 56126 Pisa PI, Italy
| | - Silvano Bertelloni
- Pediatric Unit, Maternal & Infant Department, St. Chiara University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
13
|
Regelmann MO, Rapaport R. Growth hormone treatment in patients with hypochondroplasia. Horm Res Paediatr 2015; 82:353-4. [PMID: 25531227 DOI: 10.1159/000369169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Molly O Regelmann
- Division of Pediatric Endocrinology and Diabetes, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, N.Y., USA
| | | |
Collapse
|
14
|
Pinto G, Cormier-Daire V, Le Merrer M, Samara-Boustani D, Baujat G, Fresneau L, Viaud M, Souberbielle JC, Pineau JC, Polak M. Efficacy and safety of growth hormone treatment in children with hypochondroplasia: comparison with an historical cohort. Horm Res Paediatr 2015; 82:355-63. [PMID: 25323764 DOI: 10.1159/000364807] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hypochondroplasia (HCH) is a skeletal dysplasia characterized by disproportionate short stature. The aims of the study are to evaluate efficacy and safety of recombinant human growth hormone (r-hGH) therapy in HCH children, when compared with a historical cohort of untreated HCH children. METHODS Nineteen HCH patients with an initial height standard deviation score (SDS) ≤-2 and a mean age of 9.3 ± 3.1 years were treated with a mean r-hGH dose of 0.053 mg/kg/day over 3 years. Growth charts were derived from the historical cohort (n = 40). RESULTS Height gain in the treated population was +0.62 ± 0.81 SDS greater than in the general population, and +1.39 ± 0.9 SDS greater than in the historical untreated HCH cohort (mean gain of 7.4 ± 6.6 cm gain). A negative correlation between height gain and age at treatment initiation was reported (p = 0.04). There was no significant difference in response between patients with fibroblast growth factor receptor 3 mutations and those without. No treatment-related serious adverse events were reported. CONCLUSIONS r-hGH treatment is well tolerated and effective in improving growth in HCH patients, particularly when started early. The treatment effect varies greatly and must be evaluated for each patient during treatment to determine the value of continued therapy.
Collapse
Affiliation(s)
- Graziella Pinto
- Pediatric Endocrinology, Gynecology and Diabetes, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Kaissi AA, Farr S, Ganger R, Hofstaetter JG, Klaushofer K, Grill F. Treatment of varus deformities of the lower limbs in patients with achondroplasia and hypochondroplasia. Open Orthop J 2013; 7:33-9. [PMID: 23459260 PMCID: PMC3580759 DOI: 10.2174/1874325001307010033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 12/17/2012] [Accepted: 12/19/2012] [Indexed: 11/22/2022] Open
Abstract
Angular deformities of the lower limbs are a common clinical problem encountered in pediatric orthopaedic practices particularly in patients with osteochondrodysplasias. The varus deformity is more common than the valgus deformity in achondroplasia and hypochondroplasia patients because of the unusual growth of the fibulae than that of the tibiae. We retrospectively reviewed six patients (four patients with achondroplasia and two patients with hypochondroplsia) with relevant limb deformities due to the above-mentioned entities. All patients manifested significant varus deformity of the lower limbs. Detailed phenotypic characterization, radiologic and genetic testing was carried out as baseline diagnostic tool. We described the re-alignment procedures, which have been applied accordingly. Therefore, bilateral multi-level procedures, multi-apical planning and limb lengthening have been successfully applied. While recognition of the underlying syndromic association in patients who are manifesting angular deformities is the baseline for proper orthopaedic management, this paper demonstrates how to evaluate and treat these complex patients.
Collapse
Affiliation(s)
- Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology, at the Hanusch Hospital of WGKK and, AUVA Trauma Centre Meidling, First Medical Department, Hanusch Hospital, Vienna, Austria ; Orthopaedic Hospital of Speising, Paediatric Department, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
16
|
Tarquinio DC, Motil KJ, Hou W, Lee HS, Glaze DG, Skinner SA, Neul JL, Annese F, McNair L, Barrish JO, Geerts SP, Lane JB, Percy AK. Growth failure and outcome in Rett syndrome: specific growth references. Neurology 2012; 79:1653-61. [PMID: 23035069 DOI: 10.1212/wnl.0b013e31826e9a70] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Prominent growth failure typifies Rett syndrome (RTT). Our aims were to 1) develop RTT growth charts for clinical and research settings, 2) compare growth in children with RTT with that of unaffected children, and 3) compare growth patterns among RTT genotypes and phenotypes. METHODS A cohort of the RTT Rare Diseases Clinical Research Network observational study participants was recruited, and cross-sectional and longitudinal growth data and comprehensive clinical information were collected. A reliability study confirmed interobserver consistency. Reference curves for height, weight, head circumference, and body mass index (BMI), generated using a semiparametric model with goodness-of-fit tests, were compared with normative values using Student's t test adjusted for multiple comparisons. Genotype and phenotype subgroups were compared using analysis of variance and linear regression. RESULTS Growth charts for classic and atypical RTT were created from 9,749 observations of 816 female participants. Mean growth in classic RTT decreased below that for the normative population at 1 month for head circumference, 6 months for weight, and 17 months for length. Mean BMI was similar in those with RTT and the normative population. Pubertal increases in height and weight were absent in classic RTT. Classic RTT was associated with more growth failure than atypical RTT. In classic RTT, poor growth was associated with worse development, higher disease severity, and certain MECP2 mutations (pre-C-terminal truncation, large deletion, T158M, R168X, R255X, and R270X). CONCLUSIONS RTT-specific growth references will allow effective screening for disease and treatment monitoring. Growth failure occurs less frequently in girls with RTT with better development, less morbidity typically associated with RTT, and late truncation mutations.
Collapse
|
17
|
Song SH, Balce GCE, Agashe MV, Lee H, Hong SJ, Park YE, Kim SG, Song HR. New proposed clinico-radiologic and molecular criteria in hypochondroplasia: FGFR 3 gene mutations are not the only cause of hypochondroplasia. Am J Med Genet A 2012; 158A:2456-62. [PMID: 22903874 DOI: 10.1002/ajmg.a.35564] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 06/21/2012] [Indexed: 12/26/2022]
Abstract
We applied a comprehensive set of clinical and radiological criteria for the diagnosis of hypochondroplasia (HCH) in 160 patients with short stature 58 of whom were diagnosed to have HCH. Taking into account the genotypic and phenotypic variations in HCH, we conducted a study with these 58 patients and tested them for mutations in the fibroblast growth factor receptor 3 (FGFR3) and the short stature homeobox (SHOX) gene. We characterized the phenotypes by clinical and radiologic findings. In the patients with HCH, 19 were included in Group I (FGFR3 mutations-mutations of definite significance), and 39 were in Group II (6 SHOX mutations and 33 negative for disease-causing FGFR3 mutations). The clinical findings were similar in two groups regardless of the presence or absence of mutations. More than 95% of the patients had mesomelic proportions. In Group I, the radiological findings of mesomelia of upper and lower limbs and, L1/L4 ratio in anterior-posterior and lateral view were more typical than in Group II. This study proposes comprehensive clinico-radiological criteria for the diagnosis of HCH, which would help in detecting the true incidence of this underdiagnosed condition. The presence of SHOX mutations suggest genotypic-phenotypic overlap between HCH and Leri-Weill dyschondrosteosis, though further investigation is needed to effectively elucidate the importance of these mutations. Also, the 56.9% of HCH patients with negative mutations for FGFR3 suggests that there are other undiscovered gene mutations associated with this phenotypic entity.
Collapse
Affiliation(s)
- Sang-Heon Song
- Department of Orthopaedic Surgery, Institute for Rare Diseases, Korea University Medical Center Guro Hospital, Guro-Gu, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Rothenbuhler A, Linglart A, Piquard C, Bougnères P. A pilot study of discontinuous, insulin-like growth factor 1-dosing growth hormone treatment in young children with FGFR3 N540K-mutated hypochondroplasia. J Pediatr 2012; 160:849-53. [PMID: 22137367 DOI: 10.1016/j.jpeds.2011.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/14/2011] [Accepted: 10/18/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the growth promoting effect of a recombinant growth hormone (rGH) treatment protocol adjusted on insulin-like growth factor 1 (IGF-1) dosing in children affected by the most severe forms of FGFR3 N540K-mutated hypochondroplasia. STUDY DESIGN Midterm results of an open-label, single-center, nonrandomized, 2003-2020 pilot trial to final stature, including 6 children (mean age, 2.6 ± 0.7 years; mean height SDS, -3.0 ± 0.5) with the N540K mutation of FGFR3 gene who received an rGH dosage titrated to an IGF-1 level close to 1.5 SDS of the normal range. rGH therapy was interrupted 1 day per week, 1 month per year, and 6 months every 2 years. RESULTS The mean height SDS increased by 1.9 during the 6.1 ± 0.9-year study period, reaching -0.8 to -1.3 at age 8.7 ± 1 years. The mean±SDS baseline IGF-1 value was -1.6 ± 0.5 before rGH treatment and 1.4±0.3 during the last year of observation. The average cumulative rGH dose was 0.075 ± 0.018 mg/kg/day (range, 0.059-0.100 mg/kg/day). Trunk/leg disproportion was improved. CONCLUSION IGF-1-dosing rGH treatment durably improves growth and reduces body disproportion in children with severe forms of hypochondroplasia.
Collapse
Affiliation(s)
- Anya Rothenbuhler
- Service d'Endocrinologie Pédiatrique, Hôpitaux Universitaires Paris Sud, Paris, France
| | | | | | | |
Collapse
|
19
|
Saito T, Nagasaki K, Nishimura G, Takagi M, Hasegawa T, Uchiyama M. Radiological clues to the early diagnosis of hypochondroplasia in the neonatal period: Report of two patients. Am J Med Genet A 2012; 158A:630-4. [DOI: 10.1002/ajmg.a.34424] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 10/31/2011] [Indexed: 11/10/2022]
|
20
|
Polgreen LE, Miller BS. Growth patterns and the use of growth hormone in the mucopolysaccharidoses. J Pediatr Rehabil Med 2010; 3:25-38. [PMID: 20563263 PMCID: PMC2886985 DOI: 10.3233/prm-2010-0106] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Short stature is characteristic of patients with mucopolysaccharidosis (MPS) diseases. For children with skeletal dysplasias, such as MPS, it is important to know the natural history of growth. An understanding of the natural growth pattern in each MPS disease provides a measurement to which treatments can be compared, as well as data which can help families and providers make individualized decisions about growth promoting treatments. Multiple advancements have been made in the treatment of MPS with both hematopoietic cell transplantation (HCT) and enzyme replacement therapy (ERT). The long term benefit of these treatments on growth is unknown. This article will review the published data on growth in children with MPS, and describe preliminary data on the use of human growth hormone (hGH) in children with MPS.
Collapse
Affiliation(s)
- L E Polgreen
- University of Minnesota, Department of Pediatrics, Division of Endocrinology, Minneapolis, MN, USA
| | | |
Collapse
|
21
|
Lemmens GMD, Eisler I, Buysse A, Heene E, Demyttenaere K. The effects on mood of adjunctive single-family and multi-family group therapy in the treatment of hospitalized patients with major depression. A 15-month follow-up study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2009; 78:98-105. [PMID: 19218828 DOI: 10.1159/000201935] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Family-based interventions have been shown to be effective in the treatment of depression, but they have seldom been studied in hospitalized depressed patients. This study assesses the value of the additional use of single-family or multi-family group therapy within this patient population. METHODS Eighty-three patients were randomly assigned to: (1) the treatment programme as usual (n = 23), (2) treatment as usual combined with single-family therapy (n = 25) or (3) treatment as usual combined with multi-family group therapy (n = 35). Follow-up assessments were made at 3 months and 15 months. RESULTS Multi-family group and single-family therapy conditions showed significantly higher rates of treatment responders than the group receiving the usual treatment (49, 24 and 9%, respectively), and higher rates of patients no longer using antidepressant medication (26, 16 and 0%, respectively) at 15 months. Partners taking part in the family treatments were significantly more likely to notice the improvements in the emotional health of the patient early on compared to those in the treatment as usual condition. CONCLUSIONS This study suggests that single-family and multi-family therapy may benefit hospitalized patients with major depression, and may help the partners of the patients to become aware of the patient's improvement more quickly.
Collapse
|
22
|
Bardallo Cruzado L, Bermúdez de la Vega JA, Jiménez Tejada M. Hipocondroplasia por mutación N540K. An Pediatr (Barc) 2006; 64:393-4. [PMID: 16606580 DOI: 10.1157/13086532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
23
|
Tsai T, Gombos D, Fulton L, Conway RM, O'Brien JM, Cronin JE, Muthialu A. Retinoblastoma and hypochondroplasia: a case report of two germline mutations arising simultaneously. Ophthalmic Genet 2005; 26:107-10. [PMID: 16020314 DOI: 10.1080/13816810590967998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report a rare case of a patient with two germline mutations arising de novo resulting in bilateral retinoblastoma and hypochondroplasia. DESIGN A brief review about retinoblastoma and hypochondroplasia; a case report with genetic mutational analysis results. CASE REPORT We report a patient manifesting the clinical features of both bilateral retinoblastoma and hypochondroplasia. Genetic analysis revealed two germline mutations, a seven base-pair deletion in exon 12 (G70313-703129del) in one allele of the retinoblastoma gene (RB1) and the N540K (C1620C > A) mutation in one allele of the fibroblast growth factor 3 (FGFR3) gene, a frequent mutation in hypochondroplasia. Neither parent has a personal or family history of cancer or ocular tumors. Only the patient's mother is short in stature, and her genetic analysis revealed no FGFR3 mutations. CONCLUSIONS Although the probability of both germline mutations occurring in a single individual is exceedingly low, the etiology and mechanism are unknown in this patient. To the best of our knowledge, this is the first report of two clinically distinct heritable germline mutations arising de novo in an individual.
Collapse
Affiliation(s)
- Tony Tsai
- Ocular Oncology Division, Department of Ophthalmology, University of California-San Francisco, UCSF Medical Center, 10 Koret Way, San Francisco, CA 94143, U.S.A
| | | | | | | | | | | | | |
Collapse
|
24
|
Tanaka N, Katsumata N, Horikawa R, Tanaka T. The comparison of the effects of short-term growth hormone treatment in patients with achondroplasia and with hypochondroplasia. Endocr J 2003; 50:69-75. [PMID: 12733711 DOI: 10.1507/endocrj.50.69] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The effects of recombinant human growth hormone (rhGH) treatment for three years were compared in patients with achondroplasia (ACH) and hypochondroplasia (HCH), whose diagnosis had been confirmed by DNA analysis of the fibroblast growth factor receptor 3 gene. Height SDS (H-SDS) and height velocity SDS (HV-SDS) using the standard for ACH significantly improved during three-year treatment as compared with that before treatment in both ACH and HCH except HV-SDS in the third year. The improvement was much greater in HCH than in ACH. The mean increase H-SDS using the standard for ACH in three years in ACH (from -0.2 SD to 0.1 SD) is almost negligible but that in HCH (from 1.2 SD to 2.6 SD) can be estimated as effective clinically. It can be concluded short-term GH treatment in HCH is effective to increase growth rate and H-SDS, but it has little effect in ACH. Further studies would be required to confirm the other beneficial effects of GH treatment such as increase in bone mineral density in ACH and HCH and the effect on the final height.
Collapse
Affiliation(s)
- Noriko Tanaka
- Department of Growth and Puberty, National Research Institute for Child Health and Development, Tokyo 154-8567, Japan
| | | | | | | |
Collapse
|
25
|
Abstract
The availability of somatropin [recombinant human growth hormone (GH)] has revolutionized the treatment of short stature resulting from GH deficiency. It is also widely used as an adjunct in the treatment of other disorders which do not fit the definition of classic GH deficiency, such as intrauterine growth restriction, Turner syndrome, healthy children with short stature and skeletal dysplasias. The widespread use and ready availability of GH treatment has prompted questions about its tolerability, rationality, and the psychological effects of long-term treatment, leading to several trials. Early treatment of GH deficiency will allow the child to reach his or her genetic potential, although there continues to be marked variability in the criteria used to diagnose the deficiency, and in the treatment schedule, especially during puberty. Treatment has also been shown to have a beneficial effect on growth in children with chronic renal failure, with no adverse effects on the renal function. There are, however, no long-term data to determine final height, or randomized controlled studies to justify routine use of GH in conditions such as intrauterine growth restriction. It remains controversial in conditions such as Turner syndrome and achondroplasia, where the response to treatment is only moderate. Healthy children with short stature have not been shown to have a psychological disadvantage, again proving difficult to justify prolonged GH treatment for idiopathic short stature. Meticulous monitoring, long-term follow-up to adult or near-adult final height, and well-defined endpoints of treatment need to be better clarified. The metabolic effects of treatment on the patient's lipid profile, bone mineral density, and muscle mass need careful documentation, especially with the high doses used in an already susceptible population such as low birthweight children and those with Turner syndrome. Lastly, the psychosocial impact of GH treatment, financial implications, and cost efficacy of treatment in an ever-increasing list of indications should be taken into consideration for rationalizing its use in future.
Collapse
Affiliation(s)
- Ameeta Mehta
- London Centre for Paediatric Endocrinology and Metabolism, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1, United Kingdom.
| | | |
Collapse
|
26
|
Clementi M, Milani S, Mammi I, Boni S, Monciotti C, Tenconi R. Neurofibromatosis type 1 growth charts. AMERICAN JOURNAL OF MEDICAL GENETICS 1999; 87:317-23. [PMID: 10588837 DOI: 10.1002/(sici)1096-8628(19991203)87:4<317::aid-ajmg7>3.0.co;2-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Growth abnormalities such as macrocephaly and short stature have been described and are considered a consistent finding in neurofibromatosis type 1 (NF1), one of the most common autosomal dominant disorders in man. We present here a clinical study on the growth profile of a sample of NF1 patients collected through a population-based registry that covers three contiguous regions of North-East Italy (NEI-NF Registry). Auxometric traits of 528 NF1 patients have been measured with the aim of drawing growth charts for height, weight, and head circumference (OFC). Height velocity charts were based on a subset of 143 children who underwent multiple measurements. No differences in height were apparent between NF1 and normal subjects up to age 7 (girls) and 12 (boys) years; subsequently, the 50th centile of NF1 subjects tends to overlap with the 25th centile of normal subjects, and the 3rd centile is much lower in NF1 subjects than in normal subjects, mainly during adolescence. The negatively skewed distribution of height seems to indicate that height growth impairment affects only a proportion of NF1 subjects; height growth impairment does not seem related to disease severity. As for weight, our data suggest that slight overweight is a characteristic of adult NF1 subjects (mainly among males), independent of disease severity. Height growth velocity is normal during childhood for both sexes, whereas the pubertal spurt is slightly anticipated and reduced in NF1 boys but not in girls. Our data confirm previous observations that macrocrania affects most NF1 subjects; the shape of the head growth curve is similar in NF1 and normal girls, whereas NF1 boys present an OFC pubertal growth spurt much more pronounced and delayed than normal boys. The disproportion between OFC and height seems to be related to disease severity in boys but not in girls. Growth charts presented here can be useful in neurofibromatosis clinics for the identification of the effects of secondary growth disorders, for growth prognosis, and for the evaluation of the effects of a therapy such as GH therapy after radiotherapy for optic glioma.
Collapse
Affiliation(s)
- M Clementi
- Servizio di Genetica Clinica ed Epidemiologica, Dipartimento di Pediatria, Università di Padova, Padova, Italy
| | | | | | | | | | | |
Collapse
|
27
|
Ramaswami U, Hindmarsh PC, Brook CG. Growth hormone therapy in hypochondroplasia. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1999; 88:116-7. [PMID: 10102069 DOI: 10.1111/j.1651-2227.1999.tb14368.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with hypochondroplasia present with variable phenotypes. Children with severe short stature and disproportion of the body segments usually have the mutation Asn540Lys. They respond to growth hormone (GH) therapy with an increase in spinal length and, coupled with a surgical leg-lengthening procedure, it is possible for some patients to achieve adult heights within the normal range. Some children who present with proportionate short stature and hypochondroplasia fail to increase their growth rate at puberty, although the growth spurt can be restored by GH therapy. Others, with an identical presentation, seem to grow normally during puberty. At present, there is no way of predicting who will undergo a normal pubertal growth spurt. We therefore monitor all patients during childhood and give GH treatment only to those patients who fail to develop a growth spurt at puberty. Severe cases may occasionally need treatment before puberty if their growth velocity is compromised, but these will probably also be candidates for a surgical leg-lengthening procedure.
Collapse
Affiliation(s)
- U Ramaswami
- London Centre for Paediatric Endocrinology, Middlesex Hospital, London, UK
| | | | | |
Collapse
|
28
|
Affiliation(s)
- C G Brook
- London Centre for Paediatric Endocrinology, Middlesex Hospital, London, UK
| | | |
Collapse
|
29
|
Abstract
Mutations in the tyrosine kinase domain of fibroblast growth factor receptor gene (FGFR3) have been described in some cases of hypochondroplasia (Hch). We screened 65 children with Hch diagnosed by clinical and radiologic criteria for 2 previously described mutations, C1620A and C1620C in FGFR3; 28 (43%) of 65 patients were heterozygous for the C1620A transversion resulting in lysine to asparagine substitution at codon 540 in the tyrosine kinase domain of FGFR3. The height, sitting height, and subischial leg length of these children and of 18 children with achondroplasia were analyzed at presentation, and SD scores were calculated. For comparison of growth data the patients were divided into three groups: group 1, achondroplasia defined by radiology and the presence of the G1138A mutation in the transmembrane domain of FGFR3; group 2, Hch with C1620A mutation; and group 3, Hch with no mutation identified so far. Height, sitting height, and subischial leg length SD scores were analyzed as group mean data by analysis of variance with the Student Neuman-Keuls test after testing for multiple contrasts were performed. All three groups were significantly compromised in height, although the children with achondroplasia were much shorter with significant reduction in subischial leg length. The same pattern was evident in group 2, with additional shortening of the back, the third group was proportionately short. Children with the common C1620A mutation met all of the criteria for the diagnosis of Hch with a severe phenotype that resembled achondroplasia and disproportionate short stature in early childhood. However, a substantial number of patients with proportionate short stature presented at an older age with the same radiologic characteristics and failure of the puberty growth spurt. The genetic basis of this milder phenotype not yet known.
Collapse
Affiliation(s)
- U Ramaswami
- London Centre of Paediatric Endocrinology, Great Ormond Street Childrens Hospital, United Kingdom
| | | | | | | |
Collapse
|
30
|
Stamoyannou L, Karachaliou F, Neou P, Papataxiarchou K, Pistevos G, Bartsocas CS. Growth and growth hormone therapy in children with achondroplasia: A two-year experience. ACTA ACUST UNITED AC 1997. [DOI: 10.1002/(sici)1096-8628(19971003)72:1<71::aid-ajmg15>3.0.co;2-r] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
31
|
Weber G, Prinster C, Meneghel M, Russo F, Mora S, Puzzovio M, Del Maschio M, Chiumello G. Human growth hormone treatment in prepubertal children with achondroplasia. AMERICAN JOURNAL OF MEDICAL GENETICS 1996; 61:396-400. [PMID: 8834055 DOI: 10.1002/(sici)1096-8628(19960202)61:4<396::aid-ajmg17>3.0.co;2-n] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We studied the effects of recombinant human growth hormone (GH) treatment in 6 prepubertal children with achondroplasia. The patients' age ranged from 2 11/12 to 8 5/12 years and the GH dose was of 0.1 IU/kg/day subcutaneously. Auxological assessments and bone age determinations were performed 6 months before, at the beginning, and after 6 and 12 months of therapy. The growth velocity increase during the whole year of treatment ranged from 1.1 to 2.6 cm/year in 3 patients while in the others no variation was detected. No side effects were observed during the trial apart from a slight advancement of bone age in two patients. MRI at the cervicomedullary junction and CT scan of the base of the skull did not show any variation of the dimensions of the foramen magnum at the end of the trial compared to baseline. Our study shows that r-hGH can safely increase short-term growth velocity in some but not all prepubertal children with achondroplasia. Our data confirm the individual variability in the response to the GH treatment.
Collapse
Affiliation(s)
- G Weber
- Department of Pediatrics, University of Milan, Italy
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
OBJECTIVE This study was conducted to determine the response of children with skeletal dysplasia and short stature to growth hormone therapy and whether such therapy is appropriate in skeletal dysplasia. METHODOLOGY A retrospective analysis of the Australia-wide group of children with skeletal dysplasia registered on the Ozgrow database, using growth data at commencement and at 12 monthly intervals. Eighteen females and 35 males received growth hormone (GH) therapy for at least 12 months. Patients were aged 10.3 +/- 3.3 (mean +/- s.d.) years and had severe short stature with height standard deviation score (SDS) of -3.5 +/- 1.0 (mean +/- s.d.). RESULTS Hypochondroplasia (N = 7), metaphyseal dysplasia (N = 5) and dyschondrosteosis (N = 5) were the most frequently represented specific skeletal dysplasia subgroups. These groups and the remaining heterogeneous group did not differ significantly at baseline or subsequent growth response. Duration of GH therapy was mean (range) 36 mo (12-60 mo). Sex, age or degree of short stature did not correlate with response to GH therapy. delta height SDS was 0.3 (mean) after 12 months of GH therapy, which corresponded to an increase in mean growth velocity from 4.3 cm/yr to 6.9 cm/yr. Mean GV declined after the first year, and by 36 months was only 1.1 cm/year above baseline, while delta height SDS was 0.8 CONCLUSIONS The results suggest that growth hormone therapy is not generally effective for treatment of short stature in skeletal dysplasia.
Collapse
Affiliation(s)
- C P Burren
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Vic, Australia
| | | |
Collapse
|
33
|
Guidelines for the use of growth hormone in children with short stature. A report by the Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. J Pediatr 1995; 127:857-67. [PMID: 8523180 DOI: 10.1016/s0022-3476(95)70019-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
On the basis of the information currently available, the only conditions in which GH therapy appears to be safe and effective in increasing adult height are GH deficiency and, likely, Turner syndrome. Therapy with GH also increases the growth velocity of children with CRI and may increase adult height, but no long-term data are available. Encouraging short-term results have been reported in patients with a few other conditions, such as patients with glucocorticoid-induced growth failure, renal transplantation, and Prader-Willi syndrome, but the data are limited and no long-term studies have been reported; in many other conditions the data are either inconclusive or discouraging. For children in these latter groups, GH therapy should be considered investigational and undertaken only as part of ethically sound, controlled clinical trials. Knowledge concerning the conditions in which GH is safe and effective is a prerequisite to making rational decisions concerning its use. However, in deciding whether therapy is warranted in an individual child, one must consider other important factors. The age and emotional maturity of the child, the family structure and dynamics, and even financial considerations may, in some cases, outweigh the presence of a GH-responsive condition. Likewise, the child's and the family's views about "short" stature and the likely benefits of therapy must be considered. Ultimately, a decision concerning the appropriateness of GH therapy must be individualized and based on a realistic assessment of its impact on the quality of life of the child and future adult.
Collapse
|
34
|
Abstract
Skeletal dysplasia or osteochondrodysplasia is the designation of more than 200 different disorders, that are characterized by abnormalities of the skeleton, disproportional short stature, and a variety of other problems. The underlying biochemical defect is unknown in the vast majority of skeletal dysplasias, and the diagnosis is based on radiological findings and anthropometric measurements. Despite this fact, the information on body proportions in even the more common forms of skeletal dysplasia is scarce. Patients with achondroplasia are often diagnosed shortly after birth. Linear growth is severely compromised with relatively short extremities. Head circumference is above normal and final height ranges from 115 to 145 cm in males and 112 to 137 cm in females. Individuals with hypochondroplasia may go unnoticed until puberty, at which time the growth problem becomes obvious. Sitting height to height ratio is increased, but the body disproportion may not be apparent until puberty. Final height has been reported between 118 and 165 cm. Spondyloepiphyseal and spondylometaepiphyseal dysplasias are characterized by severe impairment of growth both in trunk and extremities, and therefore the sitting height to height ratio may be normal. Final height is severely reduced and ranges from 94 to 132 cm. It is concluded that anthropometric studies of patients with skeletal dysplasia are needed. More quantitative information on body proportions may assist in the diagnostic procedure and ensure that growth promoting therapy, e.g. growth hormone, does not worsen the disproportion.
Collapse
Affiliation(s)
- N T Hertel
- Department of Growth and Reproduction, Rigshospitalet, University Hospital of Copenhagen, Denmark
| | | |
Collapse
|
35
|
Priestley BL, Harrison CJ, Gerrard MP, Gibson A. Paediatrics--Part I. Postgrad Med J 1993; 69:171-85. [PMID: 8497430 PMCID: PMC2399744 DOI: 10.1136/pgmj.69.809.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- B L Priestley
- Sheffield Children's Hospital NHS Trust, Western Bank, UK
| | | | | | | |
Collapse
|
36
|
Lippe BM, Nakamoto JM. Conventional and nonconventional uses of growth hormone. RECENT PROGRESS IN HORMONE RESEARCH 1993; 48:179-235. [PMID: 8441848 DOI: 10.1016/b978-0-12-571148-7.50011-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Although GH has been available as a therapeutic agent for the GH-deficient child for more than 30 years, the conditions of its use have yet to be optimized. The availability of biosynthetic material has provided researchers with the opportunity to develop the protocols necessary to begin to finally answer the most fundamental questions pertaining to dose, frequency, and duration of treatment. It has also permitted the initiation of prospective trials in a large number of conditions that result in childhood short stature, with the expectation that some or many of them will be treated effectively and safely. Finally, it has opened the door to an entire spectrum of potentially new uses of GH and other growth factors for so-called nonconventional indications. That these have implications that range from the short-term rapid healing of a burn graft site, to the more efficient induction of ovulation, to the long-term preservation of lean body mass has excited the interest of investigators in many fields of medicine and physiology. Thus, the recent progress reported in this paper is really the beginning of the new research that will take place with GH and growth factors.
Collapse
Affiliation(s)
- B M Lippe
- Department of Pediatrics, UCLA School of Medicine 90024
| | | |
Collapse
|
37
|
Hindmarsh PC, Bridges NA, Brook CG. Wider indications for treatment with biosynthetic human growth hormone in children. Clin Endocrinol (Oxf) 1991; 34:417-27. [PMID: 2060152 DOI: 10.1111/j.1365-2265.1991.tb00315.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
38
|
Mullis PE, Patel MS, Brickell PM, Hindmarsh PC, Brook CG. Growth characteristics and response to growth hormone therapy in patients with hypochondroplasia: genetic linkage of the insulin-like growth factor I gene at chromosome 12q23 to the disease in a subgroup of these patients. Clin Endocrinol (Oxf) 1991; 34:265-74. [PMID: 1879059 DOI: 10.1111/j.1365-2265.1991.tb03765.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Hypochondroplasia, a heterogeneous and usually mild form of chondrodystrophy, is a common cause of short stature. It often goes unrecognized in childhood and is diagnosed in adult life when disproportionate short stature becomes obvious. We performed restriction enzyme analysis of the insulin-like growth factor I (IGF-I) gene on the families of 20 white British Caucasian children with short stature attributed to hypochondroplasia by radiological and clinical criteria, who were undergoing human growth hormone (r-hGH) treatment, in 60 children with isolated growth hormone deficiency and in 50 normal individuals. The frequency of the heterozygous pattern (Hind III: 8.2, 5.2, 4.8, 3.2 kb fragments, Pvu: 8.4, 5.1, 4.7, 2.5 kb fragments) in children with hypochondroplasia was significantly higher (chi2: P less than 0.05) than in the control groups. The hypochondroplastic children whose response to r-hGH treatment was characterized by a proportionate increase in both spinal and subischial leg length were all heterozygous for two co-inherited IGF-I gene restriction fragment length polymorphism (RFLP) alleles (Hind III: 5.2, 4.8 kb; Pvu II: 5.1, 4.7 kb). Children whose response was characterized by accentuation of the body disproportion by r-hGH treatment were all homozygous for these alleles (Hind III: 4.8, 4.8 kb; Pvu II: 4.7, 4.7 kb). Their response to r-hGH treatment is significantly different (P less than 0.01). Studies of the families of the heterozygous affected children demonstrated strong linkage (lod score 3.311 at zero recombination) of the IGF-I gene locus at chromosome 12q23 to this subgroup of hypochondroplasia. The 5.2 kb Hind III and 5.1 kb Pvu II alleles are in strong linkage disequilibrium with this trait. These data indicate that IGF-I gene may be a candidate gene for involvement in the aetiology of short stature presenting with hypochondroplastic features and a proportionate response to r-hGH treatment; they also provide support for the concept of genetic heterogeneity in chondrodystrophy.
Collapse
Affiliation(s)
- P E Mullis
- Endocrine Unit, Middlesex Hospital, London, UK
| | | | | | | | | |
Collapse
|