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Tidblad A, Sävendahl L. Childhood growth hormone treatment: challenges, opportunities, and considerations. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:600-610. [PMID: 38945136 DOI: 10.1016/s2352-4642(24)00127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 07/02/2024]
Abstract
With long standing demand and popularity, growth hormone treatments continue to be a topic of interest for paediatric endocrinologists and general paediatricians due to ongoing issues regarding their long-term effects, the safety of childhood treatment, and the introduction of long-acting growth hormone preparations in the past decade. Moreover, uncertainty regarding how to approach individual patients and their treatment indications remains, particularly concerning tailored treatment goals and objectives; this uncertainty is further complicated by the multitude of approved indications that surpass substitution therapy. The paediatric endocrinologist thus grapples with pertinent questions, such as what defines reasonable treatment goals for each individual given their indications, and when (and how) to initiate the necessary discussions about risks and benefits with patients and their families. The aim of this Review is to offer advanced physiological concepts of growth hormone function, map out approved paediatric indications for treatment along with evidence on their effects and safety, highlight controversies and complexities surrounding childhood growth hormone treatment, and discuss the potential of long-acting growth hormone and future directions in the realm of childhood growth hormone treatment.
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Affiliation(s)
- Anders Tidblad
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Division of Paediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
| | - Lars Sävendahl
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Division of Paediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
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Punt LD, van der Kaay DCM, van Setten PA, de Groote K, Kruijsen AR, Bocca G, de Munnik SA, Renes JS, de Bruin C, Losekoot M, van Duyvenvoorde HA, Wit JM, Joustra SD. IGF1 Haploinsufficiency: Phenotype and Response to Growth Hormone Treatment in 9 Patients. Horm Res Paediatr 2024:1-11. [PMID: 38952118 DOI: 10.1159/000540053] [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: 04/12/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION The clinical features of bi-allelic IGF1 defects are well established, i.e., severe growth failure and microcephaly, delayed psychomotor development, and sensorineural deafness. However, information on clinical and endocrine consequences of heterozygous IGF1 variants and treatment options is scarce. We aimed at extending the knowledge base of the clinical presentation and growth response to recombinant human growth hormone (rhGH) of patients carrying such variants. METHODS Retrospective case series of patients with pathogenic heterozygous IGF1 variants. RESULTS Nine patients from six families were included, harbouring five whole or partial gene deletions and one frameshift variant resulting in a premature stop codon (three de novo, one unknown inheritance). In the other two families, variants segregated with short stature. Mean (SD) birth length was -1.9 (1.3) SDS (n = 7), height -3.8 (0.6) SDS, head circumference -2.5 (0.6) SDS, serum IGF-I -1.9 (0.7) SDS, serum IGFBP-3 1.1 (0.4) SDS (n = 7), and GH peak range 5-31 μg/L (n = 4). Five patients showed feeding problems in infancy. Average height increased after 1 and 2 years of rhGH treatment by 0.8 SDS (range 0.3-1.3 SDS) and 1.3 SDS (range 0.5-2.0 SDS), respectively. Adult height in 2 patients was -2.8 and -1.3 SDS, which was, respectively, 1.3 and 2.9 SDS taller than predicted before start of treatment. CONCLUSION Haploinsufficiency of IGF1 causes a variable phenotype of prenatal and postnatal growth failure, microcephaly, feeding difficulties, low/low-normal serum IGF-I values in contrast to serum IGFBP-3 in the upper-normal range. Treatment with rhGH increased growth in the first 2 years of treatment, and in 2 patients adult height after treatment was higher than predicted at treatment initiation.
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Affiliation(s)
- Lauren D Punt
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Daniëlle C M van der Kaay
- Division of Paediatric Endocrinology, Department of Paediatrics, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Petra A van Setten
- Department of Paediatrics, Amalia Childrens Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kirsten de Groote
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anne R Kruijsen
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gianni Bocca
- Division of Paediatric Endocrinology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sonja A de Munnik
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Judith S Renes
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
- Department of Paediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Christiaan de Bruin
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Monique Losekoot
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Jan M Wit
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sjoerd D Joustra
- Division of Paediatric Endocrinology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
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Ferrigno R, Savanelli MC, Cioffi D, Pellino V, Klain A. Auxological and metabolic effects of long-term treatment with recombinant growth hormone in children born small for gestational age: a retrospective study. Endocrine 2024; 84:213-222. [PMID: 38214878 DOI: 10.1007/s12020-023-03665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024]
Abstract
RATIONALE Children born small for gestational age (SGA) not showing catch-up during the first two years of life reportedly show an impaired growth rate and adult height, as well as a worse metabolic outcome, mainly in terms of glycemic and lipid profile, compared to general population. In SGA children with short stature, treatment with recombinant growth hormone (GH) is currently recommended until adolescence; therefore, it may last long-term. STUDY METHODS The aim of the current study was to evaluate the auxological and metabolic effects and the safety of long-term recombinant GH treatment in SGA children. The study included 15 SGA children (5 F, 10 M; mean age: 6.78 yrs) treated with GH for at least 48 months. Growth and metabolic parameters, including glycemic and lipid profile, transaminases, and urycemia, were collected every six months. RESULTS Compared to baseline, SGA children showed a significant improvement in height, weight, and growth rate after four yaers of treatment with GH (p ≤ 0.002), being already evident after six months of treatment (p < 0.001). Noteworthy, patients showed a constant, significant improvement in height throughout the treatment, as it was significantly higher at each follow-up compared to the previous one, until 42 months of treatment, except at 30 months of treatment (p < 0.001 T6VST12; p < 0.01 T12VST18, T18VST24; p < 0.05 T30VST36, T36VST42). Considering metabolic parameters, compared to baseline, a recurring increase in glycemia (p ≤ 0.028 vs T30, T36, and T48) and decrease in AST (p ≤ 0.035 vs T36, T42, and T48) and an occasional decrease in LDL cholesterol (p ≤ 0.04 vs T24 and T42) and triglycerides (p = 0.008 vs T18) and increase in urycemia (p = 0.034 vs T42). Considering safety profile, treatment was well tolerated, as the most frequently reported adverse event was poor compliance (20%); no hyperglycemia, hypercholesterolemia or hyperstransaminasemia occurred throughout the treatment, CONCLUSIONS: Long-term GH treatment showed to be effective in improving height and growth rate in SGA children, with a positive impact of metabolic profile and a safety profile, although glycemia should be carefully monitored over time.
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Affiliation(s)
- Rosario Ferrigno
- UOSD di Auxologia ed Endocrinologia, AORN Santobono-Pausilipon, Napoli, Italy.
| | | | - Daniela Cioffi
- UOSD di Auxologia ed Endocrinologia, AORN Santobono-Pausilipon, Napoli, Italy
| | - Valeria Pellino
- UOSD di Auxologia ed Endocrinologia, AORN Santobono-Pausilipon, Napoli, Italy
| | - Antonella Klain
- UOSD di Auxologia ed Endocrinologia, AORN Santobono-Pausilipon, Napoli, Italy
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Grimberg A, Hawkes CP. Growth Hormone Treatment for Non-GHD Disorders: Excitement Tempered by Biology. J Clin Endocrinol Metab 2024; 109:e442-e454. [PMID: 37450564 PMCID: PMC10795916 DOI: 10.1210/clinem/dgad417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
The success of growth hormone (GH) replacement in children with classical GH deficiency has led to excitement that other causes of short stature may benefit similarly. However, clinical experience has shown less consistent and generally less dramatic effects on adult height, perhaps not surprising in light of increased understanding of GH and growth plate biology. Nonetheless, clinical demand for GH treatment continues to grow. Upon the 20th anniversary of the US Food and Drug Administration's approval of GH treatment for idiopathic short stature, this review will consider the factors underlying the expansion of GH treatment, the biological mechanisms of GH action, the non-GH-deficient uses of GH as a height-promoting agent, biological constraints to GH action, and future directions.
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Affiliation(s)
- Adda Grimberg
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- INFANT Research Centre, University College Cork, Cork T12 DC4A, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork T12 R229, Ireland
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Becker M, Thomas M, Brachet C, Heinrichs C, Dotremont H, De Schepper J, Lysy P, Beckers D. Growth response of syndromic versus non-syndromic children born small for gestational age (SGA) to growth hormone therapy: a Belgian study. Front Endocrinol (Lausanne) 2023; 14:1112938. [PMID: 37334282 PMCID: PMC10272785 DOI: 10.3389/fendo.2023.1112938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/27/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction A substantial proportion of SGA patients present with a syndrome underlying their growth restriction. Most SGA cohorts comprise both syndromic and non-syndromic patients impeding delineation of the recombinant human growth hormone (rhGH) response. We present a detailed characterization of a SGA cohort and analyze rhGH response based on adult height (AH). Methods Clinical and auxological data of SGA patients treated with rhGH, who had reached AH, were retrieved from BELGROW, a national database of all rhGH treated patients held by BESPEED (BElgian Society for PEdiatric Endocrinology and Diabetology). SGA patients were categorized in syndromic or non-syndromic patients. Results 272 patients were included, 42 classified as syndromic (most frequent diagnosis (n=6): fetal alcohol syndrome and Silver-Russell syndrome). Compared with non-syndromic patients, syndromic were younger [years (median (P10/P90)] 7.43 (4.3/12.37) vs 10.21 (5.43/14.03), p=0.0005), shorter (height SDS -3.39 (-5.6/-2.62) vs -3.07 (-3.74/-2.62), p=0.0253) and thinner (BMI -1.70 (-3.67/0.04) vs -1.14 (-2.47/0.27) SDS, p=0.0054) at start of rhGH treatment. First year rhGH response was comparable (delta height SDS +0.54 (0.24/0.94) vs +0.56 (0.26/0.92), p=0.94). Growth pattern differed with syndromic patients having a higher prepubertal (SDS +1.26 vs +0.83, p=0.0048), but a lower pubertal height gain compared to the non-syndromic group (SDS -0.28 vs 0.44, p=0.0001). Mean rhGH dose was higher in syndromic SGA patients (mg/kg body weight/day 0.047 (0.039/0.064) vs 0.043 (0.035/0.056), p=0.0042). AH SDS was lower in syndromic SGA patients (-2.59 (-4.99/-1.57) vs -2.32 (-3.3/-1.2), p=0.0107). The majority in both groups remained short (<-2 SDS: syndromic 71%, non-syndromic 63%). Total height gain was comparable in both groups (delta height SDS +0.76 (-0.70/1.48) vs +0.86 (-0.12/1.86), p=0.41). Conclusions Compared to non-syndromic SGA patients, syndromic SGA patients were shorter when starting rhGH therapy, started rhGH therapy earlier, and received a higher dose of rhGH. At AH, syndromic SGA patients were shorter than non-syndromic ones, but their height gain under rhGH therapy was comparable.
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Affiliation(s)
- Marianne Becker
- Department of Pediatric Endocrinology and Diabetology, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Muriel Thomas
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
| | - Cécile Brachet
- Pediatric Endocrinology Unit, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Claudine Heinrichs
- Pediatric Endocrinology Unit, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Hilde Dotremont
- Department of Pediatric Endocrinology and Diabetology, University Hospital Antwerp, Edegem, Belgium
| | | | - Philippe Lysy
- Department of Pediatric Endocrinology and Diabetology, UCLouvain, Brussels, Belgium
| | - Dominique Beckers
- Department of Pediatric Endocrinology and Diabetology, UCLouvain, CHU UCL Namur, Yvoir, Belgium
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Coutant R, Leheup B, Nicolino M, Salles JP. Growth Hormone Dose Modulation and Final Height in Short Children Born Small for Gestational Age: French Real-Life Data. Horm Res Paediatr 2023; 96:495-508. [PMID: 37040726 PMCID: PMC10614259 DOI: 10.1159/000530572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 03/16/2023] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Growth hormone (GH) therapy improves height outcomes in short children born small for gestational age (SGA); however, real-world data on long-term GH exposure are few. METHODS We report results from an observational study (NCT01578135) including children born SGA, treated with GH at 126 sites in France, and followed up for >5 years until achieving final adult height (FAH) or until study termination. Primary endpoints were the proportion of patients with normal (>-2) height standard deviation score (SDS) at the last visit and with normal FAH SDS. Post hoc analyses were performed by multivariate logistic regression analysis with stepwise elimination to identify factors associated with GH dose modulation and normal height SDS achievement. RESULTS Of 1,408 registered patients, a representative sample (n = 291) was selected for long-term follow-up. At the last visit, 193/291 (66.3%) children achieved normal height SDS and 72/291 (24.7%) reached FAH. FAH SDS was >-2 for chronological age in 48 (66.7%) children and >-2 for adult age in 40 (55.6%) children. In the post hoc analyses, height SDS at the last visit was a significant determinant of whether GH dose had been modulated. Factors significantly associated with reaching normal height SDS were baseline height SDS (taller, better), age at treatment start (younger, better), treatment duration excluding discontinuation periods (longer, better), and absence of a chronic disease. Most (70%) adverse events were non-serious, with 39% considered possibly/probably related to GH treatment. CONCLUSIONS GH therapy was fairly effective in most short children born SGA. No new safety concerns were identified.
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Affiliation(s)
- Régis Coutant
- Department of Paediatric Medicine, University Hospital Angers, Angers, France
| | - Bruno Leheup
- Department of Clinical Genetics and Infant Medicine, Medical School and University Hospital of the University of Lorraine, Nancy, France
| | - Marc Nicolino
- Division of Pediatric Endocrinology and Metabolism, Lyon University Pediatric Hospital, Lyon, France
| | - Jean-Pierre Salles
- Pediatric and Adult Congenital Cardiology Unit, Children’s Hospital, Toulouse University Hospital, Toulouse, France
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Rodrígez JMR, Toda LI, López ID, Muñoz JB, Fresno LS, Hernández EF, de Arriba Muñoz A. Adult height and health-related quality of life in patients born small for gestational age treated with recombinant growth hormone. Sci Rep 2023; 13:3135. [PMID: 36823445 PMCID: PMC9950462 DOI: 10.1038/s41598-023-30281-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Health related quality of life (HRQoL) is a relevant result when assessing the course of different pathologies and the efficacy of their treatments. HRQoL has been studied previously on adults born small for gestational age (SGA), both in the general population and in patients who had received recombinant human growth hormone (rhGH) treatment, with disparate results. Our study included 50 adults who had received rhGH treatment for the SGA indication in 4 Spanish hospitals. Data have been gathered retrospectively from their clinical records, current weight and height were measured, and patients have been asked to fill out SF-36 and QoLAGHDA quality of life forms, and the Graffar test to evaluate their socio-economical status. Patient's adult height was - 1.2 ± 0.9 SD, lower than their target height of 1 ± 0.8 SD, but gaining 1.7 ± 1 SD from the beginning of the treatment. SF-36 test results showed lower scoring on Mental Health domains than on those related to Physical Health. No correlation was found between HRQoL results and final height, rhGH treatment duration or puberty. Correlation was indeed found between QoLAGHDA and several domains of SF-36, but QoLAGHDA detected fewer patients with low HRQoL than SF-36. Thus, it is concluded that SGA patient's follow-up should include a HRQoL, neuro-cognitive and psychiatric assessment in their transition to adult age. Adult SGA patients without catch up growth have impaired HRQoL, especially in mental health domains.
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Affiliation(s)
| | | | - Ignacio Díez López
- Pediatric Endocrinology Unit, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
| | - Jordi Bosch Muñoz
- Pediatric Endocrinology Unit, Arnau de Vilanova Hospital, Lleida, Spain
| | | | | | - Antonio de Arriba Muñoz
- Pediatric Endocrinology Unit, Miguel Servet Hospital, Av Isabel La Católica 1-3, 50009, Zaragoza, Spain.
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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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Juul A, Backeljauw P, Cappa M, Pietropoli A, Kelepouris N, Linglart A, Pfäffle R, Geffner M. Early Growth Hormone Initiation Leads to Favorable Long-Term Growth Outcomes in Children Born Small for Gestational Age. J Clin Endocrinol Metab 2022; 108:1043-1052. [PMID: 36469726 PMCID: PMC10099159 DOI: 10.1210/clinem/dgac694] [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: 09/30/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Early initiation of growth hormone (GH) therapy is recommended for short children born small for gestational age (SGA); however, real-world data indicate that treatment is often delayed. OBJECTIVE To assess the impact of patient age at GH therapy initiation on long-term growth outcomes and safety in short children born SGA. METHODS Analysis of pooled data from NordiNet® International Outcome Study (NCT00960128; 469 European clinics) and the ANSWER Program (NCT01009905; 207 US clinics), two large, complementary observational studies. Patients received GH as prescribed by their treating physician. Enrolled patients born SGA were categorized into three groups based on their age at GH treatment initiation: 2-<4 years, 4-<6 years, and ≥6 years. Patient characteristics at birth and GH initiation, auxology, and safety data were evaluated. RESULTS The effectiveness analysis (treatment-naïve and prepubertal patients at GH initiation) included 3,318 patients: 10.7% aged 2-<4 years at therapy initiation, 31.6% aged 4-<6 years, and 57.7% aged ≥6 years. Following 8 years of therapy, the mean improvement in height standard deviation score from baseline was significantly greater in the 2-<4 years group vs the 4-<6 years (+2.5 vs +2.2; P = 0.0054) and ≥6 years groups (+2.5 vs +1.7; P < 0.0001). No unexpected safety events were reported. CONCLUSION Early initiation of GH therapy in short children born SGA may be an important contributor to height optimization. The data are reassuring regarding the long-term safety of GH therapy in this population.
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Affiliation(s)
- Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Philippe Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marco Cappa
- Unit of Endocrinology, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Alberto Pietropoli
- Novo Nordisk Health Care AG, Global Medical Affairs Biopharm, Zürich, Switzerland
| | - Nicky Kelepouris
- Novo Nordisk Inc., Clinical, Medical and Regulatory Biopharm-RED, Plainsboro, NJ, USA
| | - Agnes Linglart
- AP-HP, Paris Saclay University, INSERM, Physiologie et Physiopathologie Endocriniennes, Endocrinology and Diabetology for Children, Bicêtre Paris Saclay Hospital, Le Kremlin-Bicetre, France
| | - Roland Pfäffle
- University of Leipzig, Medical Faculty, University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstr.19, Leipzig, Germany
| | - Mitchell Geffner
- The Saban Research Institute and the Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, CA, USA
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10
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Al Khalifah RA, Alhakami A, AlRuthia Y, Al Sarraj HZ, Abulqasim J, Al-Rasheedi A, NurHussen A, Naji A. The long-term growth, cost-effectiveness, and glycemic effects of growth hormone therapy on children born small for gestational age over 10 years: a retrospective cohort study. J Pediatr Endocrinol Metab 2022; 35:1357-1368. [PMID: 36203313 DOI: 10.1515/jpem-2022-0379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to report our 10-year experience of treating short children born small for gestational age (SGA) by comparing the long-term growth, metabolic safety, and cost-effectiveness of recombinant human growth hormone (rhGH) therapy in short children born SGA with those in rhGH-treated children with growth hormone deficiency (GHD) and Turner syndrome. METHODS We performed a 10-year retrospective cohort study at King Saud University Medical City. We included children aged 3-16 years who received rhGH for GHD, SGA, or Turner syndrome for >1 year. RESULTS A total of 166 children received rhGH therapy for GHD, 58 for SGA, and 16 for Turner syndrome. During the last study visit, the average height change was 21 cm for GHD children and 14 cm for children born SGA (p-value <0.001). The height SDS change was 0.84 for GHD children and 0.55 for SGA children (p-value=0.004). The average cost-effectiveness ratios for treating GHD and SGA children were USD 1,717.22 and USD 1,157.19 per centimeter gained, respectively. Moreover, the mean incremental cost-effectiveness ratio for GHD vs. SGA patients was USD 2,820.39 per centimeter gained. Dysglycemia developed in 70 patients: 43 (36.44%), 22 (40.74%), and 5 (13%) in the GHD, SGA, and Turner syndrome groups, respectively. CONCLUSIONS rhGH is effective in height improvement of short children. However, pursuing rhGH treatment for children born SGA requires a shared decision-making approach to balance the modest benefit of final adult height gain with the long-term metabolic effects, considering the acceptable costs on the Saudi healthcare system.
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Affiliation(s)
- Reem Abdullah Al Khalifah
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amal Alhakami
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Division, Department of Clinical Science, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hadeel Zohair Al Sarraj
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Endocrinology Division, Department of Pediatrics, Ad Diriyah Hospital, Riyadh Third Health Cluster, Riyadh, Saudi Arabia
| | - Jumana Abulqasim
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ameinah Al-Rasheedi
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pediatrics, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Akram NurHussen
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ammar Naji
- Pediatric Endocrine Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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11
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Response to Treatment with Recombinant Human Growth Hormone (rhGH) of Short Stature Children Born Too Small for Gestational Age (SGA) in Selected Centres in Poland. J Clin Med 2022; 11:jcm11113096. [PMID: 35683483 PMCID: PMC9181578 DOI: 10.3390/jcm11113096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Short stature resulting from SGA is an obligatory indication for treatment with rhGH. The aim of the study was to assess the response to rhGH treatment in patients treated in the years 2016−2020 in six clinical centers in Poland. During the analysis, auxological data were collected, and anthropometrical parameters (Ht, SDS Ht, HV and ΔHV) were reassessed. Subgroups of patients with dysmorphic features (DYSM), fetal alcohol syndrome (FAS) and Silver-Russel syndrome (SRS) were selected. The study group consisted of 235 children (137 boys). The medium initial age was 9.08 years, and 190 patients were in the prepubertal stage. The poor response to treatment was defined as ΔHt SDS < 0.3 and/or ΔHV < 3 cm/year. Seventeen per cent of all patients after the first year and 44% after the second year met the ΔHt SDS < 0.3 criterion, and 56% during the first and 73% during the second year met the ΔHV < 3 cm/year criterion. Our data suggest that patients with SRS may show the best response to treatment, which was sustained throughout the follow-up period. The best response in all subgroups was observed during the first 12 months of therapy. Although the proportion of patients meeting the poor response criteria was high, only a few patients exceeded the 97th percentile for IGF-1 concentration during the first year of treatment. This might suggest that increasing the dose of rhGH in the second treatment year in order to sustain accelerated HV would be safe in these patients.
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12
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Lee HS, Kum CD, Rho JG, Hwang JS. Long-term effectiveness of growth hormone therapy in children born small for gestational age: An analysis of LG growth study data. PLoS One 2022; 17:e0266329. [PMID: 35472208 PMCID: PMC9041836 DOI: 10.1371/journal.pone.0266329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose
Growth hormone (GH) treatment has been used to improve growth in short children who were born small for gestational age (SGA). The aim of this study was to investigate the long-term efficacy of GH treatment in these children.
Methods
Data from a multicenter observational clinical trial (ClinicalTrials.gov NCT01604395, LG growth study) were analyzed for growth outcome and prediction model in response to GH treatment. One hundred fifty-two children born SGA were included.
Results
The mean age of patients born SGA was 7.13 ± 2.59 years. Height standard deviation score (SDS) in patients born SGA increased from -2.55 ± 0.49 before starting treatment to -1.13 ± 0.76 after 3 years of GH treatment. Of the 152 patients with SGA, 48 who remained prepubertal during treatment used model development. The equation describing the predicted height velocity during 1st year of GH treatment is as follows: the predictive height velocity (cm) = 10.95 + [1.12 x Height SDS at initial treatment (score)] + [0.03 x GH dose (ug/kg/day)] + [0.30 x TH SDS at initial treatment (score)] + [0.05 x age (year)] + [0.15 x Weight SDS at initial treatment (score)] ± 1.51 cm.
Conclusions
GH treatment improved growth outcome in short children born SGA. We also developed a prediction model that is potentially useful in determining the optimal growth outcome for each child born SGA.
Trial registration
ClinicalTrials.gov Identifier: NCT01604395.
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Affiliation(s)
- Hae Sang Lee
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Change Dae Kum
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Jung Gi Rho
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
- * E-mail:
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13
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Longitudinal study of the newborn small for gestational age. Growth recovery and conditioning factors. NUTR HOSP 2022; 39:520-529. [PMID: 35012321 DOI: 10.20960/nh.03907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND small-for-gestational-age (SGA) newborns present a higher morbidity and mortality rate when compared to infants born appropriate for gestational age (AGA), as well as insufficient growth, with height far from their target and in some cases a low final height (< -2 SDs). OBJECTIVE the aim of this study was to determine when catch-up growth (CUG) in height occurs in these children, and which factors are associated with lack of CUG. MATERIAL AND METHODS this is a retrospective study of SGAs born between 2011 and 2015 in a secondary hospital. Anthropometric measurements were taken consecutively until CUG was reached, and fetal, placental, parental, newborn, and postnatal variables were studied. RESULTS a total of 358 SGAs were included from a total of 5,585 live newborns. At 6 and 48 months of life, 93.6 % and 96.4 % of SGAs achieved CUG, respectively. By subgroups, symmetric SGAs performed worse than asymmetric SGAs with CUG in 84 % and 92 % at 6 and 48 months of life, respectively. The same occurred in the subgroup of preterm SGAs with respect to term SGAs, with worse CUGs of 88.2 % and 91.2 % at 6 and 48 months of life, respectively. Prematurity, symmetrical SGA, intrauterine growth retardation (IUGR), preeclampsia, previous child SGA, perinatal morbidity, and comorbidity during follow-up were associated with absence of CUG. CONCLUSIONS the majority of SGAs had CUG in the first months of life. The worst outcomes were for preterm and symmetric SGAs.
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14
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Taghizadeh B, Jaafari MR, Zarghami N. New insight into the importance of formulation variables on parenteral growth hormone preparations: potential effect on the injection-site pain. Front Endocrinol (Lausanne) 2022; 13:963336. [PMID: 36263321 PMCID: PMC9576007 DOI: 10.3389/fendo.2022.963336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Reducing injection-site pain (ISP) in patients with chronic conditions such as growth hormone deficiency is a valuable strategy to improve patient compliance and therapeutic efficiency. Thus understanding different aspects of pain induction following subcutaneous injection of biotherapeutics and identifying the responsible factors are vital. Here we have discussed the effects of formulation's viscosity, concentration, osmolality, buffering agents, pH, and temperature as well as injection volume, dosing frequency, and different excipients on ISP following subcutaneous injection of commercially available recombinant human growth hormone products. Our literature review found limited available data on the effects of different components of parenteral rhGH products on ISP. This may be due to high cost associated with conducting various clinical trials to assess each excipient in the formulation or to determine the complex interactions of different components and its impact on ISP. Recently, conducting molecular dynamics simulation studies before formulation design has been recommended as an alternative and less-expensive approach. On the other hand, the observed inconsistencies in the available data is mainly due to different pain measurement approaches used in each study. Moreover, it is difficult to translate data obtained from animal studies to human subjects. Despite all these limitations, our investigation showed that components of parenteral rhGH products can significantly contribute to ISP. We suggest further investigation is required for development of long acting, buffer-free, preservative-free formulations. Besides, various excipients are currently being investigated for reducing ISP which can be used as alternatives for common buffers, surfactants or preservatives in designing future rhGH formulations.
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Affiliation(s)
- Bita Taghizadeh
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Reza Jaafari
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- *Correspondence: Nosratollah Zarghami,
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15
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Adler E, Lambert AS, Bouvattier C, Thomas-Teinturier C, Rothenbuhler A, de Boissieu P, Linglart A. Determinants of Final Height in Patients Born Small for Gestational Age Treated with Recombinant Growth Hormone. Horm Res Paediatr 2021; 94:52-62. [PMID: 34182561 DOI: 10.1159/000516557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION About 8% of children born small for gestational age (SGA) do not reach a final height within the normal range. Recombinant human growth hormone (rhGH) has been shown to be effective in increasing the final height in children born SGA. Our objective was to identify predictive factors of final height in children born SGA treated with rhGH. MATERIALS AND METHODS In this retrospective study, conducted in a tertiary pediatric endocrinology referral center, we recruited all patients born SGA (defined as birth length or weight <10th percentile) treated with rhGH for more than 12 months for whom final height data were available. Some patients had received gonadotropin-releasing hormone (GnRH) analog therapy. RESULTS We included 252 patients with an average birth length of -2.0 ± 0.7 SD and birth weight of -1.7 ± 1.0 SD. After 4.6 ± 2.8 years of rhGH treatment, their height increased from -2.2 ± 0.9 SD to -1.5 ± 0.9 SD. In multivariate analysis, we identified 8 factors that predict 46% of the final height, namely, cause of SGA (p < 0.0001), GnRH analog therapy >2 years (p = 0.006), birth length (p < 0.02), height at the start of rhGH (p < 0.0001), IGF-1 level at the start of rhGH (p = 0.0002), growth velocity during the 1st year of treatment (p = 0.0002), and age and height at the onset of puberty (p < 0.0001, p = 0.0007, respectively). CONCLUSION In this large cohort of SGA patients who had reached their final height, we were able to confirm that growth hormone increases final height in short SGA children. In addition, we identified several factors associated with a better response to growth hormone treatment.
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Affiliation(s)
- Elodie Adler
- AP-HP, Bicêtre Paris Saclay Hospital, DMU SEA, Endocrinology and Diabetes for Children, Le Kremlin Bicêtre, France.,Paris Saclay Medical University, INSERM U1185, Bicêtre Paris Saclay Hospital, Le Kremlin Bicêtre, France
| | - Anne-Sophie Lambert
- AP-HP, Bicêtre Paris Saclay Hospital, DMU SEA, Endocrinology and Diabetes for Children, Le Kremlin Bicêtre, France
| | - Claire Bouvattier
- AP-HP, Bicêtre Paris Saclay Hospital, DMU SEA, Endocrinology and Diabetes for Children, Le Kremlin Bicêtre, France
| | - Cécile Thomas-Teinturier
- AP-HP, Bicêtre Paris Saclay Hospital, DMU SEA, Endocrinology and Diabetes for Children, Le Kremlin Bicêtre, France
| | - Anya Rothenbuhler
- AP-HP, Bicêtre Paris Saclay Hospital, DMU SEA, Endocrinology and Diabetes for Children, Le Kremlin Bicêtre, France.,Paris Saclay Medical University, INSERM U1185, Bicêtre Paris Saclay Hospital, Le Kremlin Bicêtre, France
| | - Paul de Boissieu
- AP-HP, Epidemiology and Public Health Department, Bicêtre Paris Saclay Hospital, Le Kremlin Bicêtre, France
| | - Agnès Linglart
- AP-HP, Bicêtre Paris Saclay Hospital, DMU SEA, Endocrinology and Diabetes for Children, Le Kremlin Bicêtre, France.,Paris Saclay Medical University, INSERM U1185, Bicêtre Paris Saclay Hospital, Le Kremlin Bicêtre, France
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16
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Management of Short Stature: Use of Growth Hormone in GH-Deficient and non-GH-Deficient Conditions. Indian J Pediatr 2021; 88:1203-1208. [PMID: 34609657 DOI: 10.1007/s12098-021-03892-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Growth hormone (GH) is an important driver for somatic growth and increase in height in children. The development of recombinant human GH has greatly increased its availability, and hence the potential for its use and abuse. GH therapy should only be offered to patients with established and approved indications. Common pediatric indications for treatment include growth hormone deficiency, Turner syndrome, Prader-Willi syndrome, small for gestational age, chronic renal insufficiency, and idiopathic short stature. Before initiating treatment, the family should be counseled about the treatment goals, costs, and possible adverse effects from the treatment. It is important for patients to have realistic expectations from the treatment. The dose of GH should be individualized for the indication and will require titration in each patient based on response to the treatment and the adverse effects. Overall, GH has a good safety record. However, GH treatment has many potential and real adverse effects that need to be considered and monitored during treatment. Recently, safety concerns regarding the long-term effect of GH therapy on cardiovascular morbidity have come under scrutiny.
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17
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Netchine I, van der Steen M, López-Bermejo A, Koledova E, Maghnie M. New Horizons in Short Children Born Small for Gestational Age. Front Pediatr 2021; 9:655931. [PMID: 34055692 PMCID: PMC8155308 DOI: 10.3389/fped.2021.655931] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/01/2021] [Indexed: 12/26/2022] Open
Abstract
Children born small for gestational age (SGA) comprise a heterogeneous group due to the varied nature of the cause. Approximately 85-90% have catch-up growth within the first 4 postnatal years, while the remainder remain short. In later life, children born SGA have an increased risk to develop metabolic abnormalities, including visceral adiposity, insulin resistance, and cardiovascular problems, and may have impaired pubertal onset and growth. The third "360° European Meeting on Growth and Endocrine Disorders" in Rome, Italy, in February 2018, funded by Merck KGaA, Germany, included a session that examined aspects of short children born SGA, with three presentations followed by a discussion period, on which this report is based. Children born SGA who remain short are eligible for GH treatment, which is an approved indication. GH treatment increases linear growth and can also improve some metabolic abnormalities. After stopping GH at near-adult height, metabolic parameters normalize, but pharmacological effects on lean body mass and fat mass are lost; continued monitoring of body composition and metabolic changes may be necessary. Guidelines have been published on diagnosis and management of children with Silver-Russell syndrome, who comprise a specific group of those born SGA; these children rarely have catch-up growth and GH treatment initiation as early as possible is recommended. Early and moderate pubertal growth spurt can occur in children born SGA, including those with Silver-Russell syndrome, and reduce adult height. Treatments that delay puberty, specifically metformin and gonadotropin releasing hormone analogs in combination with GH, have been proposed, but are used off-label, currently lack replication of data, and require further studies of efficacy and safety.
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Affiliation(s)
- Irène Netchine
- Sorbonne Université, INSERM, UMR_S938 Centre de Recherche Saint Antoine, APHP, Hôpital Armand Trousseau, Explorations Fonctionnelles Endocriniennes, Paris, France
| | - Manouk van der Steen
- Department of Paediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Abel López-Bermejo
- Girona Biomedical Research Institute, Dr. Josep Trueta Hospital, Girona, Spain
| | | | - Mohamad Maghnie
- Department of Pediatrics, Institute for Research, Hospitalization and Health Care (IRCCS) Children's Hospital Giannina Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, University of Genova, Genova, Italy
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18
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Prevalence of children born small for gestational age with short stature who qualify for growth hormone treatment. Ital J Pediatr 2021; 47:82. [PMID: 33794966 PMCID: PMC8015030 DOI: 10.1186/s13052-021-01026-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Recombinant human growth hormone (rhGH) is approved in Europe as a treatment for short children born small for gestational age (SGA) since 2003. However, no study evaluated the prevalence of SGA children with short stature who qualify for rhGH in Europe so far. This study aimed to investigate in an Italian population the prevalence of children born SGA, of short stature in children born SGA, and of SGA children who qualify for rhGH treatment at 4 years of age. METHODS We conducted a population-based study on primary care pediatricians' databases in Trieste, Italy. Data was collected on 3769 children born between 2004 and 2014. SGA was defined as birth weight and/or birth length ≤ - 2 SDS. Data on height and weight were registered at the closest well-being visit to 1, 2, 3, 4 years of age. Short stature was defined as height ≤ - 2 SDS. Short children born SGA who qualify for rhGH treatment were identified according to Note AIFA #39 criteria (age ≥ 4 years; height ≤ - 2.5 SDS; growth velocity < 50th percentile). RESULTS Full data at birth were available for 3250 children. The SGA prevalence was 3.6% (0.8% SGA for weight, 2.2% SGA for length, 0.6% SGA for both weight and length). The prevalence of short stature among SGA children was 9% at 1 year of age, 6% at 2 years (significantly higher in preterm in the first 2 years), 4% at 3 years, 3% at 4 years (all born at term). At 4 years of age, median height SDS was - 0.52. One child born SGA was eligible for GH treatment (0.8% among SGA children). CONCLUSIONS The prevalence in a general pediatric population of children born SGA who qualify for GH treatment was 1:3250. Although the prevalence of SGA in our population was similar to previous studies, catch-up growth was recorded earlier in our sample compared to previous reports, and term babies had late catch-up. Height SDS of children born SGA at 4 years of age was lower than expected (- 0.52 SDS).
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19
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Kum CD, Rho JG, Park HK, Lee HS, Hwang JS. Factors influencing growth hormone therapy effect during the prepubertal period in small for gestational age children without catch-up growth. Ann Pediatr Endocrinol Metab 2021; 26:31-37. [PMID: 33819956 PMCID: PMC8026334 DOI: 10.6065/apem.2040096.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/23/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Because small for gestational age (SGA) children who fail to experience catch-up growth have an increased risk of short stature in adulthood, growth hormone (GH) treatment is recommended for effective growth. In this study, we evaluated the effect of GH treatment during the prepubertal period and analyzed for correlation between GH treatment response and clinical factors in SGA children. METHODS A retrospective, single-center study was conducted from 2014 to 2020. A total of 34 prepubertal children of short stature up to 4 years of age and born as SGA were enrolled. We recorded clinical data including birth data, age, weight, height, bone age (BA), and insulin-like growth factor 1 (IGF-1) levels. RESULTS The mean gestational age and birth weight were 37.50±2.51 weeks and 2,200.00±546.79 g. At the start of GH treatment, the mean chronological age and BA were 5.54±1.73 years and 4.52±1.85 years, respectively. The height standard deviation score (SDS) (-2.47±0.45) and IGF-1 SDS (0.16±1.57) were calculated. Height velocity was 9.43±1.40 cm during the first GH treatment year and 7.63±1.16 cm during the second year (P<0.05). The treatment growth response was positively correlated with young age (P=0.047) and lower BA (P=0.049) at the start of treatment. In multiple regression analysis, IGF-1 SDS change had a significantly positive association with GH treatment response (P=0.045). CONCLUSION GH treatment is effective for short stature SGA children who do not experience catch-up growth. Early initiation of GH treatment improved growth outcomes. As IGF-1 SDS is positively correlated with height SDS, IGF-1 monitoring is important during GH treatment of SGA prepubertal children.
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Affiliation(s)
- Chang Dae Kum
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jung Gi Rho
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Hong Kyu Park
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hae Sang Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea,Address for correspondence: Jin Soon Hwang Department of Pediatrics, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea
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20
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Walczak M, Szalecki M, Horneff G, Lebl J, Kalina-Faska B, Giemza T, Moldovanu F, Nanu M, Zouater H. Long-term follow up of carbohydrate metabolism and adverse events after termination of Omnitrope® treatment in children born small for gestational age. Ther Adv Endocrinol Metab 2021; 12:20420188211013121. [PMID: 34104396 PMCID: PMC8111548 DOI: 10.1177/20420188211013121] [Citation(s) in RCA: 2] [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] [Received: 11/25/2020] [Accepted: 04/08/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Recombinant human growth hormone (rhGH) therapy can affect carbohydrate metabolism and lead to impaired glucose tolerance during treatment. In addition, short children born small for gestational age (SGA) are predisposed to metabolic abnormalities. This study assessed the long-term safety of rhGH (Omnitrope®) use in short children born SGA. METHODS This was a follow-up observational study of patients from a phase IV study. The baseline visit was the final visit of the phase IV study. Further visits were planned after 6 months (F1), 1 year (F2), 5 years (F3), and 10 years (F4). The primary objective was to evaluate the long-term effect of rhGH treatment on the development of diabetes mellitus; secondary objectives included incidence/severity of adverse events (AEs). RESULTS In total, 130 subjects were enrolled in the follow-up study; 99 completed F1, 88 completed F2, and 13 completed F3 (no subject reached F4). The full analysis set for evaluation comprised 118 patients (64 female). Mean (standard deviation) duration of follow up was 39.6 (24.4) months. No subject was newly diagnosed with diabetes. The results for carbohydrate metabolism parameters were consistent with this finding. A total of 144 AEs were reported in 54 subjects; these were mostly of mild-to-moderate intensity (96.5%) and not suspected to be related to previous rhGH treatment (94.4%). Serious AEs (n = 18) were reported in eight patients; three (in one patient) were suspected as possibly related to previous rhGH treatment (anemia, menorrhagia, oligomenorrhoea). One fatal event occurred (sepsis), which was judged as not related to previous rhGH treatment. CONCLUSIONS None of the participating subjects, who had all been previously treated with Omnitrope® in a phase IV study, developed diabetes during this follow-up study. In addition, no other unexpected or concerning safety signals were observed.
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Affiliation(s)
- Mieczyslaw Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Zachodniopomorskie, Poland
| | - Mieczyslaw Szalecki
- Collegium Medicum UJK, Kielce, Children’s Memorial Health Institute, Warsaw, Poland
| | - Gerd Horneff
- Department of Pediatrics, Center for Pediatric Rheumatology, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
- Department of Pediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Jan Lebl
- Department of Pediatrics, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Barbara Kalina-Faska
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Faculty of Medical Science, Katowice, Slaskie, Poland
| | | | - Florentina Moldovanu
- National Institute for Mother and Child Health, ‘Alessandrescu Rusescu’, Bucharest, Romania
| | - Michaela Nanu
- National Institute for Mother and Child Health, ‘Alessandrescu Rusescu’, Bucharest, Romania
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Giacomozzi C. Genetic Screening for Growth Hormone Therapy in Children Small for Gestational Age: So Much to Consider, Still Much to Discover. Front Endocrinol (Lausanne) 2021; 12:671361. [PMID: 34122345 PMCID: PMC8194404 DOI: 10.3389/fendo.2021.671361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022] Open
Abstract
Children born small for gestational age (SGA), and failing to catch-up growth in their early years, are a heterogeneous group, comprising both known and undefined congenital disorders. Care for these children must encompass specific approaches to ensure optimal growth. The use of recombinant human growth hormone (rhGH) is an established therapy, which improves adult height in a proportion of these children, but not with uniform magnitude and not in all of them. This situation is complicated as the underlying cause of growth failure is often diagnosed during or even after rhGH treatment discontinuation with unknown consequences on adult height and long-term safety. This review focuses on the current evidence supporting potential benefits from early genetic screening in short SGA children. The pivotal role that a Next Generation Sequencing panel might play in helping diagnosis and discriminating good responders to rhGH from poor responders is discussed. Information stemming from genetic screening might allow the tailoring of therapy, as well as improving specific follow-up and management of family expectations, especially for those children with increased long-term risks. Finally, the role of national registries in collecting data from the genetic screening and clinical follow-up is considered.
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Angulo M, Abuzzahab MJ, Pietropoli A, Ostrow V, Kelepouris N, Tauber M. Outcomes in children treated with growth hormone for Prader-Willi syndrome: data from the ANSWER Program® and NordiNet® International Outcome Study. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2020; 2020:20. [PMID: 33292530 PMCID: PMC7653711 DOI: 10.1186/s13633-020-00090-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Background Growth hormone (GH) deficiency is common in patients with Prader-Willi syndrome (PWS) and leads to short adult stature. The current study assessed clinical outcomes based on real-world observational data in pediatric patients with PWS who were treated with GH. Methods Data from patients previously naïve to treatment with GH who began therapy with somatropin were collected from 2006 to 2016 in the observational American Norditropin® Studies: Web-Enabled Research (ANSWER) Program® and NordiNet® International Outcome Study. Variables affecting change from baseline in height standard deviation scores (HSDS; n = 129) and body mass index standard deviation scores (BMI SDS; n = 98) were determined. Results Patients included in both HSDS and BMI SDS analyses were treated with a mean GH dose of 0.03 mg/kg/d (SD, 0.01 mg/kg/d). Results from the HSDS analysis revealed that baseline age and years on treatment had a significant impact on the change in HSDS. In the BMI SDS analysis, longer GH treatment time led to a greater change in BMI SDS from baseline, and patients with a higher BMI at the start of treatment had a greater decrease in BMI over time. Conclusions GH is effective in the management of children with PWS. Earlier treatment resulted in a greater gain in height, and a longer treatment period resulted in better outcomes for both height and BMI. Trial registration This study was registered with ClinicalTrials.gov (NCT01009905) on November 9, 2009.
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Affiliation(s)
| | | | | | - Vlady Ostrow
- Novo Nordisk Inc., 800 Scudders Mills Rd, Plainsboro, NJ, 08536, USA
| | - Nicky Kelepouris
- Novo Nordisk Inc., 800 Scudders Mills Rd, Plainsboro, NJ, 08536, USA.
| | - Maithe Tauber
- Center for Physiopathology of Toulouse-Purpan, and the Reference Centre for PWS, Department of Endocrinology, Children's Hospital, CHU Toulouse, Toulouse, France
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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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Height outcomes in children with growth hormone deficiency and idiopathic short stature treated concomitantly with growth hormone and aromatase inhibitor therapy: data from the ANSWER program. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2020; 2020:19. [PMID: 33042202 PMCID: PMC7537098 DOI: 10.1186/s13633-020-00089-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 08/30/2020] [Indexed: 11/22/2022]
Abstract
Background Treatment of children with growth hormone deficiency (GHD) or idiopathic short stature (ISS) using GH is only effective for bone growth prior to epiphyseal fusion. Aromatase inhibitor therapy (AIT) blocks estrogen production, thereby delaying epiphyseal fusion. The current study analyzed baseline characteristics and longitudinal data of male patients with GHD or ISS who were treated with GH and concomitant AIT. Methods Data were obtained from the observational American Norditropin® Studies: Web-Enabled Research (ANSWER) Program, which collected efficacy and safety data of patients treated with Norditropin®. A longitudinal cohort approach compared patient characteristics, including chronologic age, bone age, and height standard deviation score (HSDS), in GH-treated males before and after AIT initiation. Results A total of 142 GH-naïve patients with GHD (n = 115) or ISS (n = 27) with mean (± SD) baseline chronological ages of 12.10 ± 3.00 and 10.76 ± 3.07 years, respectively, were analyzed. The majority were classified at advanced Tanner stages II to V. Patients with GHD had mean HSDS of − 1.97 ± 0.78 at baseline and − 0.99 ± 0.88 prior to AIT initiation, while corresponding values for patients with ISS were − 2.15 ± 0.72 and − 1.04 ± 0.79, respectively. In patients evaluated after 2 years of concomitant AIT, mean HSDS had decreased to − 0.40 ± 1.16 and − 0.65 ± 0.52 for patients with GHD and ISS, respectively. Patients with GHD had a mean bone age/chronological age ratio (BA/CA) of 0.91 ± 0.11 at baseline and 0.97 ± 0.10 prior to AIT initiation, while corresponding values for patients with ISS were 0.85 ± 0.16 and 0.99 ± 0.10, respectively. In patients evaluated after 2 years of concomitant AIT, mean BA/CA values were 0.95 ± 0.10 and 0.96 ± 0.06 for patients with GHD and ISS, respectively. Conclusions In this real-world analysis, use of AIT with GH in males appeared to be associated with ongoing growth over 2 years, and AIT likely augmented growth potential as indicated by continued HSDS increase with decreased BA/CA after AIT initiation. Trial registration This trial was sponsored by Novo Nordisk and is registered with ClinicalTrials.gov (NCT01009905). Registered November 11, 2009; retrospectively registered
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25
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Labarta JI, de Arriba A, Ferrer M, Loranca M, Martos JM, Rodríguez A, Samaniego ML, Sánchez-Cenizo L. Growth and metabolic effects of long-term recombinant human growth hormone (rhGH) treatment in short children born small for gestational age: GH-RAST study. J Pediatr Endocrinol Metab 2020; 33:923-932. [PMID: 32623373 DOI: 10.1515/jpem-2019-0438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/30/2020] [Indexed: 11/15/2022]
Abstract
Objectives To study the efficacy and influence on metabolism of recombinant human growth hormone (rhGH) treatment in short children born small for gestational age (SGA). Methods Retrospective, observational, multicenter study in 305 short children born SGA, treated with rhGH during a mean ± SD of 5.03 ± 1.73 years at a mean ± SD dose of 37 ± 8 μg/kg/day. Auxological and metabolic assessment including glucose and lipids profile were collected. Results Mean ± SD age at the start of treatment was 7.11 ± 2.78 years. Height and weight improved significantly until the end of treatment from mean -2.72 (CI95%: -2.81 to -2.63) standard deviation score (SDS) to -1.16 (CI95%: -1.44 to -0.88) SDS and from -1.62 (CI95%: -1.69 to -1.55) SDS to -0.94 (CI95%: -1.14 to -0.74) SDS respectively. Mean height gain was 1.27 (CI95%: 0.99-1.54) SDS. Prepubertal patients showed higher height gain than pubertal children (mean [CI95%] = 1.44 [CI95%: 1.14-1.74] vs. 0.73 [CI95%: 0.22-1.24], p=0.02). Height gain SDS during treatment negatively correlated with chronological age (CA) and bone age (BA) delay and positively correlated with duration of treatment, height gain during first year of treatment, years on prepubertal treatment and height SDS from target height (TH). Glucose, insulin, and triglycerides increased significantly but remained within the normal range. Total and LDL-cholesterol decreased significantly, and HDL-cholesterol remained unchanged. Conclusions rhGH treatment in short SGA children effectively normalized height in most of the patients and showed a safe metabolic profile. Children who benefit the most are those with greater height SDS distance from TH, BA delay, longer duration of treatment and prepubertal treatment initiation.
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Affiliation(s)
| | | | - Marta Ferrer
- Hospital Universitario Miguel Servet, Zaragoza, Spain
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26
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Adult height in short children born small for gestational age treated with growth hormone. Med Clin (Barc) 2020; 154:289-294. [PMID: 31427155 DOI: 10.1016/j.medcli.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/27/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Recombinant human growth hormone (rhGH) treatment in small for gestational age (SGA) children has been effective, although there is significant variability in the response. Adult height and the factors that determine the long-term response are evaluated. PATIENTS AND DESIGN A retrospective study of 80 patients born SGA with short stature treated with rhGH and followed until adult height (23 males). RESULTS The group starting treatment pre-puberty reached a higher Adult height (-1.4±0.6 vs. -1.9±.6 in pubertal children), the highest final height gain was achieved in those treated for at least 2years prepuberty (1.32±.5 SDS). Factors associated with greater adult height gain were: a) less height, weight and BMI at start of treatment, b) lower chronological and bone age with lower IGF-I before treatment, c) greater distance to target height, d) higher growth velocity the first and second year of treatment, and higher height gain before and during puberty. The percentage of patients with good response in the first year ranged from 46.6% to 81.6% depending on the criteria. Growth velocity increase ≥3cm/ first year correlated best with long-term response. CONCLUSION rhGH treatment in children born SGA produced a varying increase in adult height that allowed them to reach their adult height. The best results occurred in the prepubertal group and did not depend on pituitary GH response.
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Al Shaikh A, Daftardar H, Alghamdi AA, Jamjoom M, Awidah S, Ahmed ME, Soliman AT. Effect of growth hormone treatment on children with idiopathic short stature (ISS), idiopathic growth hormone deficiency (IGHD), small for gestational age (SGA) and Turner syndrome (TS) in a tertiary care center. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:29-40. [PMID: 32191651 PMCID: PMC7569569 DOI: 10.23750/abm.v91i1.9182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To assess the long-term effect of growth hormone (GH) therapy in a large cohort of short children with different etiologies. PATIENTS AND METHODS We evaluated retrospectively the anthropometric data of 252 short children [height SDS <-2: 154 children with growth hormone deficiency (GHD), 63 with idiopathic short stature (ISS), 26 with SGA, and 9 with Turner syndrome (TS)] who were treated, in our center, with GH between 1-2007 and 1-2018. Before and during recombinamt growth-hormone (recGH) treatment, auxological parameters including height (Ht), weight (Wt), Ht - Z score (HtSDS), body mass index (BMI) and BMISDS were recorded every 6 months; bone age (BA) was assessed every 12 months. RESULTS At the end of first year of rhGH therapy and after an average of 3 years treatment all groups of short children had significant increase in HtSDS, which was higher in GHD compared to other groups. Children with GHD, SGA, ISS and TS increased their HtSDS by an average of 2.2, 1.46, 0.6 and 0.99 SD, respectively at the end of follow up period (for all groups, p: <0.001). The bone age/chronological age (BA/CA) ratio did not differ significantly among ISS, GHD and SGA groups after GH therapy. The HtSDS gain was higher in children with GHD compared to other ISS, SGA and TS groups (p:< 0.01; p: 0.015 and p: 0.029, respectively). HtSDS improvement occurred during the first 3 years of rhGH therapy. The BMISDS increased significantly in children with GHD, after 3 years of rhGH therapy (p: < 0.001). After rhGH treatment, the BMISDS decreased significantly in children with ISS and SGA (p: < 0.01 and < 0.001, respectively) but did not change in children with TS (p: 0.199). CONCLUSIONS Children with GHD, SGA, ISS and TS exhibited significant increases in HtSDS when treated with rhGH for 3 years. The HtSDS gain was higher in children with GHD compared to other groups.
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Affiliation(s)
- Adnan Al Shaikh
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Hadeer Daftardar
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Abdul Aziz Alghamdi
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Majd Jamjoom
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Saniah Awidah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Mohamed E Ahmed
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Ashraf T Soliman
- Professor of Pediatrics and Endocrinology, University of Alexandria, Egypt.
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Goedegebuure WJ, Kerkhof GF, Hokken-Koelega ACS. Glomerular filtration rate, blood pressure and microalbuminuria in adults born SGA: A 5-year longitudinal study after cessation of GH treatment. Clin Endocrinol (Oxf) 2019; 91:892-898. [PMID: 31512772 DOI: 10.1111/cen.14095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Growth hormone treatment increases glomerular filtration rate (GFR), as serum IGF-I stimulates the renin-angiotensin system. Infants born with a low birth weight have a smaller number of nephrons, which cause a lower GFR, a higher blood pressure and a higher albumin-to-creatinine ratio in early adulthood. METHOD A total of 261 young adults born SGA, previously treated with growth hormone (SGA-GH), were longitudinally followed. Glomerular filtration rate, based on serum creatinine levels, was determined at cessation of GH treatment and at 6 months, 2 years and 5 years thereafter. Glomerular filtration rate, blood pressure and urinary albumin-to-creatinine ratio at 5 years after cessation of GH were compared with untreated age-matched controls (56 untreated short subjects born SGA [SGA-S], 118 subjects born SGA with spontaneous catch-up growth [SGA-CU], 135 subjects born appropriate for gestational age [AGA]). RESULTS Glomerular filtration rate decreased significantly only during the first 6 months after cessation of GH treatment, while remaining well within the normal range (124.6 vs 120.2 mL/min/1.73 m2 , P < .001). SGA-GH adults had a similar GFR, blood pressure and urinary albumin-to-creatinine ratio as the healthy controls born SGA and AGA. CONCLUSION In conclusion, our 5 years longitudinal follow-up study shows a decrease in GFR during 6 months after GH cessation, but thereafter GFR remained stable and within the normal range. Glomerular filtration rate, blood pressure and urinary albumin-to-creatinine ratio at 21 years of age were similar in GH-treated young adults born SGA and untreated controls born SGA or AGA. We conclude that long-term GH treatment in children born SGA has no unfavourable effects on kidney function in early adulthood. PRÉCIS: We present a longitudinal study on kidney function in the follow-up of growth hormone-treated young adults who were born small for gestational age.
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Affiliation(s)
- Wesley J Goedegebuure
- Department of Paediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerthe F Kerkhof
- Department of Paediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anita C S Hokken-Koelega
- Department of Paediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Tornese G, Pricci F, Pellegrin MC, Villa M, Rotondi D, Agazio E, Barbi E. Practical tools to identify short children born small-for-gestational-age eligible for rhGH treatment according to Italian regulation. Ital J Pediatr 2019; 45:130. [PMID: 31639023 PMCID: PMC6805524 DOI: 10.1186/s13052-019-0715-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
Recombinant human growth hormone (rhGH) is an approved and effective treatment for short children born small for gestational age (SGA). Prevalence of children eligible for treatment as SGA is reported to be 1:1800. The latest data from the National Registry of Growth Hormone therapy (RNAOC) showed that the number of children treated with SGA indication is still small (prevalence 0.37/100,000) and these children are significantly less reported than those treated for growth hormone deficiency (GHD), although GHD prevalence is 1:4000-1:10,000. This means that many short children born SGA are still not properly identified, and therefore not treated with rhGH, or misdiagnosed as GHD. This article provides some practical tools for the identification of children eligible for rhGH treatment.
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Affiliation(s)
- Gianluca Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
| | - Flavia Pricci
- Department Cardiovascular, endocrine-metabolic disease and aging, Istituto Superiore di Sanità, Rome, Italy
| | | | - Marika Villa
- Department Cardiovascular, endocrine-metabolic disease and aging, Istituto Superiore di Sanità, Rome, Italy
| | - Daniela Rotondi
- Department Cardiovascular, endocrine-metabolic disease and aging, Istituto Superiore di Sanità, Rome, Italy
| | - Elvira Agazio
- Department Cardiovascular, endocrine-metabolic disease and aging, Istituto Superiore di Sanità, Rome, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.,University of Trieste, Trieste, Italy
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Walenkamp MJE, Robers JML, Wit JM, Zandwijken GRJ, van Duyvenvoorde HA, Oostdijk W, Hokken-Koelega ACS, Kant SG, Losekoot M. Phenotypic Features and Response to GH Treatment of Patients With a Molecular Defect of the IGF-1 Receptor. J Clin Endocrinol Metab 2019; 104:3157-3171. [PMID: 30848790 DOI: 10.1210/jc.2018-02065] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 03/04/2019] [Indexed: 02/06/2023]
Abstract
CONTEXT The phenotype and response to GH treatment of children with an IGF1R defect is insufficiently known. OBJECTIVE To develop a clinical score for selecting children with short stature for genetic testing and evaluate the efficacy of treatment. DESIGN AND SETTING Case series with an IGF1R defect identified in a university genetic laboratory. PATIENTS AND INTERVENTIONS Of all patients with sufficient clinical data, 18 had (likely) pathogenic mutations (group 1) and 7 had 15q deletions including IGF1R (group 2); 19 patients were treated with GH. MAIN OUTCOME MEASURES Phenotype and response to GH treatment. RESULTS In groups 1 and 2, mean (range) birth weight, length, and head circumference (HC) SD scores (SDSs) were -2.1 (-3.7 to -0.4), -2.7 (-5.0 to -1.0), and -1.6 (-3.0 to 0.0), respectively. At presentation, height, HC, and serum IGF-1 SDSs were -3.0 (-5.5 to -1.7), -2.5 (-4.2 to -0.5), and +1.2 (-1.3 to 3.2), respectively. Feeding problems were reported in 15 of 19 patients. A clinical score with 76% sensitivity is proposed. After 3 years of GH treatment [1.1 (0.2) mg/m2/d] height gain in groups 1 (n = 12) and 2 (n = 7) was 0.9 SDS and 1.3 SDS (at a mean IGF-1 of 3.5 SDS), less than reported for small for gestational age (1.8 SDS). CONCLUSION A clinical score encompassing birth weight and/or length, short stature, microcephaly, and IGF-1 is useful for selecting patients for IGF1R analysis. Feeding problems are common and the growth response to GH treatment is moderate.
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Affiliation(s)
- Marie J E Walenkamp
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jasmijn M L Robers
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Jan M Wit
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Wilma Oostdijk
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Anita C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sarina G Kant
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Monique Losekoot
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
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Postnatal management of growth failure in children born small for gestational age. J Pediatr (Rio J) 2019; 95 Suppl 1:23-29. [PMID: 30550759 DOI: 10.1016/j.jped.2018.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To discuss the etiology and growth consequences of small size at birth and the indications, effects, and safety of biosynthetic growth hormone therapy in children born small for gestational age. SOURCE OF DATA A comprehensive and non-systematic search was carried out in the PubMed, LILACS, and SciELO databases from 1980 to the present day, using the terms "small for gestational age," "intrauterine growth restriction," and "growth hormone". The publications were critically selected by the authors. DATA SYNTHESIS Although the majority of children born small for gestational age show spontaneous catch-up growth during the first two years of life, some of them remain with short stature during childhood, with high risk of short stature in adult life. Treatment with growth hormone might be indicated, preferably after 2-4 years of age, in those small for gestational age children who remain short, without catch-up growth. Treatment aims to increase growth velocity and to reach a normal height during childhood and an adult height within target height. Response to growth hormone treatment is variable, with better growth response during the pre-pubertal period. CONCLUSIONS Treatment with growth hormone in short children born small for gestational age is safe and effective to improve adult height. Efforts should be done to identify the etiology of small size at birth before treatment.
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32
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Cardoso‐Demartini AA, Boguszewski MC, Alves CA. Postnatal management of growth failure in children born small for gestational age. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Finken MJJ, van der Steen M, Smeets CCJ, Walenkamp MJE, de Bruin C, Hokken-Koelega ACS, Wit JM. Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications. Endocr Rev 2018; 39:851-894. [PMID: 29982551 DOI: 10.1210/er.2018-00083] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/21/2018] [Indexed: 12/25/2022]
Abstract
Children born small for gestational age (SGA), defined as a birth weight and/or length below -2 SD score (SDS), comprise a heterogeneous group. The causes of SGA are multifactorial and include maternal lifestyle and obstetric factors, placental dysfunction, and numerous fetal (epi)genetic abnormalities. Short-term consequences of SGA include increased risks of hypothermia, polycythemia, and hypoglycemia. Although most SGA infants show catch-up growth by 2 years of age, ∼10% remain short. Short children born SGA are amenable to GH treatment, which increases their adult height by on average 1.25 SD. Add-on treatment with a gonadotropin-releasing hormone agonist may be considered in early pubertal children with an expected adult height below -2.5 SDS. A small birth size increases the risk of later neurodevelopmental problems and cardiometabolic diseases. GH treatment does not pose an additional risk.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Carolina C J Smeets
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Marie J E Walenkamp
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Christiaan de Bruin
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
| | - Anita C S Hokken-Koelega
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Jan M Wit
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
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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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Dörr HG, Bettendorf M, Binder G, Dötsch J, Hauffa B, Mohnike K, Müller HL, Woelfle J. Effekte eines späten Beginns einer Therapie mit Wachstumshormon. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-017-0267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Growth hormone (GH) was first isolated from cadaver pituitary glands, requiring laborious and expensive collection of glands, followed by extraction and purification of the hormone. This limited supply restricted its use to children with severe GH deficiency who were treated with low dosages and suboptimal schedules. The development of recombinant DNA-derived GH, allowed the production of virtually unlimited amounts of GH, leading to the approval for therapy for a large number of childhood conditions characterized by non-GH deficient short stature. The aim of this review is to provide a critical overview on the daily use of GH in two paradigmatic conditions of non-GH deficient short stature which are children born small for gestational age and with idiopathic short stature, highlighting the available strength of evidence for efficacy and safety.
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Affiliation(s)
- Annalisa Deodati
- University of Rome Tor Vergata, Bambino Gesù Children’s Hospital, Dipartimento di Pediatria Universitario Ospedaliero, Rome, Italy
| | - Stefano Cianfarani
- University of Rome Tor Vergata, Bambino Gesù Children’s Hospital, Dipartimento di Pediatria Universitario Ospedaliero, Rome, Italy
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Karolinska Institutet, Department of Women’s and Children’s Health, Stockholm, Sweden
,* Address for Correspondence: Bambino Gesù Children’s Hospital, Dipartimento di Pediatria Universitario Ospedaliero, Rome, Italy Phone: +39 06 6859 3074 E-mail:
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Abstract
Approximately 10% of small for gestational age (SGA) children maintain a small body size throughout childhood and often into adult life with a decreased pubertal spurt. Growth hormone (GH) therapy increases short-term growth in a dose-dependent manner and adult height had now been well documented. Shorter children might benefit from a higher dose at start (50μg/kg/day). The response to GH treatment was similar for both preterm and term short SGA groups and the effect of GH treatment on adult height showed a wide variation in growth response. As a whole, mean adult height is higher than -2 SDS in 60% of patients and 70% reached an adult height in their target height with better results with higher doses and combined GnRH analog therapy in those who were short at onset of puberty.
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Affiliation(s)
- Maïthé Tauber
- Unité d'endocrinologie, obésité, maladies osseuses, génétique et gynécologie médicale, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France; Institut national de la santé et de la recherche médicale unité 1043, centre de physiopathologie de Toulouse Purpan, université Paul-Sabatier, Toulouse, France.
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Rial Rodríguez JM, de Arriba Muñoz A, Bosch Muñoz J, Cabanas Rodríguez P, Cañete Estrada R, Díez López I, Hawkins Solís MM, Martínez-Aedo Ollero MJ, Rodríguez Dehli AC, Ibáñez Toda L. Tratamiento con hormona de crecimiento en pequeños para la edad gestacional en España. An Pediatr (Barc) 2017; 86:249-254. [DOI: 10.1016/j.anpedi.2016.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022] Open
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Growth hormone treatment in small for gestational age children in Spain. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Savage MO, Backeljauw PF, Calzada R, Cianfarani S, Dunkel L, Koledova E, Wit JM, Yoo HW. Early Detection, Referral, Investigation, and Diagnosis of Children with Growth Disorders. Horm Res Paediatr 2017; 85:325-32. [PMID: 27055026 DOI: 10.1159/000444525] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/08/2016] [Indexed: 11/19/2022] Open
Abstract
Early diagnosis is a key objective in clinical medicine, and early detection of pathological short stature has tangible benefits for growth prognosis and the well-being of the child. Despite late diagnosis being common in growth disorders, programmes of height screening in primary care are not universal in developed countries and may be random or non-existent. A notable exception is automated growth monitoring in Finland, where an algorithm to detect abnormal growth is integrated into children's electronic health records, resulting in increased diagnoses of pathological short stature. Evidence-based anthropometric criteria for referral of short stature to secondary or tertiary care are now published, due largely to excellent studies in the Netherlands. Following referral of the short child, the protocol for laboratory investigations remains somewhat controversial because in healthy children their diagnostic yield can be too low for cost-effectiveness. However, outside of tertiary academic paediatric endocrinology centres, baseline screening tests are considered worthwhile and may speed up diagnosis and treatment. Finally, auxological cut-offs cannot replace good clinical practice, and the understanding that early and effective management depends on commitment to a diagnosis and individualisation of therapy in the short child cannot be overemphasised.
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Affiliation(s)
- Martin O Savage
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, UK
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van der Steen M, Hokken-Koelega ACS. Growth and Metabolism in Children Born Small for Gestational Age. Endocrinol Metab Clin North Am 2016; 45:283-94. [PMID: 27241965 DOI: 10.1016/j.ecl.2016.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Most children born SGA show spontaneous catch-up growth to a normal weight and height above -2 SDS; however, 10% remain short. GH treatment improves adult height and has positive effects on body composition, blood pressure and serum lipids. At 6.5 years after stopping GH treatment, body composition, blood pressure, and lipid levels are similar to untreated short SGA adults indicating that GH-induced catch-up in height has no unfavorable effects on metabolic health. GH-induced reduction in insulin sensitivity is reversible after stopping GH. It remains to be elucidated how metabolic health develops when these subjects become older.
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Affiliation(s)
- Manouk van der Steen
- Dutch Growth Research Foundation, P.O. box 23068, 3001 KB Rotterdam, The Netherlands; Erasmus University Medical Center, Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Anita C S Hokken-Koelega
- Dutch Growth Research Foundation, P.O. box 23068, 3001 KB Rotterdam, The Netherlands; Erasmus University Medical Center, Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
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Qie D, Yang F. [Efficacy of different doses of recombinant human growth hormone in the treatment of short stature in children born small for gestational age]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:247-253. [PMID: 26975824 PMCID: PMC7389993 DOI: 10.7499/j.issn.1008-8830.2016.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of different doses of recombinant human growth hormone (rhGH) in the treatment of short stature in children born small for gestational age (SGA). METHODS A total of 37 children with short stature born SGA were enrolled, and based on the dose of rhGH treatment, they were divided into low-dose rhGH group (0.1-0.15 IU/kg daily) and high-dose rhGH group (0.16-0.2 IU/kg daily). The changes in height standard deviation score (ΔHtSDS), height velocity (HV), serum levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3), and fasting blood glucose at 3, 6, 9, 12, and 24 months after treatment were compared between the two groups. RESULTS ΔHtSDS and HV both increased after the treatment with high- and low-dose rhGH, but ΔHtSDS and HV in the high-dose rhGH group were significantly higher than in the low-dose rhGH group 9, 12 and 24 months after treatment (P<0.05). Both high- and low-dose rhGH treatment increased serum levels of IGF-1 and IGFBP-3. Serum levels of IGF-1 and IGFBP-3 were positively correlated with HtSDS in both groups. One child each in the high- and low-dose rhGH groups experienced transient slight increase in fasting blood glucose (6.1 mmol/L). There were no cases of abnormal thyroid function. CONCLUSIONS rhGH has good efficacy in the treatment of short stature in children born SGA, with few adverse events, and high-dose rhGH has some advantages over low-dose rhGH.
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Affiliation(s)
- Di Qie
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
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Giacomozzi C, Deodati A, Shaikh MG, Ahmed SF, Cianfarani S. The impact of growth hormone therapy on adult height in noonan syndrome: a systematic review. Horm Res Paediatr 2016; 83:167-76. [PMID: 25721697 DOI: 10.1159/000371635] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recombinant human growth hormone (rhGH) is being used to promote linear growth in short children with Noonan syndrome. However, its efficacy is still controversial. AIMS To systematically determine the impact of rhGH therapy on adult height in children with Noonan syndrome. METHODS We searched the Cochrane Central Register of Controlled Trials, ISI Web of Science, MEDLINE, and the bibliographic references from all retrieved articles published until April 2014. Studies reporting adult/near-adult height in children with Noonan syndrome treated with rhGH or reporting at least a 3-year follow-up were analysed. Quality and strength of recommendation were assessed according to the Endocrine Society criteria. RESULTS No controlled trials reporting adult height were available. Five studies were identified reporting adult height or near adult height. Data comparison showed inter-individual variability in the response to rhGH, mean height gain standard deviation score ranging between 0.6 and 1.4 according to national standards, and between 0.6 and 2 according to Noonan standards. Significant biases affected all the studies. CONCLUSIONS High-quality controlled trials on the impact of rhGH therapy on adult height are lacking, and the robustness of available data is not sufficient to recommend such therapy in children with Noonan syndrome.
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Affiliation(s)
- Claudio Giacomozzi
- Dipartimento di Medicina Pediatrica, Bambino Gesù Children's Hospital, Rome, Italy
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44
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Renes JS, Willemsen RH, Mulder JC, Bakker-van Waarde WM, Rotteveel J, Oostdijk W, Houdijk ECAM, Westerlaken C, Noordam C, Verrijn Stuart AA, Odink RJ, de Ridder MAJ, Hokken-Koelega ACS. New insights into factors influencing adult height in short SGA children: Results of a large multicentre growth hormone trial. Clin Endocrinol (Oxf) 2015; 82:854-61. [PMID: 25409576 DOI: 10.1111/cen.12677] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 06/05/2014] [Accepted: 11/15/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Growth hormone (GH) treatment is effective in improving adult height (AH) in short children born SGA. However, there is a wide variation in height gain, even after adjustment for predictive variables. It is therefore important to investigate new factors which can influence the response to GH. OBJECTIVE To investigate the efficacy of GH treatment (1 mg/m(2/) day) in short SGA children on AH. To assess the relation between spontaneous catch-up growth after birth and growth during puberty on the total height gain SDS to AH. PATIENTS Longitudinal GH trial in 170 children. RESULTS Median age at start of GH was 7·1 years and height -3·0 SDS. AH was -1·8 SDS (TH-corrected AH -1·1 SDS) in boys and -1·9 SDS (TH-corrected AH -1·3 SDS) in girls. Spontaneous catch-up growth after birth was ≥0·5 SDS in 42% of children. In contrast to expectation, spontaneous catch-up growth was negatively correlated with total height gain SDS during GH (P = 0·009). During puberty, height SDS declined (-0·4 SDS in boys and -0·5 SDS in girls) resulting in a lower total height gain SDS than expected. Pubertal height gain was 25·5 cm in boys and 15·3 cm in girls, significantly lower compared to AGA children (P < 0·001). At onset of puberty, BA for boys and girls was moderately advanced (P = 0·02 and P < 0·001, respectively). Growth velocity was comparable to AGA children during the first two years of puberty, but thereafter significantly lower until reaching AH (P < 0·001). CONCLUSION In contrast to our hypothesis, children with greater spontaneous catch-up growth after birth show a lower total height gain SDS during GH. Height SDS declines from mid-puberty, due to a marked early deceleration of growth velocity.
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Affiliation(s)
- J S Renes
- Department of Pediatrics, Division of Endocrinology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - R H Willemsen
- Department of Pediatrics, Division of Endocrinology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J C Mulder
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
| | - W M Bakker-van Waarde
- Department of Pediatrics, Division of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - J Rotteveel
- Department of Pediatrics, Division of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
| | - W Oostdijk
- Department of Pediatrics, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - E C A M Houdijk
- Department of Pediatrics, Haga Hospitals - Juliana Children's Hospital, Den Haag, The Netherlands
| | - C Westerlaken
- Department of Pediatrics, Canisius Hospital, Nijmegen, The Netherlands
| | - C Noordam
- Department of Pediatrics, Division of Endocrinology, University Medical Center Radboud, Nijmegen, The Netherlands
| | - A A Verrijn Stuart
- Department of Pediatrics, Division of Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R J Odink
- Department of Pediatrics, Catharina Hospital, Eindhoven, The Netherlands
| | - M A J de Ridder
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A C S Hokken-Koelega
- Department of Pediatrics, Division of Endocrinology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
- Dutch Growth Research Foundation, Rotterdam, The Netherlands
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Preterm infants with severe extrauterine growth retardation (EUGR) are at high risk of growth impairment during childhood. Eur J Pediatr 2015; 174:33-41. [PMID: 24953378 DOI: 10.1007/s00431-014-2361-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 06/06/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Extrauterine growth retardation (EUGR) seriously affects premature newborns and is related to the impairment of growth during childhood. There are very limited data available concerning the growth outcome of EUGR children. Our aim was to assess the growth outcome in a cohort of children born before 34 weeks of gestation with severe EUGR. This was a retrospective multicenter study, performed in outpatient endocrinology clinic. A total of 103 premature children with weight and/or length below -2 standard deviation score (SDS) of "intrauterine" growth expectation at the time of discharge from hospital (within 42 weeks of postmenstrual age) were included in the study. The study participants underwent a thorough anthropometric assessment at a mean age of 3.9 years ± 1.7 SD. Of the EUGR children, 12.6 % showed a height below -2 SDS and 7.7 % even below -2.5 SDS. Growth impairment was more common in males than in females (17 vs. 8 %). The prevalence of subnormal weight (below -2 SDS) was 13.6 %, being higher in males than in females (17 vs. 10 %). BMI values below -2 SDS were found in 18.4 % of our study population (22.7 % in males and 12 % in females). The 19.6 % of EUGR children did not catch up in head circumference during early childhood. Length at term was the major predictor of height in childhood (P < 0.001). CONCLUSION A significant proportion of children born prematurely with severe EUGR show growth retardation in childhood thus suggesting the need for a close clinical follow-up to determine their growth potential and implement effective intervention strategies.
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Jensen RB, Thankamony A, O'Connell SM, Kirk J, Donaldson M, Ivarsson SA, Söder O, Roche E, Hoey H, Dunger DB, Juul A. A randomised controlled trial evaluating IGF1 titration in contrast to current GH dosing strategies in children born small for gestational age: the North European Small-for-Gestational-Age Study. Eur J Endocrinol 2014; 171:509-18. [PMID: 25080293 DOI: 10.1530/eje-14-0419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Short children born small for gestational age (SGA) are treated with a GH dose based on body size, but treatment may lead to high levels of IGF1. The objective was to evaluate IGF1 titration of GH dose in contrast to current dosing strategies. METHODS In the North European Small-for-Gestational-Age Study (NESGAS), 92 short pre-pubertal children born SGA were randomised after 1 year of high-dose GH treatment (67 μg/kg per day) to three different regimens: high dose (67 μg/kg per day), low dose (35 μg/kg per day) or IGF1 titration. RESULTS The average dose during the second year of the randomised trial did not differ between the IGF1 titration group (38 μg/kg per day, s.d. 0.019) and the low-dose group (35 μg/kg per day, s.d. 0.002; P=0.46), but there was a wide variation in the IGF1 titration group (range 10-80 μg/kg per day). The IGF1 titration group had significantly lower height gain (0.17 SDS, s.d. 0.18) during the second year of the randomised trial compared with the high-dose group (0.46 SDS, s.d. 0.25), but not significantly lower than the low-dose group (0.23 SDS, s.d. 0.15; P=0.17). The IGF1 titration group had lower IGF1 levels after 2 years of the trial (mean 1.16, s.d. 1.24) compared with both the low-dose (mean 1.76, s.d. 1.48) and the high-dose (mean 2.97, s.d. 1.63) groups. CONCLUSION IGF1 titration of GH dose in SGA children proved less effective than current dosing strategies. IGF1 titration resulted in physiological IGF1 levels with a wide range of GH dose and a poorer growth response, which indicates the role of IGF1 resistance and highlights the heterogeneity of short SGA children.
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Affiliation(s)
- Rikke Beck Jensen
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Ajay Thankamony
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Susan M O'Connell
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Jeremy Kirk
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Malcolm Donaldson
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Sten-A Ivarsson
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Olle Söder
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Edna Roche
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Hilary Hoey
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - David B Dunger
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Anders Juul
- Department of Growth and ReproductionRigshospitalet, University of Copenhagen, Copenhagen, DenmarkDepartment of PediatricsAddenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ Cambridge, UKDepartment of PediatricsThe National Children's Hospital, Trinity College, University of Dublin, Dublin, IrelandDepartment of EndocrinologyBirmingham Children's Hospital, Birmingham, UKDepartment of EndocrinologyRoyal Hospital for Sick Children, Glasgow, UKDepartment of Clinical SciencesEndocrine and Diabetes Unit, University of Lund, Malmø, SwedenPediatric Endocrinology UnitDepartment of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Boguszewski MCS, Lindberg A, Wollmann HA. Three-year growth response to growth hormone treatment in very young children born small for gestational age-data from KIGS. J Clin Endocrinol Metab 2014; 99:2683-8. [PMID: 24758180 DOI: 10.1210/jc.2013-4117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Children born small for gestational age (SGA) with poor growth during the first years of life may remain short in stature during childhood and as adults. OBJECTIVE To evaluate the 3-year growth response to GH treatment in very young short children born SGA, and to test the existing predictions models for growth response developed for older SGA children. SETTING KIGS (The Pfizer International Growth Database). PATIENTS A total of 620 SGA children (birth length and/or weight below -2 SD score [SDS]) on GH treatment, 156 in the 2- to 4-year-old group (100 boys; median age, 3.3 y), and 464 in the 4- to 6-year-old group (284 boys; median age, 4.9 y). RESULTS Median values and 10th-90th percentiles are presented. Both groups presented a significant increase in height velocity during GH treatment. Median height SDS increased from -3.9 (-5.4 to -2.9) at the start to -2.2 (-3.8 to -1.0) at 3 years in the 2- to 4-year-old group (P < .01) and from -3.4 (-4.5 to -2.6) to -2.0 (-3.3 to -0.9) in the 4- to 6-year-old group (P < .01). Median weight SDS increased from -3.8 (-5.9 to -2.4) to -2.1 (-4.1 to -0.5) in the 2- to 4-year-old group (P < .01). Respective values for the 4- to 6-year-old group were -3.1 (-4.8 to -1.8) to -1.6 (-3.1 to -0.1) SDS (P < .01). First- and second-year growth response could be estimated by the SGA model. CONCLUSION Very young children born SGA without spontaneous catch-up growth presented a significant improvement in height and weight during the 3 years of GH treatment. Growth response could be estimated by the SGA model.
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Affiliation(s)
- Margaret C S Boguszewski
- Department of Pediatrics (M.C.S.B.), Federal University of Paraná, Curitiba PR 80060-900, Brazil; Pfizer Inc (A.L.), Endocrine Care, SE-190 91 Sollentuna, Sweden; and Pfizer Inc (H.A.W.), Endocrine Care, 10117 Berlin, Germany
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Saggese G, Fanos M, Simi F. SGA children: auxological and metabolic outcomes - the role of GH treatment. J Matern Fetal Neonatal Med 2014; 26 Suppl 2:64-7. [PMID: 24059556 DOI: 10.3109/14767058.2013.832870] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The definition Small for Gestational Age (SGA) describes those newborns weighing and/or measuring in length <-2 SD than expected for their gestational age. These subjects are at higher risk of short stature, neonatal complications, alterations of glucose, lipid metabolism, body composition, bone metabolism and puberty, neurocognitive vulnerabilities and alterations of the GH-IGF-I axis. With regards to growth, in 85-90% of the cases children born SGA experience a period of catch up growth that allows them to achieve an adult stature within normal range. In a 10-15% of the cases, the catch up growth period does not take place and this entails short stature in adulthood. In the latter group, GH treatment may be considered to achieve adult height in the range of genetical target stature. With reference to glucose and lipid metabolism, young adults born SGA and particularly those with early catch up growth are at higher risk of developing insulin resistance, type 2 diabetes mellitus, arterial hypertension, dyslipidemia, overweight, obesity and metabolic syndrome. Subjects born SGA are in need of a correct diagnostic and eventually therapeutic approach.
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Affiliation(s)
- Giuseppe Saggese
- Department of Pediatrics, Pediatric Endocrine Unit, University Hospital of Pisa , Italy
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Sotos JF, Tokar NJ. Growth hormone significantly increases the adult height of children with idiopathic short stature: comparison of subgroups and benefit. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2014; 2014:15. [PMID: 25075207 PMCID: PMC4114101 DOI: 10.1186/1687-9856-2014-15] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/13/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Children with Idiopathic Short Stature do not attain a normal adult height. The improvement of adult height with treatment with recombinant human growth hormone (rhGH), at doses of 0.16 to 0.28 mg/kg/week is modest, usually less that 4 cm, and they remain short as adults. The benefit obtained seems dose dependent and benefits of 7.0 to 8.0 cm have been reported with higher doses of 0.32 to 0.4 mg/kg/week, but the number of studies is limited. The topic has remained controversial. OBJECTIVE The objective was to conduct a retrospective analysis of our experience with 123 children with ISS treated with 0.32 ± 0.03 mg/kg/week of rhGH, with the aim of comparing the different subgroups of non-familial short stature, familial short stature, normal puberty, and delayed puberty and to assess the benefit by comparison with 305 untreated historical controls, from nine different randomized and nonrandomized controlled studies. RESULTS Eighty eight of our children (68 males and 20 females) attained an adult height or near adult height of -0.71 SDS (0.74 SD) (95% CI, -0.87 to -0.55) with a benefit over untreated controls of 9.5 cm (7.4 to 11.6 cm) for males and 8.6 cm (6.7 to 10.5 cm) for females. In the analysis of the subgroups, the adult height and adult height gain of children with non-familial short stature were significantly higher than of familial short stature. No difference was found in the cohorts with normal or delayed puberty in any of the subgroups, except between the non-familial short stature and familial short stature puberty cohorts. This has implications for the interpretation of the benefit of treatment in studies where the number of children with familial short stature in the controls or treated subjects is not known. The treatment was safe. There were no significant adverse events. The IGF-1 values were essentially within the levels expected for the stages of puberty. CONCLUSION Our experience was quite positive with normalization of the heights and growth of the children during childhood and the attainment of normal adult heights, the main two aims of treatment.
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Affiliation(s)
- Juan F Sotos
- Nationwide Children's Hospital, The Ohio State University - College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
| | - Naomi J Tokar
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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50
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Binder G, Liebl M, Woelfle J, Eggermann T, Blumenstock G, Schweizer R. Adult height and epigenotype in children with Silver-Russell syndrome treated with GH. Horm Res Paediatr 2014; 80:193-200. [PMID: 24051620 DOI: 10.1159/000354658] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022] Open
Abstract
AIMS To compare adult heights of GH-treated and GH-untreated patients with Silver-Russell syndrome (SRS) who were epigenotyped. METHODS This was a nonrandomized retrospective study with matched controls at a single center. Molecular analysis of 32 out of 37 GH-treated patients (16 females) revealed IGF2-H19 epimutations in 12 and maternal uniparental disomy of chromosome 7 (matUPD7) in 5 patients; 15 were negative. At start of GH, mean age was 7.2 years and mean height -3.34 standard deviation score (SDS). Mean GH dose used was 51 µg/kg·day, mean duration of therapy was 5.6 years. Puberty was blocked by GnRH analogs in 16 patients. The untreated group comprised 13 individuals (5 females, mean age 6.8 years and mean height -3.34 SDS). End points were adult height and overall height gain. RESULTS GH-treated patients reached an adult height of -2.12 ± 0.98 SDS gaining 1.22 SDS in comparison to baseline. Adult height SDS of the untreated was -3.13 ± 1.37 SDS. The matched treated patients were significantly taller than their untreated counterparts. Outcome was dependent on height at start of GH and duration of therapy. Height gain was highest in the shortest patients. CONCLUSIONS GH improved adult height in SRS to a comparable degree as reported in nonsyndromic SGA children. A trend toward a better outcome in matUPD7 needs confirmation in larger cohorts.
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Affiliation(s)
- G Binder
- Paediatric Endocrinology, University Children's Hospital, Tübingen, Germany
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