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Rapaport R, Wit JM, Savage MO. Growth failure: 'idiopathic' only after a detailed diagnostic evaluation. Endocr Connect 2021; 10:R125-R138. [PMID: 33543731 PMCID: PMC8052574 DOI: 10.1530/ec-20-0585] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/29/2021] [Indexed: 01/02/2023]
Abstract
The terms 'idiopathic short stature' (ISS) and 'small for gestational age' (SGA) were first used in the 1970s and 1980s. ISS described non-syndromic short children with undefined aetiology who did not have growth hormone (GH) deficiency, chromosomal defects, chronic illness, dysmorphic features or low birth weight. Despite originating in the pre-molecular era, ISS is still used as a diagnostic label today. The term 'SGA' was adopted by paediatric endocrinologists to describe children born with low birth weight and/or length, some of whom may experience lack of catch-up growth and present with short stature. GH treatment was approved by the FDA for short children born SGA in 2001, and by the EMA in 2003, and for the treatment of ISS in the US, but not Europe, in 2003. These approvals strengthened the terms 'SGA' and 'ISS' as clinical entities. While clinical and hormonal diagnostic techniques remain important, it is the emergence of genetic investigations that have led to numerous molecular discoveries in both ISS and SGA subjects. The primary message of this article is that the labels ISS and SGA are not definitive diagnoses. We propose that the three disciplines of clinical evaluation, hormonal investigation and genetic sequencing should have equal status in the hierarchy of short stature assessments and should complement each other to identify the true pathogenesis in poorly growing patients.
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Affiliation(s)
- Robert Rapaport
- Division of Pediatric Endocrinology & Diabetes, Mount Sinai Kravis Children’s Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jan M Wit
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin O Savage
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, London, UK
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Jung MH, Suh BK, Ko CW, Lee KH, Jin DK, Yoo HW, Hwang JS, Chung WY, Han HS, Prusty V, Kim HS. Efficacy and Safety Evaluation of Human Growth Hormone Therapy in Patients with Idiopathic Short Stature in Korea - A Randomised Controlled Trial. EUROPEAN ENDOCRINOLOGY 2020; 16:54-59. [PMID: 32595770 DOI: 10.17925/ee.2020.16.1.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND This trial evaluated the efficacy and safety of growth hormone (GH) therapy (Norditropin®; Novo Nordisk, Bagsværd, Denmark) in paediatric patients with idiopathic short stature (ISS) in Korea. METHODS This was an open-label, parallel-group, multicentre, interventional trial (ClinicalTrials.gov identifier: NCT01778023). Pre-pubertal patients (mean age 6.2 years; height, 107.1 cm) were randomised 2:1 to 12 months' GH treatment (0.469 mg/kg/week; group A, n=36) or 6 months untreated followed by 6 months' GH treatment (group B, n=18). Safety analysis was based on adverse events (AEs) in all GH-treated patients. RESULTS After 6 months, height velocity (Ht-V), change in both height standard deviation score (Ht-SDS) and insulin-like growth factor 1 (mean difference [95% confidence interval {CI}]: 5.15 cm/year [4.09, 6.21]; 0.57 [0.43, 0.71]; 164.56 ng/mL [112.04, 217.08], respectively; all p<0.0001) were greater in group A than in group B. Mean difference in Ht-V for 0-6 months versus 6-12 months was 2.80 cm/year (95% CI 1.55, 4.04) for group A and -4.60 cm/year (95% CI -6.12, -3.09; both p<0.0001) for group B. No unexpected AEs were reported. CONCLUSIONS During the first 6 months, height was significantly increased in GH-treated patients versus untreated patients with ISS. Safety of GH was consistent with the known safety profile.
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Affiliation(s)
- Min Ho Jung
- The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Byung-Kyu Suh
- The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Cheol Woo Ko
- Kyungpook National University Hospital, Daegu, South Korea
| | | | - Dong-Kyu Jin
- Samsung Medical Center, Sung Kyun Kwan University, Seoul, South Korea
| | | | | | | | - Heon-Seok Han
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Vinay Prusty
- Novo Nordisk Pharma Gulf FZ-LLC, Dubai, United Arab Emirates
| | - Ho-Seong Kim
- Severance Hospital, Yonsei University Health System, Seoul, South Korea
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Rapaport R, Lee P, Ross J, Saenger P, Ostrow V, Piccoli G. Growth hormone therapy in children born small for gestational age: results from the ANSWER program. Endocr Connect 2018; 7:EC-18-0286. [PMID: 30139820 PMCID: PMC6198185 DOI: 10.1530/ec-18-0286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/23/2018] [Indexed: 11/18/2022]
Abstract
Growth hormone (GH) is used to treat short stature and growth failure associated with growth disorders. Birth size and GH status variably modulate response to GH therapy. The aim of this study was to determine the effect of birth size on response to GH therapy, and to determine the impact of GH status in patients born small for gestational age (SGA) on response to GH therapy. Data from the prospective, non-interventional American Norditropin® Studies: Web-Enabled Research (ANSWER) Program were analyzed for several growth outcomes in response to GH therapy over 3 years. GH-naïve children from the ANSWER Program were included in this analysis: SGA with peak GH ≥10 ng/mL (20 mIU/l), SGA with peak GH <10 ng/mL (20 mIU/l), isolated growth hormone deficiency (IGHD) born SGA, IGHD not born SGA, and idiopathic short stature. For patients with IGHD, those who did not meet criteria for SGA at birth showed greater improvements in height SDS and BMI SDS than patients with IGHD who met criteria for SGA at birth. For patients born SGA, response to GH therapy varied with GH status. Therefore, unlike previous guidelines, we recommend that GH status be established in patients born SGA to optimize GH therapy.
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Affiliation(s)
- Robert Rapaport
- R Rapaport, PEDIATRIC ENDOCRINOLOGY, MOUNT SINAI SCHOOL OF MEDICINE, NEW YORK, 10029, United States
| | - Peter Lee
- P Lee, Penn State College of Medicine, Hershey, United States
| | - Judith Ross
- J Ross, Thomas Jefferson University, Philadelphia, United States
| | - Paul Saenger
- P Saenger, NYU Winthrop Hospital, Mineola, United States
| | - Vlady Ostrow
- V Ostrow, Novo Nordisk Inc, Plainsboro, United States
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Wit JM, van Duyvenvoorde HA, van Klinken JB, Caliebe J, Bosch CA, Lui JC, Gijsbers AC, Bakker E, Breuning MH, Oostdijk W, Losekoot M, Baron J, Binder G, Ranke MB, Ruivenkamp CA. Copy number variants in short children born small for gestational age. Horm Res Paediatr 2014; 82:310-8. [PMID: 25300501 PMCID: PMC4236248 DOI: 10.1159/000367712] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/18/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/AIMS In addition to genome-wide association studies (GWAS), height-associated genes may be uncovered by studying individuals with extreme short or tall stature. METHODS Genome-wide analysis for copy number variants (CNVs), using single nucleotide polymorphism (SNP) arrays, was performed in 49 index cases born small for gestational age with persistent short stature. Segregation analysis was performed, and genes in CNVs were compared with information from GWAS, gene expression in rodents' growth plates, and published information. RESULTS CNVs were detected in 13 cases. In 5 children a known cause of short stature was found: UPD7, UPD14, a duplication of the SHOX enhancer region, an IGF1R deletion, and a 22q11.21 deletion. In the remaining 8 cases, potential pathogenic CNVs were detected, either de novo (n = 1), segregating (n = 2), or not segregating with short stature (n = 5). Bioinformatic analysis of the de novo and segregating CNVs suggested that HOXD4, AGPS, PDE11A, OSBPL6, PRKRA and PLEKHA3, and possibly DGKB and TNFRSF11B are potential candidate genes. A SERPINA7 or NRK defect may be associated with an X-linked form of short stature. CONCLUSION SNP arrays detected 5 known causes of short stature with prenatal onset and suggested several potential candidate genes.
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Affiliation(s)
- Jan M. Wit
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jan B. van Klinken
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Janina Caliebe
- Paediatric Endocrinology Section, Children’s Hospital, University of Tübingen, Tübingen, Germany
| | - Cathy A.J. Bosch
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Julian C. Lui
- Section on Growth and Development, National Institutes of Health, Bethesda, MD, USA
| | - Antoinet C.J. Gijsbers
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Egbert Bakker
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn H. Breuning
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma Oostdijk
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Losekoot
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeffrey Baron
- Section on Growth and Development, National Institutes of Health, Bethesda, MD, USA
| | - Gerhard Binder
- Paediatric Endocrinology Section, Children’s Hospital, University of Tübingen, Tübingen, Germany
| | - Michael B. Ranke
- Paediatric Endocrinology Section, Children’s Hospital, University of Tübingen, Tübingen, Germany
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Meazza C, Pagani S, Pietra B, Tinelli C, Calcaterra V, Bozzola E, Bozzola M. Different long-term response to growth hormone therapy in small- versus appropriate-for-gestational-age children with growth hormone deficiency. Horm Res Paediatr 2013; 79:214-9. [PMID: 23635718 DOI: 10.1159/000350239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/20/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The role of birth weight on growth hormone (GH) therapy response in GH-deficient (GHD) children has not been fully elucidated. Therefore, we examined the growth of 23 small-for-gestational-age GHD children (SGA-GHD, 11 females and 12 males), 26 appropriate-for-gestational-age GHD children (AGA-GHD, 11 females and 15 males) during the first 5 years of GH therapy and that of 22 non-GH-treated SGA children (12 females and 10 males). METHODS We collected height and height velocity measurements yearly. RESULTS In AGA-GHD children, height was always greater than in the SGA groups and significantly increased from the fourth year of treatment. Height velocity was higher (SGA-GHD: 1.72 ± 0.30 standard deviation score, SDS, AGA-GHD: 2.67 ± 0.21 SDS; p = 0.039) in AGA-GHD children during the first year of treatment. The AGA-GHD group showed the highest percentage (52.4%) of subjects surpassing mid-parental height and the greatest height gain after 5 years of follow-up. CONCLUSION Our results show that birth size is an important factor affecting the response to GH therapy in GHD children during the first 5 years of treatment. The paediatric endocrinologist should be aware of this factor when planning the management of GHD children born SGA.
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Affiliation(s)
- Cristina Meazza
- Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Centro di Ricerca di Auxologia, Pavia, Italy
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Ranke MB, Lindberg A, Mullis PE, Geffner ME, Tanaka T, Cutfield WS, Tauber M, Dunger D. Towards optimal treatment with growth hormone in short children and adolescents: evidence and theses. Horm Res Paediatr 2013; 79:51-67. [PMID: 23446062 DOI: 10.1159/000347121] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/15/2013] [Indexed: 11/19/2022] Open
Abstract
Treatment with growth hormone (GH) has become standard practice for replacement in GH-deficient children or pharmacotherapy in a variety of disorders with short stature. However, even today, the reported adult heights achieved often remain below the normal range. In addition, the treatment is expensive and may be associated with long-term risks. Thus, a discussion of the factors relevant for achieving an optimal individual outcome in terms of growth, costs, and risks is required. In the present review, the heterogenous approaches of treatment with GH are discussed, considering the parameters available for an evaluation of the short- and long-term outcomes at different stages of treatment. This discourse introduces the potential of the newly emerging prediction algorithms in comparison to other more conventional approaches for the planning and evaluation of the response to GH. In rare disorders such as those with short stature, treatment decisions cannot easily be deduced from personal experience. An interactive approach utilizing the derived experience from large cohorts for the evaluation of the individual patient and the required decision-making may facilitate the use of GH. Such an approach should also lead to avoiding unnecessary long-term treatment in unresponsive individuals.
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Affiliation(s)
- Michael B Ranke
- Paediatric Endocrinology Section, Children's Hospital, University of Tuebingen, Tuebingen, Germany.
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