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Tanaka T. Changes, limitations, and prospects of adult height in GH treatment for Japanese GHD patients. Clin Pediatr Endocrinol 2022; 31:211-224. [DOI: 10.1297/cpe.2022-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/21/2022] [Indexed: 11/04/2022] Open
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Tanaka T, Naiki Y, Horikawa R. Combined Treatment with Gonadotropin-releasing Hormone Analog and Anabolic Steroid Hormone Increased Pubertal Height Gain and Adult Height in Boys with Early Puberty for Height. Clin Pediatr Endocrinol 2012; 21:35-43. [PMID: 23926409 PMCID: PMC3698904 DOI: 10.1297/cpe.21.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 02/27/2012] [Indexed: 11/06/2022] Open
Abstract
Twenty-one boys with a height of 135 cm or less at onset of puberty were treated with a
combination of GnRH analog and anabolic steroid hormone, and their pubertal height gain
and adult height were compared with those of untreated 29 boys who enter puberty below 135
cm. The mean age at the start of treatment with a GnRH analog, leuprorelin acetate depot
(Leuplin®) was 12.3 yr, a mean of 1.3 yr after the onset of puberty, and GnRH
analog was administered every 3 to 5 wk thereafter for a mean duration of 4.1 yr. The
anabolic steroid hormone was started approximately 1 yr after initiation of treatment with
the GnRH analog. The mean pubertal height gain from onset of puberty till adult height was
significantly greater in the combination treatment group (33.9 cm) than in the untreated
group (26.4 cm) (p<0.0001). The mean adult height was significantly greater in the
combination treatment group (164.3 cm) than in the untreated group (156.9 cm)
(p<0.0001). The percentage of subjects with an adult height of 160 cm or taller was
90.5% (19/21) in the combination treatment group, and it was 13.8% (4/29) in the untreated
group (p<0.0001). Since growth of the penis and pubic hair is promoted by the anabolic
steroid hormone, no psychosocial problems arose because of delayed puberty. No clinically
significant adverse events appeared. Combined treatment with GnRH analog and anabolic
steroid hormone significantly increased height gain during puberty and adult height in
boys who entered puberty with a short stature, since the period until epiphyseal closure
was extended due to deceleration of the bone age maturation by administration of the GnRH
analog and the growth rate at this time was maintained by the anabolic steroid
hormone.
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Affiliation(s)
- Toshiaki Tanaka
- Tanaka Growth Clinic, Tokyo, Japan ; Division of Endocrinology, National Center for Child Health and Development, Tokyo, Japan
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Darendeliler F, Berberoğlu M, Ocal G, Adiyaman P, Bundak R, Günöz H, Baş F, Darcan S, Gökşen D, Arslanoğlu I, Yildiz M, Ercan O, Ercan G, Ozerkan E, Can S, Böber E, Adal E, Sarikaya S, Dallar Y, Siklar Z, Bircan I, Bideci A, Yüksel B, Büyükgebiz A. Response to growth hormone with respect to pubertal status on increased dose in idiopathic growth hormone deficiency: an analysis of Turkish children in the KIGS database (Pfizer International Growth Study). J Pediatr Endocrinol Metab 2005; 18:949-54. [PMID: 16355808 DOI: 10.1515/jpem.2005.18.10.949] [Citation(s) in RCA: 3] [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
AIM To compare the growth response to growth hormone (GH) treatment in patients with idiopathic GH deficiency (IGHD) who were prepubertal with the response of those who were pubertal at the onset of GH therapy on an increased GH dose. PATIENTS AND METHODS Among the Turkish patients enrolled in the Pfizer International Growth Study (KIGS) database with the diagnosis of IGHD, the growth data over 2 years of GH therapy were analyzed longitudinally of 113 (79 M) prepubertal (Group 1) and 44 (33 M) pubertal (Group 2) patients. Pubertal signs were reported to be present initially or to have appeared within 6 months of GH therapy in Group 2. Mean +/- SD age at onset of therapy was 8.7 +/- 3.5 and 13.5 +/- 1.8 years; height SDS -4.2 +/- 1.4 and -3.2 +/- 1.1 (p < 0.05) in Groups 1 and 2, respectively. Mid-parental height (MPH) SDS did not show a significant difference between the two groups (-1.5 +/- 1.1 vs -1.7 +/- 1.1). RESULTS Delta height SDS over 2 years of therapy was significantly higher in Group 1 (1.1 +/- 1.0) than in Group 2 (0.7 +/- 0.6) (p <0.05) in spite of a significantly lower dose of GH (14.6 +/- 3.3 in Group 1 vs 17.0 +/- 3.1 IU/m2/week in Group 2, p < 0.05). Ht--MPH SDS showed an increase from -2.4 +/- 1.7 to -1.4 +/- 1.5 in Group 1 and from -1.5 +/- 1.5 to -0.8 +/- 1.3 in Group 2. Overall delta height SDS showed negative correlations with age (r = -0.32), height SDS (r = -0.41) and height--MPH SDS (r = -0.40) at onset of therapy (p < 0.001). CONCLUSIONS These data show that in IGHD the slight increase (15-20%) in the dose of GH during puberty was not adequate to maintain height velocity at the same magnitude as in prepuberty, and thus was not cost effective.
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Affiliation(s)
- F Darendeliler
- Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Espigares R, Martín de Lara I, Ruiz-Cabello F, Ortega L, Ferrández Longás A, Argente J, Salvatori R. Phenotypic analysis and growth response to different growth hormone treatment schedules in two siblings with an inactivating mutation in the growth hormone-releasing hormone receptor gene. J Pediatr Endocrinol Metab 2004; 17:793-800. [PMID: 15237716 DOI: 10.1515/jpem.2004.17.5.793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mutations in the GHRH receptor (GHRHR) gene (GHRHR) are emerging as a common cause of familial isolated growth hormone deficiency (IGHD) type IB. The use of gonadotropin-releasing hormone (GnRH) analogues has been advocated as a tool to delay puberty in patients with isolated GH deficiency (IGHD), allowing longer time for the beneficial effect of exogenous human GH (hGH) treatment on growth. We describe two male siblings with IGHD due to a homozygous missense GHRHR mutation who, because they were started on hGH therapy at different ages, presented with different height SDS at the onset of puberty and therefore had different predicted target heights. The shorter brother was treated with GnRH analogue plus hGH for 3 years, whereas the other brother received only hGH. Despite different predicted heights at the onset of puberty, they attained similar final heights. We conclude that in patients with IGHD, GnRH analogue treatment should be considered to delay puberty and obtain a maximal growth response if hGH treatment is started in late childhood and the predicted height at puberty onset is below the genetic target.
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Affiliation(s)
- R Espigares
- Pediatric Endocrinology Unit, Virgen de las Nieves Hospital, Granada, Spain.
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Papagianni M, Stanhope R. Should the dose of growth hormone be increased during the growth spurt of children with isolated growth hormone deficiency? J Pediatr Endocrinol Metab 2003; 16:1095-7. [PMID: 14594167 DOI: 10.1515/jpem.2003.16.8.1095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maria Papagianni
- Great Ormond Street Hospital for Children, The Middlesex Hospital (UCLH), London, UK
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Abstract
The main aim of sex steroid replacement during induction of puberty is to obtain a balance between healthy psychological and somatic development and optimal final height and peak bone mass (PBM). At present, the age at which it is considered appropriate to begin inducing puberty is younger than it was in the past. This trend aims for optimisation of prepubertal and pubertal growth through earlier onset of growth hormone (GH) therapy and administration of higher doses during puberty as necessary. Adequate initiation of puberty should ensure not only optimal final height and psychological balance, but also normal body proportions, appropriate bone formation and preservation of fertility for children with GH and gonadotropin deficiencies.
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Affiliation(s)
- Ferenc Péter
- Buda Children's Hospital, 1023, Budapest, Bolyai-u. 5-7, Hungary.
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Sampaolo P, Calcaterra V, Klersy C, Alfei A, De Leonardis C, Maino M, Larizza D. Pelvic ultrasound evaluation in patients with Turner syndrome during treatment with growth hormone. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:172-177. [PMID: 12905513 DOI: 10.1002/uog.144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Treatment with growth hormone (GH), alone or in combination with oxandrolone, is used in patients affected by Turner syndrome to improve growth velocity and adult height. Since GH interacts with gonadotropins in the stimulation of the human ovary, the aim of our study was to evaluate the possible effects of GH administration on uterine and ovarian characteristics. METHODS We performed pelvic ultrasound assessment in 29 patients with Turner syndrome aged 7.5-16.6 years (19 with 45,X karyotype; 10 with variant karyotypes) before and during treatment with GH alone. Uterine volume and ovarian size and morphology were compared to those of 23 age-matched girls with Turner syndrome not treated with GH. Both patients and controls were divided into prepubertal and pubertal groups. Cross-sectional and longitudinal studies (before and every 6 months during GH treatment for 2 years) were performed. RESULTS We observed a significantly higher uterine anteroposterior diameter and volume in younger (< or = 11 years) GH-treated Turner syndrome girls than in those who were untreated. Also visualization and heterogeneous echopattern of the ovaries were significantly more frequent in treated than in untreated Turner syndrome patients, particularly before the age of 11 years. The longitudinal study showed a significant increase in uterine volume, more related to treatment than to age. Spontaneous breast development and menarche were found more frequently in GH-treated Turner syndrome girls. CONCLUSION Growth hormone therapy can have a co-gonadotropin role in patients with Turner syndrome.
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Affiliation(s)
- P Sampaolo
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Abstract
Dynamic interactions among growth hormone, IGF-1, and sex steroidal hormones have a major role in the achievement of full height potential and the body composition changes in adolescence. Testosterone and estrogen affect the growth hormone neuroendocrine rhythms, and growth hormone, in turn, potentiates many of the metabolic actions of the sex steroids. Leptin is also thought to have a key regulatory role in the process of sexual development in the child, but the precise nature of these interactions is unclear. The targeted replacement of hormonal deficiencies in puberty and manipulation of the timing of pubertal maturation have resulted in better strategies to treat profoundly short children during this period; however, more research is needed to determine the consequences of such approaches in aspects of metabolism other than linear growth.
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Affiliation(s)
- N Mauras
- Division of Endocrinology, Nemours Children's Clinic, Jacksonville, Florida, USA.
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Karavanaki K, Kontaxaki C, Maniati-Christidi M, Petrou V, Dacou-Voutetakis C. Growth response, pubertal growth and final height in Greek children with growth hormone (GH) deficiency on long-term GH therapy and factors affecting outcome. J Pediatr Endocrinol Metab 2001; 14:397-405. [PMID: 11327373 DOI: 10.1515/jpem.2001.14.4.397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The growth data of 156 children (100 boys, 56 girls) with growth hormone deficiency (GHD), treated with human growth hormone (GH) for 5.7+/-3.7 years, from 1970-1997, were retrospectively analyzed to assess the efficacy of GH treatment and the factors involved. 62.2% of the studied population had idiopathic GHD (IGHD) and 35.2% had organic GHD (OGHD). At initiation of treatment, chronological age (CA) was 10.1+/-4.0 years in children with IGHD and 9.7+/-4.0 years in those with OGHD, while bone age (BA) was 7.0+/-3.7 and 7.7+/-3.2 years, respectively. The SDS of the growth velocity during the first year of therapy (GV1) was negatively related to CA at start of therapy (r = -0.53, p = 0.01). 109 children have reached final height (FH): 67 boys (FH = 165.3+/-6.3 cm) and 42 girls (FH = 153.9+/-5.4 cm). FH SDS was not significantly different from target height (TH) SDS. In the total group, FH SDS was positively related to height SDS for CA and BA at start of therapy (p = 0.01, p = 0.001, respectively), to TH SDS (r = 0.40, p = 0.001), and to GV1 (r = 0.33, p = 0.001). TH SDS was not different between the IGHD and OGHD groups (-1.02+/-0.8 vs. -0.94+/-6.9). The height gain at puberty did not differ between the groups with induced or spontaneous puberty in boys (23.7+/-8.6 vs. 25.4+/-6.9, not significant), while in girls it was higher in the group with spontaneous puberty (12.7+/-7.3 vs. 20.0+/-9.0, p = 0.008). The age and height at start of puberty was higher in girls and boys with induced puberty. In the total group, the FH SDS of children with induced puberty was higher in comparison with those with spontaneous puberty (-1.0+/-0.8 vs. -1.7+/-0.9, p = 0.001) and it was positively related to the height at start of puberty. When the two sexes were analyzed separately, the difference reached significance only in boys. In conclusion, children with GHD on GH treatment achieved a final height which was comparable to their genetic potential. The FH of children with OGHD was not different from those with IGHD. The age and height at start of puberty were the most significant determining factors for FH. Hence, a better FH might be expected by delaying or arresting puberty.
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Affiliation(s)
- K Karavanaki
- First Pediatric Department, Athens University Medical School, Aghia Sophia Children's Hospital, Greece
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Trainer PJ, Palermo M, Kirk JM, Fanciulli G, Perry LH, Delitala G, Besser GM. Quantitative growth hormone secretion and final adult height. Clin Endocrinol (Oxf) 1999; 51:597-602. [PMID: 10594520 DOI: 10.1046/j.1365-2265.1999.00844.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The relationship of quantitative GH secretion to height, growth velocity and puberty is complex and has been the subject of extensive study in children. This study was designed to relate quantitative GH secretion to final height. SUBJECTS Twenty tall (> 183 cm, 90th centile for adult height) and 20 short (< 166 cm, 10th centile) postpubertal men who had recently completed linear growth (age range 18-27 years). MEASUREMENTS GH dynamics were studied on four occasions; insulin (0.15 units/kg, iv)-induced hypoglycaemia and GHRH (100 mg, iv) with and without the anticholinesterase, pyridostigmine (120 mg orally). Spontaneous nocturnal GH secretion was assessed by 20 minute sampling from 2100 h until 0600 h. GH was measured by IRMA. Analysis was by comparison of peak GH response and area under the curve (AUC). GH profiles were further analysed using the 'pulsar' programme. RESULTS The mean height in the tall group was 187.7 cm (range 183-197) compared to 163.5 cm (range 160-166) for the short group. No difference existed between groups in the GH response to hypoglycaemia or GHRH with and without pyridostigmine. Area under the curve, pulse number, length and amplitude for spontaneous nocturnal GH secretion showed no significant difference between the tall and short subjects. Serum IGF-I (mean 230.5 +/- 15. 4 vs. 230.6 +/- 18.9 microg/l) did not differ between the groups. CONCLUSIONS Quantitative GH secretion does not appear to be an important determinant of final height in healthy individuals.
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Affiliation(s)
- P J Trainer
- Department of Endocrinology, St. Bartholomew's Hospital, London, UK.
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Affiliation(s)
- M L Vance
- Department of Internal Medicine, University of Virginia Medical Center, Charlottesville 22908, USA
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Abstract
OBJECTIVE To examine the growth response over 3 years of growth hormone deficient (GHD) and non-GHD children who have received growth hormone (GH) in Australia. METHODOLOGY A retrospective study of a group of patients (1362 children) who commenced GH prior to 1 September 1990. Data were collected at 12 growth centres located in major cities throughout Australia. The data were transferred after informed consent to the national OZGROW database located at the Royal Alexandra Hospital for Children, Sydney, NSW. Of the 1362 children, 898 had received 3 years or more GH therapy and were eligible for this analysis. This cohort was then categorized by diagnosis. Growth response was assessed using height standard deviation score, estimated mature height, growth velocity (GV), GH dose and bone age (years). RESULTS For children who completed 3 years therapy, the baseline characteristics among diagnostic groups were similar with mean height standard deviation score (SDS) less than -3 SDS (except for the malignancy group) and mean GV ranging from 3.5 to 4.4cm/year. The GV during the first year improved in all groups (7.7-9.4cm/year)followed by an attenuated response during the second and third years of therapy. After 3 years GH therapy the GHD group with peak levels <10 mU/L demonstrated the greatest change in estimated mature height and height SDS. The GHD group with peak levels between > or = 10 but <2OmU/L had a growth response similar to the non-GHD children for all outcome parameters. Change in bone age ranged from 3.1 to 3.8 years with no differences being noted between the diagnostic groups, nor consistently with pubertal status. CONCLUSIONS Australian GH guidelines have targeted very short children when compared to other series. This large cohort of non-GHD children has demonstrated short-term benefits of GH therapy; however, the long-term benefit remains unclear until these children reach final adult height.
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Affiliation(s)
- C T Cowell
- The Robert Vines Research Growth Centre, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
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Trainer PJ, Holly J, Medbak S, Rees LH, Besser GM. The effect of recombinant IGF-I on anterior pituitary function in healthy volunteers. Clin Endocrinol (Oxf) 1994; 41:801-7. [PMID: 7889617 DOI: 10.1111/j.1365-2265.1994.tb02796.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Insulin-like growth factor-I is the mediator of many of the actions of GH and is a potent metabolic regulator. Recombinant IGF-I (rhIGF-I) is of potential value in the treatment of syndromes associated with either GH or insulin resistance. This study was designed to assess the effects of subcutaneous (s.c.) rhIGF-I on anterior pituitary function. DESIGN Double-blind, placebo controlled, randomized cross-over study. The interval between investigations was 2 weeks. SUBJECTS Twelve normal volunteers received on one occasion a single s.c. dose of 40 micrograms/kg rhIGF-I and on the other, placebo. MEASUREMENTS Circulating levels were measured, over 24 hours, of GH, LH, FSH, PRL, TSH, cortisol, ACTH, glucose, IGF-I, IGF-II, insulin, C-peptides; IGF binding proteins by Western ligand blotting; total IGF bioactivity using FRTL-5 thyroid cells; and glucose by the glucose oxidase method. RESULTS Recombinant IGF-I increased AUC for plasma IGF-I, measured by radioimmunoassay (rhIGF-I mean 7065 +/- SEM 33 vs 3895 +/- 204 micrograms/l, P < 0.0001) and IGF bioactivity (22.5 +/- 3.4 vs 14.2 +/- 1.8 U/ml, P < 0.001) but plasma IGF-II fell (9308 +/- 403 vs 11052 +/- 451 micrograms/l, P < 0.0001). There was no biochemical or clinical evidence of hypoglycaemia and no difference in mean glucose levels. No difference existed in AUC for GH, LH, FSH, ACTH and cortisol between rhIGF-I and placebo; additionally, pulse number and amplitude for GH and LH were unaffected. TSH fell following rhIGF-I (33.0 +/- 3.36 vs 42.5 +/- 5.98 mU h/l, P = 0.01). Both mean plasma C-peptide (0.73 +/- 0.06 vs 0.91 +/- 0.05 nmol/l, P = 0.03), and insulin (10.81 +/- 1.02 vs 15.36 +/- 1.18 mU/l, P = 0.03) were lower following rhIGF-I. There was no change in IGFBPs. CONCLUSION A single injection of 40 micrograms/kg of subcutaneous rhIGF-I does not cause hypoglycaemia. IGF bioactivity was increased without inhibition of GH secretion. The only change observed in anterior pituitary function was a fall in plasma TSH.
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Affiliation(s)
- P J Trainer
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
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Zadik Z, Chalew S, Zung A, Landau H, Leiberman E, Koren R, Voet H, Hochberg Z, Kowarski A. Effect of long-term growth hormone therapy on bone age and pubertal maturation in boys with and without classic growth hormone deficiency. The journal The Journal of Pediatrics 1994. [DOI: 10.1016/s0022-3476(18)31671-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zadik Z, Chalew SA, Zung A, Lieberman E, Kowarski AA. Short stature: new challenges in growth hormone therapy. J Pediatr Endocrinol Metab 1993; 6:303-10. [PMID: 7920998 DOI: 10.1515/jpem.1993.6.3-4.303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Until recently, the limited supplies of pituitary derived growth hormone (GH) enabled us to treat only those patients who were classical GH deficient. With the unlimited supplies of recombinant GH available, there is no limitation to the number of patients we can treat. It becomes necessary, however, to select those patients who will most benefit from GH therapy. Our preliminary results demonstrate that the short-term growth response to growth hormone is not an all-or-none phenomenon. The lower the growth velocity and the growth hormone reserve, the better the growth response to therapy. On the other hand we do not recommend institution of GH therapy for children with a normal growth rate and a normal GH spontaneous secretion. In children with classical GH deficiency (GHD) and in children with a subnormal spontaneous secretion of GH (NSD) adult height prediction decreases when GH therapy is started at an age older than 12. We have found that GHD and NSD boys differ in their growth pattern. Pubertal maturation and bone age maturation progress more rapidly in NSD patients. Therefore special caution is needed in NSD patients older than 12 years. The older the patient and the longer the treatment period, the faster the pubertal process can advance. Further studies are needed before recommendations for therapy in non-classical GHD patients can be made. Until patients involved in clinical trials reach final height, recommendations for new indications cannot be made.
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Affiliation(s)
- Z Zadik
- Pediatric Endocrine Unit, Kaplan Hospital, Rehovot, Israel
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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
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Abstract
Growth during puberty does not appear to be the major determinate of final height in isolated GH deficient patients. Early diagnosis and commencement of therapy are probably the most important factors, as reflected by the correlation between final height and height at the onset of puberty. The cost effectiveness of increasing the dose of GH during puberty does not appear to represent any advantage from the data presently available. Indeed, such an approach may have a deleterious effect on final height by shortening the duration of pubertal maturation. Further prospective studies are required to demonstrate the effectiveness of manipulating the onset and duration of puberty using gonadotrophin releasing hormone analogues on final height in isolated GH deficiency.
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Price DA. Puberty in children with idiopathic growth hormone deficiency on growth hormone treatment: preliminary analysis of the data from the Kabi Pharmacia International Growth Study. ACTA PAEDIATRICA SCANDINAVICA. SUPPLEMENT 1991; 379:117-24; discussion 125. [PMID: 1815452 DOI: 10.1111/j.1651-2227.1991.tb12061.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In total, 524 children (335 boys, 189 girls) with idiopathic growth hormone deficiency (GHD) who had entered puberty after at least 1 year of growth hormone (GH) treatment were studied. Spontaneous onset of puberty occurred in 319 boys and 174 girls, and puberty was induced in 16 boys and 15 girls. Median chronological and bone ages at onset of spontaneous puberty were 14.8 and 13.4 years in boys, and 13.3 and 11.8 years in girls, respectively. Age at onset of spontaneous puberty was correlated to age at start of GH treatment. Puberty was induced at a median chronological age of 16.0 years in boys and 14.4 years in girls. Height velocity increased in the year before spontaneous puberty in boys and girls, and rose further to a maximum (median, 8.3 cm/year) in the first year of puberty in boys. In girls, the maximum height velocity occurred in the year before puberty (median, 6.5 cm/year). Height velocity increased in the year before spontaneous puberty in boys and girls, and rose further to a maximum (median, 8.3 cm/year) in the first year of puberty in boys. In girls, the maximum height velocity occurred in the year before puberty (median, 6.5 cm/year). Height velocity during the first year of puberty was inversely correlated to age at puberty onset (r = -0.56, p = 0.0001). After medical induction of puberty, height velocities in the first year of puberty were 5.4 and 3.4 cm/year for boys and girls, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D A Price
- Department of Child Health, University of Manchester, Royal Manchester Children's Hospital, UK
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