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Hokken-Koelega ACS, van der Steen M, Boguszewski MCS, Cianfarani S, Dahlgren J, Horikawa R, Mericq V, Rapaport R, Alherbish A, Braslavsky D, Charmandari E, Chernausek SD, Cutfield WS, Dauber A, Deeb A, Goedegebuure WJ, Hofman PL, Isganatis E, Jorge AA, Kanaka-Gantenbein C, Kashimada K, Khadilkar V, Luo XP, Mathai S, Nakano Y, Yau M. International Consensus Guideline on Small for Gestational Age (SGA): Etiology and Management from Infancy to Early Adulthood. Endocr Rev 2023; 44:539-565. [PMID: 36635911 PMCID: PMC10166266 DOI: 10.1210/endrev/bnad002] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/31/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
This International Consensus Guideline was developed by experts in the field of SGA of 10 pediatric endocrine societies worldwide. A consensus meeting was held and 1300 articles formed the basis for discussions. All experts voted about the strengths of the recommendations. The guideline gives new and clinically relevant insights into the etiology of short stature after SGA birth, including novel knowledge about (epi)genetic causes. Besides, it presents long-term consequences of SGA birth and new treatment options, including treatment with gonadotropin-releasing hormone agonist (GnRHa) in addition to growth hormone (GH) treatment, and the metabolic and cardiovascular health of young adults born SGA after cessation of childhood-GH-treatment in comparison with appropriate control groups. To diagnose SGA, accurate anthropometry and use of national growth charts are recommended. Follow-up in early life is warranted and neurodevelopment evaluation in those at risk. Excessive postnatal weight gain should be avoided, as this is associated with an unfavorable cardio-metabolic health profile in adulthood. Children born SGA with persistent short stature < -2.5 SDS at age 2 years or < -2 SDS at age of 3-4 years, should be referred for diagnostic work-up. In case of dysmorphic features, major malformations, microcephaly, developmental delay, intellectual disability and/or signs of skeletal dysplasia, genetic testing should be considered. Treatment with 0.033-0.067 mg GH/kg/day is recommended in case of persistent short stature at age of 3-4 years. Adding GnRHa treatment could be considered when short adult height is expected at pubertal onset. All young adults born SGA require counseling to adopt a healthy lifestyle.
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Affiliation(s)
- Anita C S Hokken-Koelega
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Stefano Cianfarani
- Department of Systems Medicine, University of Rome 'Tor Vergata', Children's Hospital, Rome, Italy.,Diabetology and Growth Disorders Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, the Sahlgrenska Academy, the University of Gothenburg and Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Veronica Mericq
- Institute of Maternal and Child Research, faculty of Medicine, University of Chile
| | - Robert Rapaport
- Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | | | - Debora Braslavsky
- Centro de Investigaciones Endocrinológicas "Dr. Cesar Bergadá" (CEDIE), División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece.,Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Steven D Chernausek
- Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Andrew Dauber
- Division of Endocrinology, Children's National Hospital, Washington, DC 20012, USA
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City and College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Wesley J Goedegebuure
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Alexander A Jorge
- Unidade de Endocrinologia Genética (LIM25) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | | | - Xiao-Ping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sarah Mathai
- Department of Pediatrics, Christian Medical College, Vellore, India
| | - Yuya Nakano
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Mabel Yau
- Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
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Non-Obese Type 2 Diabetes with a History of Being an Extremely Preterm Small-for-Gestational-Age Infant without Early Adiposity Rebound. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148560. [PMID: 35886410 PMCID: PMC9317845 DOI: 10.3390/ijerph19148560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Adiposity rebound (AR), which is defined as a situation in which the body mass index (BMI) starts to increase after infancy, is a predictive marker of future development of type 2 diabetes. The patient was a 20-year-old male. He was born at 28 gestational weeks with a birthweight of 642 g (−3.20 standard deviation, small-for-gestational age [SGA]). AR during early childhood or obesity in later childhood was not observed. At the onset of type 2 diabetes (20 years of age), his BMI, body fat percentage, and body fat mass were within normal ranges (20.4, 18.4% and 10.8 kg, respectively). However, his muscle mass was 44.7 kg, with low muscle mass of the trunk and upper limbs, which was lower than the standard reference, indicating that myogenic insulin resistance was involved in the development of non-obese type 2 diabetes. This case report describes a patient with no presentation of AR and obesity during childhood, who was born extremely preterm SGA, developed non-obese type 2 diabetes with low muscle mass. We suggest that patients born extremely preterm SGA should be carefully observed for the development of type 2 diabetes, even if they did not have AR in early childhood or had not become obese.
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López‐Siguero JP, Martínez‐Aedo MJ, Bermúdez de la Vega JA, Bosch‐Muñoz J, Lechuga‐Sancho AM, Villalobos T. Growth hormone treatment does not to lead to insulin resistance nor excessive rise in IGF-1 levels, while improving height in patients small for gestational age A long-term observational study. Clin Endocrinol (Oxf) 2022; 96:558-568. [PMID: 34882803 PMCID: PMC9299847 DOI: 10.1111/cen.14626] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE In children born small for gestational age (SGA), the relationship between growth hormone (GH) treatment and insulin resistance (IR) has only been investigated for a short period, necessitating a longer observation period. This study aimed to evaluate the long-term (10 years) effect of GH to SGA-children on IR and safety during treatment. DESIGN This was a multicenter observational study. PATIENTS SGA-children who received GH treatment in Spain (stratified by Tanner-stage and age at GH onset [two groups: ≤6 years old or >6 years old]). MEASUREMENTS The analysed variables (yearly measures) included auxologic, metabolic (insulin-like growth factor-1 (IGF-1), height velocity [HV], weight and homeostatic model assessment-IR [HOMA-IR]) and safety data. Data were collected prospectively (since the study approval: 2007) and retrospectively (since the initiation of GH treatment: 2005-2007). RESULTS A total of 389 SGA children (369 Tanner-I) were recruited from 27 centres. The mean age (standard deviation) of the children at GH treatment onset was 7.2 (2.8) years old. IGF-1 (standard deviation score [SDS]) and HOMA-IR values tended to increase until the sixth year of GH-treatment, with significant differences being observed only during the first year, while these remained stable in the later years (within normal ranges). Height (SDS) increased significantly (basal: -3.0; tenth year: -1.13), and the maximum HV (SDS) occurred during the first year (2.75 ± 2.39). CONCLUSIONS HOMA-IR values increased significantly in SGA-children during the first year of GH-treatment, remained stable and were within normal ranges in all cases. Our 10-year data suggests that long-term GH treatment does not promote IR and is well-tolerated, safe and effective.
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Affiliation(s)
- Juan P. López‐Siguero
- Paediatric Endocrinology UnitHospital Universitario Materno‐Infantil Carlos HayaMálagaSpain
| | - Maria J. Martínez‐Aedo
- Paediatric Endocrinology UnitHospital Universitario Materno‐Infantil Carlos HayaMálagaSpain
| | | | - Jordi Bosch‐Muñoz
- Endocrinology UnitHospital Universitario Arnau de VilanovaLleidaSpain
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Suzuki J, Urakami T, Morioka I. Greater insulin resistance in short children born small-for-gestational age than in children with growth hormone deficiency at the early period of growth hormone therapy. Pediatr Int 2021; 63:1180-1184. [PMID: 33453088 DOI: 10.1111/ped.14603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/06/2020] [Accepted: 01/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND We compared insulin resistance and glucose metabolism during growth hormone (GH) therapy between 43 short children born small-for-gestational age (SGA) and 42 children identify as growth hormone deficiency (GHD). METHODS The study compared fasting plasma glucose (FPG), fasting immunoreactive insulin (IRI) and homeostasis model assessment insulin resistance index (HOMA-IR) during 24-month GH therapy between the two groups. RESULTS Mean FPG, fasting IRI, and HOMA-IR values at 3-month GH therapy were significantly higher than those before and at 12- and 24-month GH therapy in both groups. These markers were significantly higher in short children born SGA than GHD children until 12-month GH therapy but were not different at 24-month GH therapy in both groups. CONCLUSIONS The increased secretion of insulin observed in short children born SGA might be a compensatory mechanism for the prevention of hyperglycemia that can progress to diabetes mellitus. However, these metabolic markers gradually declined after 3 months of GH therapy and returned to baseline values at 24 months. These results suggest that short children born SGA have greater insulin resistance than GHD children at the early period of GH therapy, however, increased insulin resistance is improved over a long period.
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Affiliation(s)
- Junichi Suzuki
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
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Mak D, Ryan KA, Han JC. Review of Insulin Resistance in Dilated Cardiomyopathy and Implications for the Pediatric Patient Short Title: Insulin Resistance DCM and Pediatrics. Front Pediatr 2021; 9:756593. [PMID: 34778146 PMCID: PMC8581153 DOI: 10.3389/fped.2021.756593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 01/07/2023] Open
Abstract
Energy metabolism in the heart is affected during states of dysfunction. Understanding how the heart utilizes substrates in cardiomyopathy may be key to the development of alternative treatment modalities. Myocardial insulin resistance has been proposed as a possible barrier to effective glucose metabolism in the heart. Extensive literature on the topic in adult individuals exists; however, review in the pediatric population is sparse. The pathophysiology of disease in children and adolescents is unique. The aim of this paper is to review the current knowledge on insulin resistance in dilated cardiomyopathy while also filling the gap when considering care in the pediatric population.
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Affiliation(s)
- Daniel Mak
- Division of Pediatric Endocrinology, Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Kaitlin A Ryan
- Division of Pediatric Cardiology, Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis, TN, United States
| | - Joan C Han
- Division of Pediatric Endocrinology, Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis, TN, United States
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Horikawa R, Tanaka T, Nishinaga H, Nishiba Y, Yokoya S. The long-term safety and effectiveness of growth hormone treatment in Japanese children with short stature born small for gestational age. Clin Pediatr Endocrinol 2020; 29:159-171. [PMID: 33088015 PMCID: PMC7534526 DOI: 10.1297/cpe.29.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/28/2020] [Indexed: 11/21/2022] Open
Abstract
This study aimed to characterize the safety and effectiveness of GH
treatments, in usual clinical practice, in children with short stature born small for
gestational age (SGA). This was a multicenter, open-label, non-interventional study
(NCT01110928) conducted at 150 sites in Japan (2009–2018). The
primary objective was to assess the type and frequency of serious adverse drug reactions
(SADRs) associated with long-term GH use. Overall, 452 naïve and 46 non-naïve (previously
treated) children were enrolled. GH treatment was well‑tolerated, with SADRs occurring in
1.3% (6/452) and 0% (0/46) of naïve and non-naïve children, respectively. No new safety
concerns or notable changes in glucose metabolism were identified during long-term
treatment. Altogether, 57 children (32 naïve and 25 non-naïve) reached near adult height
(NAH). In naïve and non-naïve children, mean ± standard deviation (SD) height standard
deviation score (SDS) at NAH were –2.03 ± 0.77 and –1.53 ± 0.81, respectively,
representing a change of +0.85 ± 0.72 and +1.24 ± 0.66 from baseline height SDS,
respectively. Mean treatment duration to NAH was 4.29 (naïve) and 7.26 (non-naïve) yr.
Thus, long-term GH treatment for short stature in children born SGA was confirmed to have
a good safety profile and was effective for improving adult height.
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Affiliation(s)
- Reiko Horikawa
- Department of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | | | | | | | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University, Fukushima, Japan
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Sydlik C, Weissenbacher C, Roeb J, Pozza SBD, Schmidt H. Evaluation of Changes in Insulin Sensitivity in Prepubertal Small for Gestational Age Children Treated with Growth Hormone. Indian J Endocrinol Metab 2019; 23:14-21. [PMID: 31016147 PMCID: PMC6446669 DOI: 10.4103/ijem.ijem_91_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although growth hormone (GH) therapy for children born small for gestational age (SGA) has been approved for many years, there are still concerns about increasing their risk for insulin resistance and diabetes mellitus type 2. Monitoring of glucose homeostasis is therefore generally recommended, but there is no consensus on either the methods or consequences. METHODS AND AIMS The aim of our study was to analyze the oral Glucose Tolerance Tests (oGTTs) which were performed yearly from baseline to 4 years of GH therapy in a collective of 93 SGA children, who were prepubertal during the whole follow-up. We looked for correlations with auxological and laboratory data as well as predictive baseline results for glucose homeostasis during further treatment. RESULTS While glucose levels remained constant, insulin secretion increased from baseline to the first year of GH therapy. Insulin sensitivity index (ISI) showed no significant change afterwards; HOMA1, HOMA2, and QUICKI stabilized after the second year. For all indices mean values never reached pathological levels and no cases of diabetes mellitus were induced. Higher gestational age, lower birth length, and older age at start of GH therapy were associated with lower insulin sensitivity. No predictive factors for later insulin resistance could be found. CONCLUSION As expected, in GH-treated prepubertal SGA children insulin resistance was induced, but not to pathological levels. No special risk factors for disturbed glucose homeostasis could be identified. Based on our opinion, performing oGTTs in GH-treated SGA children at baseline and in puberty should remain mandatory, but the current study recommendations regarding further surveillance of glucose homeostasis are questionable.
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Affiliation(s)
- Carmen Sydlik
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
| | - Claudia Weissenbacher
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
| | - Julia Roeb
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
| | - Susanne Bechtold-Dalla Pozza
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
| | - Heinrich Schmidt
- Department of Pediatric Endocrinology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilian-University of Munich, Lindwurmstr, Munich, Germany
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Yokoya S, Tanaka T, Itabashi K, Osada H, Hirai H, Seino Y. Efficacy and safety of growth hormone treatment in Japanese children with small-for-gestational-age short stature in accordance with Japanese guidelines. Clin Pediatr Endocrinol 2018; 27:225-234. [PMID: 30393439 PMCID: PMC6207802 DOI: 10.1297/cpe.27.225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022] Open
Abstract
The efficacy and safety of recombinant human GH (rhGH) treatment were assessed in
Japanese children with small-for-gestational-age short stature. A total of 88 patients
were enrolled in the comparative and extension studies. At the end of the comparative
study (24 mo), the mean height SD score for chronological age had significantly increased
in the 0.23 mg/kg/wk and 0.47 mg/kg/wk groups with increments of 0.84 ± 0.42 and 1.50 ±
0.44 SD, respectively. In the extension study, the dose could be increased based on the
pre-defined growth criteria. Increments in height SD scores over the 24 to 36 mo period at
doses of 0.23 mg/kg/wk, 0.23 to 0.47 mg/kg/wk, and 0.47 mg/kg/wk were 0.25 ± 0.28, 0.46 ±
0.21, and 0.28 ± 0.16 SD, respectively. The growth effect increased following dose
escalation even in the low responders in the initial 2-yr treatment at 0.23 mg/kg/wk,
indicating the effectiveness of dose escalation in accordance with the Japanese
guidelines. rhGH at 0.47 mg/kg/wk provided a greater degree of growth promotion after 24
mo. The safety profile appeared to be tolerable and was similar in all groups. Considering
the increased insulin resistance, the recommendations of the regulatory authorities should
be followed to minimize the risks of rhGH treatment.
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Affiliation(s)
- Susumu Yokoya
- National Center for Child Health and Development, Tokyo, Japan
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Tanaka T, Yokoya S, Hoshino Y, Hiro S, Ohki N. Long-term safety and efficacy of daily recombinant human growth hormone treatment in Japanese short children born small for gestational age: final report from an open and multi-center study. Clin Pediatr Endocrinol 2018; 27:145-157. [PMID: 30083031 PMCID: PMC6073065 DOI: 10.1297/cpe.27.145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/14/2018] [Indexed: 12/05/2022] Open
Abstract
Our study aimed at evaluating the safety and efficacy of GH treatment up to near adult height (NAH) for short children born small for gestational age (SGA). This was a multi-center, open-label, long-term extension study after a one-year, randomized, open-label, dose-response study. The primary objective was to assess safety, determined by adverse events and laboratory test parameters. Height parameters were evaluated as a secondary objective. The final data after all patients completed the study were reported. Overall, 61 patients were enrolled in the study. GH treatment was well tolerated. No notable changes in HbA1c levels, oral glucose tolerance tests and glucose metabolism were observed. No new safety concerns related to long-term treatment up to NAH were identified. Twenty patients (11 boys and 9 girls) reached NAH with a mean height of 159.1 cm and 146.9 cm, respectively. The mean change in height SDS from baseline to NAH was +1.9 in boys and +1.8 in girls. Long-term GH treatment for SGA short stature was confirmed to be safe and effective for the normalization of adult height.
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Affiliation(s)
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University, Fukushima, Japan
| | - Yuko Hoshino
- Clinical Research, Development Japan, Pfizer Japan Inc., Tokyo, Japan
| | - Shintaro Hiro
- Clinical Statistics, Development Japan, Pfizer Japan Inc., Tokyo, Japan
| | - Nobuhiko Ohki
- Medical Affairs, Rare Disease, Pfizer Japan Inc., Tokyo, Japan
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Kojima-Ishii K, Toda N, Okubo K, Tocan V, Ohyama N, Makimura M, Matsuo T, Ochiai M, Ohga S, Ihara K. Metabolic and immunological assessment of small-for-gestational-age children during one-year treatment with growth hormone: the clinical impact of apolipoproteins. Endocr J 2018; 65:449-459. [PMID: 29459555 DOI: 10.1507/endocrj.ej17-0485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Children born small for gestational age (SGA) are at a higher risk for metabolic disorders later in life. In this study, we aimed to characterize young SGA children without catch-up growth and evaluate the effects of GH treatment on endocrinological, metabolic, and immunological parameters. Study design is a one-year single hospital-based study included prospective observation of SGA patients during 12 months of GH treatment. Clinical and laboratory profiles of SGA children at baseline were compared with controls born appropriate size for age. Twenty-six SGA children (median age, 3.4 years) and 26 control children (median age, 3.8 years) were enrolled. Anthropometric, hematologic, biochemical, immunological, and endocrinological parameters were assessed at baseline and 1, 3, 6, 9, and 12 months after the start of GH treatment. As a result, median height SD score (SDS) of SGA children increased by +0.42 with 12-month GH treatment. Body mass index SDS was lower in SGA children than in controls. Serum apolipoprotein A1 increased, whereas apolipoprotein B decreased during GH treatment. Serum leptin and resistin levels, which were lower in SGA children than in controls at baseline, did not change remarkably with GH treatment. Monocyte counts, which were lower in SGA patients at baseline, increased after GH treatment. Neutrophil counts significantly increased after GH treatment. Natural killer cell ratios, which were higher in SGA patients, decreased after GH treatment. In conclusion, there was no evidence suggesting metabolic abnormalities in SGA children. Serum apolipoprotein changes might predict the beneficial role of GH treatment in lowering cardiometabolic risk.
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Affiliation(s)
- Kanako Kojima-Ishii
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Naoko Toda
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Kazuhiro Okubo
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Noriko Ohyama
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Mika Makimura
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka 802-0077, Japan
| | - Terumichi Matsuo
- Department of Pediatrics, National Hospital Organization Kyushu Medical Center, Fukuoka 810-8563, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Kenji Ihara
- Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan
- Department of Pediatrics, Faculty of Medicine, Oita University, Oita 879-5593, Japan
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Gómez-Guzmán E, Cañete MD, Valle-Martos R, Cañete R, Valle M, Jiménez-Reina L, Caballero-Villarraso J. Short-Term Evaluation of Left Ventricular Mass and Function in Children With Growth Hormone Deficiency After Replacement Treatment. Front Pediatr 2018; 6:174. [PMID: 29971224 PMCID: PMC6018080 DOI: 10.3389/fped.2018.00174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/29/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Our study was designed to assess the effects of GHD on nutritional and metabolic parameters, brain natriuretic peptide (BNP) levels, and left ventricular mass (LVM) in prepubertal children and after short-term GH replacement therapy. Materials and Methods: This prospective study enrolled 81 children. We compared 40 GHD children (16 males and 24 females) to 41 healthy children (control group) (18 males and 23 females). All subjects were at Tanner Stage I (aged 7-11 years). At the baseline, a blood sample was drawn and echocardiographic images were obtained. These tests were repeated on the GHD subjects after 6 months of GH replacement therapy. Body surface, weight, size, blood pressure, heart rate, glucose, insulin, HOMA-IR, HOMA-β, QUICKI, cholesterol, HDLc, LDLc, triglycerides, IGF1, and IGFBP3 were measured. Indexed LVM, diastolic and systolic diameter (dD-sD), diastolic and systolic LV function, isovolumic relaxation time, right ventricle function, and BNP levels were obtained through echocardiography. These parameters were correlated to growth factors. Data were analyzed using Student's t-test or U-Mann-Whitney-test and Pearson's correlation, considering p < 0.05 to be significant. Results: Indexed LVM was smaller in GHD patients than in controls, whereas diastolic and systolic functions, BNP, metabolic, and nutritional profiles were similar. After treatment, nutritional and metabolic profiles significantly improved, though diastolic and systolic functions did not seem to have changed. There was a significant increase in LVM. Indexed LVM was similar to that of controls. Significant correlations were obtained between LVM-IGF1 and sD-IGFBP3. Conclusions: GHD in childhood is associated with a lower indexed LVM. In the short-term, GH increases the indexed LVM, while maintaining normal systolic and diastolic functions, BNP, and an improved lipid profile.
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Affiliation(s)
- E Gómez-Guzmán
- Cardiology Unit, Hospital Reina Sofía de Córdoba, Cordova, Spain.,Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain
| | - M D Cañete
- Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain
| | | | - R Cañete
- Cardiology Unit, Hospital Reina Sofía de Córdoba, Cordova, Spain.,Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain
| | - M Valle
- Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain.,Clinical Analysis Services, Hospital Valle De Los Pedroches, Cordova, Spain
| | - L Jiménez-Reina
- Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain.,Facultad de Medicina y Enfermería, Universidad de Córdoba, Cordova, Spain
| | - J Caballero-Villarraso
- Instituto Maimonides de Investigación Biomédica de Cordoba, Cordova, Spain.,Clinical Analysis Services, Hospital Valle De Los Pedroches, Cordova, Spain
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Hirayama S, Nagasaka H, Nakagawa S, Takuwa M, Nakacho M, Yorifuji T, Kondou H, Tsukahara H, Morioka I, Ishida A, Yamato S, Miida T. Growth hormone activates hepatic and cerebral cholesterol metabolism in small-for-gestational age children without catch-up growth. J Clin Lipidol 2017; 11:1032-1042. [DOI: 10.1016/j.jacl.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/13/2017] [Accepted: 05/22/2017] [Indexed: 11/15/2022]
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