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Corripio-Collado R, Fernández-Ramos C, González-Casado I, Moreno-Macián F, López-Siguero JP, Labarta-Aizpún JI. Delphi consensus on the diagnosis and treatment of patients with short stature in Spain: GROW-SENS study. J Endocrinol Invest 2022; 45:887-897. [PMID: 34791604 PMCID: PMC8918130 DOI: 10.1007/s40618-021-01696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/21/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE To identify consensus aspects related to the diagnosis, monitoring, and treatment of short stature in children to promote excellence in clinical practice. METHODS Delphi consensus organised in three rounds completed by 36 paediatric endocrinologists. The questionnaire consisted of 26 topics grouped into: (1) diagnosis; (2) monitoring of the small-for-gestational-age (SGA) patient; (3) growth hormone treatment; and (4) treatment adherence. For each topic, different questions or statements were proposed. RESULTS After three rounds, consensus was reached on 16 of the 26 topics. The main agreements were: (1) diagnosis tests considered as a priority in Primary Care were complete blood count, biochemistry, thyroid profile, and coeliac disease screening. The genetic test with the greatest diagnostic value was karyotyping. The main criterion for initiating a diagnostic study was prediction of adult stature 2 standard deviations below the target height; (2) the main criterion for initiating treatment in SGA patients was the previous growth pattern and mean parental stature; (3) the main criterion for response to treatment was a significant increase in growth velocity and the most important parameter to monitor adverse events was carbohydrate metabolism; (4) the main attitude towards non-responding patients is to check their treatment adherence with recording devices. The most important criterion for choosing the delivery device was its technical characteristics. CONCLUSIONS This study shows the different degrees of consensus among paediatric endocrinologists in Spain concerning the diagnosis and treatment of short stature, which enables the identification of research areas to optimise the management of such patients.
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Affiliation(s)
- R. Corripio-Collado
- Paediatric Endocrinology Unit, Hospital Universitario Parc Taulí, Sabadell, Barcelona Spain
| | - C. Fernández-Ramos
- Paediatric Endocrinology Unit, Hospital Universitario Basurto, Bilbao, Spain
| | - I. González-Casado
- Pediatric Endocrinology Deparment, Hospital Universitario La Paz, Madrid, Spain
| | - F. Moreno-Macián
- Paediatric Endocrinology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J.-P. López-Siguero
- Paediatric Endocrinology Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación de Málaga (IBIMA), Malaga, Spain
| | - J.-I. Labarta-Aizpún
- Paediatric Endocrinology Unit, Paediatric Department., Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- Department of Microbiology, Pediatrics, Radiology, and Public Health. School of Medicine, Zaragoza University, Avenida Isabel la Catolica 1-3, 50009 Zaragoza, Spain
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Liau ZQG, Wang Y, Lin HY, Cheong CK, Gupta S, Hui JHP. Orthopedic concerns of a child with short stature. Curr Opin Pediatr 2022; 34:82-91. [PMID: 34840250 DOI: 10.1097/mop.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Pediatric short stature poses severe concerns to the patient, parents, and physicians. Management for pediatric short stature is still widely debated due to heterogenous etiological factors and treatment options. This review will address the approach to pediatric short stature, commonly within the subset of skeletal dysplasia resulting in disproportionate short stature. The following will be discussed: the etiology, clinical, and radiological evaluations, and management for pediatric short stature. RECENT FINDINGS Early recognition of short stature and appropriate referrals is shown to benefit the patient and reduce parental concern. A multidisciplinary team, comprising an orthopedic surgeon, is fundamental to provide holistic care and ensure overall good quality of life. Advancements in clinical diagnostic tools and diversified treatment modalities today provides optimism in managing pediatric short stature. SUMMARY Skeletal dysplasia can be treated with good prognosis if diagnosed and managed early. Thorough clinical, radiological, laboratory, and even genetic investigations are important to differentiate and manage various types of skeletal dysplasia. Our review will provide a comprehensive and up-to-date approach to skeletal dysplasia for pediatric orthopedic surgeons, and indications for physicians to refer patients with suspected short stature to pediatric orthopedic surgeons.
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Affiliation(s)
- Zi Qiang Glen Liau
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster
- Department of Orthopaedic Surgery, National University Health System
| | - Yuhang Wang
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Hong-Yi Lin
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Chin Kai Cheong
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Shobhit Gupta
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster
- Department of Orthopaedic Surgery, National University Health System
| | - James Hoi Po Hui
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster
- Department of Orthopaedic Surgery, National University Health System
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Lee B, Kwon CY. Review of economic analysis of available interventions on idiopathic short stature: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24871. [PMID: 33607861 PMCID: PMC7899841 DOI: 10.1097/md.0000000000024871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Idiopathic short stature (ISS) causes a high economic burden worldwide. As part of a research project that synthesizes economic evidence for Korean medicine treatment of ISS, we describe the methods that will be used for the comprehensive review of articles that analyze health-related economic evaluation for available interventions for ISS using a systematic review methodology. METHODS Eight electronic English, Korean, and Chinese databases will be searched from their inception until December 2020 to identify studies on the economic evaluation of available interventions on ISS, without language, study design, or publication status restrictions. From the included studies, the effectiveness, utility, and cost data will be collected as the outcome measures by two researchers independently. Descriptive analysis of individual studies will be conducted. If it is judged that the interventions and outcomes of the included studies are sufficiently homogeneous, we will attempt a quantitative synthesis through meta-analysis using Review Manager version 5.4 software (Cochrane, London, UK). RESULTS This study will summarize the evidence regarding the economic evaluation of available interventions for ISS. CONCLUSIONS The findings of this review will help clinicians and patients in evidence-based decision-making in clinical settings and help policy makers develop effective policies and distribute resources based on the available evidence.
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Affiliation(s)
- Boram Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, 62 Yangjeong-ro, Busanjin-gu, Busan, Republic of Korea
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Abstract
PURPOSE OF THE REVIEW This review will provide an overview of the microcephalic primordial dwarfism (MPD) class of disorders and provide the reader comprehensive clinical review with suggested care guidelines for patients with microcephalic osteodysplastic primordial dwarfism, type II (MOPDII). RECENT FINDINGS Over the last 15 years, significant strides have been made in the diagnosis, natural history, and management of MOPDII. MOPDII is the most common and well described form of MPD. The classic features of the MPD group are severe pre- and postnatal growth retardation, with marked microcephaly. In addition to these features, individuals with MOPDII have characteristic facies, skeletal dysplasia, abnormal dentition, and an increased risk for cerebrovascular disease and insulin resistance. Biallelic loss-of-function mutations in the pericentrin gene cause MOPDII, which is inherited in an autosomal recessive manner.
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Affiliation(s)
- Michael B. Bober
- 0000 0001 2166 5843grid.265008.9Stanley Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA USA
- 0000 0004 0458 9676grid.239281.3A. I. DuPont Hospital for Children, 1600 Rockland-Road, Wilmington, DE 19803 USA
| | - Andrew P. Jackson
- 0000 0004 1936 7988grid.4305.2MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU UK
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Abstract
Neurovascular diseases are among the leading causes of mortality and permanent disability due to stroke, aneurysm, and other cardiovascular complications. Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and Marfan syndrome are two neurovascular disorders that affect smooth muscle cells through accumulation of granule and osmiophilic materials and defective elastic fiber formations respectively. Moyamoya disease, hereditary hemorrhagic telangiectasia (HHT), microcephalic osteodysplastic primordial dwarfism type II (MOPD II), and Fabry's disease are disorders that affect the endothelium cells of blood vessels through occlusion or abnormal development. While much research has been done on mapping out mutations in these diseases, the exact mechanisms are still largely unknown. This paper briefly introduces the pathogenesis, genetics, clinical symptoms, and current methods of treatment of the diseases in the hope that it can help us better understand the mechanism of these diseases and work on ways to develop better diagnosis and treatment.
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Affiliation(s)
- Christine Sam
- Genomics Research Center (One of the State-Province Key Laboratory of Biopharmaceutical Engineering, China), Harbin, China
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Miura K, Oznono K. [Clinical condition and therapy of bone diseases]. Clin Calcium 2013; 23:1789-1794. [PMID: 24292534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Skeletal dysplasia is the term which represents disorders including growth and differentiation of bone, cartilage and ligament. A lot of diseases are included, and new disorders have been added. However, the therapy of most bone diseases is less well-established. Achondroplasia, hypochondroplasia, and osteogenesis imperfecta are most frequent bone diseases. There is no curative treatment for these diseases, however, supportive therapies are available ; for example, growth-hormone therapy for achondroplasia and hypochondroplasia, and bisphosphonate therapy for osteogenesis imperfecta. In addition, enzyme replacement therapy for hypophosphatasia is now on clinical trial.
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Affiliation(s)
- Kohji Miura
- Department of pediatrics, Osaka Graduate School of Medicine, Japan
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Kleszczyński J, Błoch M, Hofbauer K, Dominiak P. Metatropic dysplasia in four-year-old boy--physiotherapy and orthopaedic care problems--case report. Ortop Traumatol Rehabil 2012; 14:289-302. [PMID: 22764341 DOI: 10.5604/15093492.1002258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Metatropic dysplasia is a rare skeletal dysplasia caused by a mutation in the VDRL4 gene. Characteristic abnormalities include tubular bones with short diaphyses and wide metaphyses, delayed ossification of the ischio/pubic bone, and platyspondyly. The main problem is progressive kyphoscoliosis, which significantly limits the patient's motor development. Another complication is compression of the cervical spinal cord, which reverses any improvements in the child's motor performance. The paper presents a description of a 4-year-old boy with metatropic dysplasia treated by orthopaedic bracing and spinal cord decompression surgery at the C1-2 level. Particular attention is paid to physiotherapy, which allowed restoration of motor functions to match the needs of daily activity.
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Affiliation(s)
- Jacek Kleszczyński
- Division of Physiotherapy in Paediatrics and Neurology, Department of Physiotherapy in Musculoskeletal Dysfunctions, University of Physical Education in Wroclaw.
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van Duyvenvoorde HA, van Setten PA, Walenkamp MJE, van Doorn J, Koenig J, Gauguin L, Oostdijk W, Ruivenkamp CAL, Losekoot M, Wade JD, De Meyts P, Karperien M, Noordam C, Wit JM. Short stature associated with a novel heterozygous mutation in the insulin-like growth factor 1 gene. J Clin Endocrinol Metab 2010; 95:E363-7. [PMID: 20668042 DOI: 10.1210/jc.2010-0511] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Homozygous IGF1 deletions or mutations lead to severe short stature, deafness, microcephaly, and mental retardation. Heterozygosity for an IGF-I defect may modestly decrease height and head circumference. OBJECTIVE The objective of the study was to investigate the clinical features of heterozygous carriers of a novel mutation in the IGF1 gene in comparison with noncarriers in a short family and to establish the effect of human GH treatment. SUBJECTS Two children, their mother, and their maternal grandfather carried the mutation and were compared with two relatives who were noncarriers. RESULTS The two index cases had severe short stature (height sd score -4.1 and -4.6), microcephaly, and low IGF-I levels. Sequencing of IGF1 revealed a heterozygous duplication of four nucleotides, resulting in a frame shift and a premature termination codon. The mother and maternal grandfather had the same IGF1 mutation. Adult height (corrected for shrinking and secular trend) and head circumference sd score of carriers of the paternally transmitted mutation was -2.5 and -1.8, in comparison with -1.6 and 0.3 in noncarriers, respectively. After 2 yr of GH treatment, both index cases exhibited increased growth. CONCLUSIONS Heterozygosity for this novel IGF1 mutation in children born from a mother with the same mutation, presumably in combination with other genetic factors for short stature, leads to severe short stature, which can be successfully treated with GH.
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Affiliation(s)
- H A van Duyvenvoorde
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
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9
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VEST M, GIRARD J. Stoffwechselwirkungen von gereinigtem menschlichem Wachstumshormon beim Zwergwuchs und bei der Anorexia nervosa im Kindesalter. Dtsch Med Wochenschr 2009; 87:1705-13. [PMID: 13925653 DOI: 10.1055/s-0028-1114007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Rayburg M, Davies SM, Mehta PA, Crockett M, Jodele S. Successful reduced-intensity bone marrow transplantation in a patient with bone marrow failure associated with Seckel syndrome. Br J Haematol 2008; 142:675-6. [PMID: 18503579 DOI: 10.1111/j.1365-2141.2008.07239.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVES This study examined how much parents are willing to pay and/or willing to stay to make their child's intravenous (IV) catheter placement painless. METHODS A prospective survey was conducted using a questionnaire administered to a consecutive sample of parents presenting to an emergency department (ED). Eligible subjects were parents accompanying a child 8 years of age or younger. A hypothetical visit to the ED, requiring an IV for their child, was described. Parents were asked if they would prefer to make the IV catheter placement painless and if so, how much of an increase in out-of-pocket cost (none, 15 dollars, and 100 dollars) and/or length of stay they would be willing to incur (no time, 15 minutes, 1 hour). Statistics were chiefly descriptive. Associations of demographic elements with willingness to pay and willingness to stay were analyzed using chi and t tests, where appropriate. RESULTS One hundred eight subjects were available for analysis. Most parents were mothers (71%), white (53%), and with previous IVs (70%). Most children were boys (55%) with no previous IV placements (55%). The choice of a painless IV placement was independent of demographics and IV experience. Most parents (89%) chose a painless IV placement. Of these parents, 65% chose a willingness to stay of 1 extra hour, and 77% a willingness to pay at least 15 dollars; 37% of parents would pay 100 dollars. Willingness to pay was dependent on both income (P = 0.014) and ethnicity (P = 0.0013). Willingness to stay was independent of both income (P = 0.24) and ethnicity (P = 0.07). CONCLUSIONS Parents are willing to spend both time and money to make their child's IV placement painless. This information should be considered when choosing therapies to reduce the pain of IV placement.
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Affiliation(s)
- Reza James Daugherty
- Division of Pediatric Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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13
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Kosaki K, Izumi K, Hasegawa T. [Russell-Silver syndrome]. Nihon Rinsho 2006; Suppl 3:436-9. [PMID: 17022582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/physiopathology
- Abnormalities, Multiple/therapy
- Chromosome Aberrations
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 7/genetics
- Diagnosis, Differential
- Dwarfism/diagnosis
- Dwarfism/genetics
- Dwarfism/physiopathology
- Dwarfism/therapy
- Face/abnormalities
- Fetal Growth Retardation/diagnosis
- Fetal Growth Retardation/genetics
- Fetal Growth Retardation/physiopathology
- Fetal Growth Retardation/therapy
- Genes, Recessive
- Genomic Imprinting/genetics
- Growth Disorders/diagnosis
- Growth Disorders/genetics
- Growth Disorders/physiopathology
- Growth Disorders/therapy
- Humans
- Prognosis
- Syndrome
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Affiliation(s)
- Kenjiro Kosaki
- Department of Pediatrics, Keio University School of Medicine
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Izumikawa Y. [Martsolf syndrome]. Nihon Rinsho 2006; Suppl 3:473-5. [PMID: 17022590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Yoshinori Izumikawa
- Nago Ryoikuen (Hospital for the children with severe intellectual and physical disabilities)
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15
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Kuniba H, Egashira M, Motomura H, Motomura K, Kondoh T. [Rud syndrome]. Nihon Rinsho 2006; Suppl 3:485-7. [PMID: 17022593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Hideo Kuniba
- Department of Pediatrics, Nagasaki University School of Medicine
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Inokuchi M, Hasegawa T. [Deprivation dwarfism]. Nihon Rinsho 2006; Suppl 1:102-4. [PMID: 16776104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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17
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Suzuki M. [Role and limitation of internal medicine in therapy of patients with anorexia nervosa]. Seishin Shinkeigaku Zasshi 2006; 108:717-23. [PMID: 17128533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Dedov II, Iudenich ON. [The condition and prospects of Russian endocrinology]. Vestn Ross Akad Med Nauk 2006:38-45. [PMID: 17111923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The article presents a brief essay dedicated to the development of endocrinology in our country since pre-war time. The article covers the most promising areas of endocrinology, from endemic goiter to the introduction of the newest technologies to endocrinology, and informs the readers about structural and organizational changes in the diabetological service, including the establishment of Institute of Diabetes and Institute of Pediatric Endocrinology, the first ones in Russia, the establishment of diabetological service, including State Registry of Diabetic Patients, a school for adult patients, etc. Another issue is the establishment of Growth Center and the introduction of genetic engineering growth hormone preparations into the practice of treatment of short children. Once again, the authors emphasize the issue of fighting endemic goiter. Many tasks of Russian endocrinology are now considered weighty matters of state.
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Affiliation(s)
- Inga Thorsdottir
- Unit for Nutrition Research, Landspitali-University Hospital and University of Iceland, Landspitali, IS-101 Reykjavik, Iceland.
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Posey KL, Hayes E, Haynes R, Hecht JT. Role of TSP-5/COMP in pseudoachondroplasia. Int J Biochem Cell Biol 2004; 36:1005-12. [PMID: 15094116 DOI: 10.1016/j.biocel.2004.01.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Revised: 01/07/2004] [Accepted: 01/13/2004] [Indexed: 11/15/2022]
Abstract
Pseudoachondroplasia (PSACH) is a well-characterized dwarfing condition associated with disproportionate short stature, abnormal joints and osteoarthritis requiring joint replacement. PSACH is caused by mutations in cartilage oligomeric matrix protein (COMP). COMP, the fifth member of the thrombospondin (TSP) gene family, is a pentameric protein found primarily in the extracellular matrix of musculoskeletal tissues. Functional studies have shown that COMP binds types II and IX collagens but the role of COMP in the extracellular matrix remains to be defined. Mutations in COMP interfere with calcium-binding and protein conformation. PSACH growth plate and growth plate chondrocytes studies indicate that COMP mutations have a dominant negative effect with both COMP and type IX collagen being retained in large rER cisternae. This massive retention causes impaired chondrocyte function with little COMP secreted into the matrix and premature loss of chondrocytes. Deficiency of linear growth results from loss of chondrocytes from the growth plate. Secondarily, the matrix contains minimal COMP, which may be normal and/or mutant, and little type IX collagen. This deficiency results in abnormal joints that are easily eroded and cause painful osteoarthritis. Unlike other misfolded proteins that are targeted for degradation, much of the retained COMP escapes degradation, compromises cell function, and causes cell death. Gene therapy will need to target the reduction of COMP in order to restore normal chondrocyte function and longevity.
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Affiliation(s)
- Karen L Posey
- Department of Pediatrics, Medical School at Houston, University of Texas Health Science Center, 6431 Fannin, Room MSB 3.306, Houston, TX 77030, USA
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21
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Zung A, Zadik Z. [New approaches in the treatment of short stature]. Harefuah 2002; 141:1059-65, 1089. [PMID: 12534205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Over the past years, the efforts to improve the final height of children with short stature has yielded new modalities of therapy. New types of injection devices, mainly ready-to-use injection pens with multi-dose vials of reconstituted growth hormone (GH), have made the treatment technically easier and less stressful for the patients. A new type of slow-release GH injected once or twice a month has recently been studied. In addition, several types of synthetic GH-secretagogues were examined, with the advantage of being introduced by the oral or nasal route. The recognition of the pivotal role of estrogens in skeletal maturation and subsequent growth arrest, was the basis for the use of aromatase inhibitor in a pioneering study, with promising results. We have concluded the review with an update on the benefit of GH therapy in children with normal short stature, based on 12 studies that provided data on the final height of these children.
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Affiliation(s)
- Amnon Zung
- Pediatric Endocrine Unit, Kaplan Medical Center, Rehovot, Israel
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22
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Hintz RL. Approaches to the diagnosis and management of growth failure. Pediatr Ann 2000; 29:537-8. [PMID: 11016046 DOI: 10.3928/0090-4481-20000901-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
With the human genome project approaching its completion date of 2005, gene-based technology will play an increasingly important role in health-care delivery. Non-autologous somatic gene therapy is a novel application in which non-autologous cell lines engineered to secrete a recombinant protein are enclosed within immunoisolation devices and implanted into all patients requiring the same product for therapy. The development of this technology requires a multi-disciplinary effort towards optimization of the biomaterial used to manufacture the implantable devices and selection of the appropriate cell lines for enclosure. The efficacy of this technology is illustrated in the treatment of dwarfism and lysosomal storage disease in murine models. The potential of a safe and cost-effective gene-based delivery method should have wide applications in treating both classical genetic disorders and non-Mendelian diseases.
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Affiliation(s)
- P L Chang
- Department of Biology, McMaster University, Hamilton, Ontario, Canada.
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Abstract
We describe 19 males with Aarskog syndrome who were treated with growth hormone (GH) and enrolled in the National Cooperative Growth Study (NCGS). There was a significant increase in both growth rate (3.9 +/- 1.9 cm/yr vs 8.9 +/- 1.7 cm/yr, p < 0.001) and height SD score (change in HtSDS = 1.0 +/- 0.8). The increase in HtSDS was dependent on treatment duration, frequency of injections, weight-for-height SDS, and HtSDS at enrollment. The results of our study suggest a positive effect of GH treatment on growth and adult height in Aarskog syndrome patients.
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Affiliation(s)
- A Petryk
- Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
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25
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Chang PL, Van Raamsdonk JM, Hortelano G, Barsoum SC, MacDonald NC, Stockley TL. The in vivo delivery of heterologous proteins by microencapsulated recombinant cells. Trends Biotechnol 1999; 17:78-83. [PMID: 10087608 DOI: 10.1016/s0167-7799(98)01250-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The microencapsulation of recombinant cells is a novel and potentially cost-effective method of heterologous protein delivery. A 'universal' cell line, genetically modified to secrete any desired protein, is immunologically protected from tissue rejection by enclosure in microcapsules. The microcapsule can then be implanted in different recipients to deliver recombinant proteins in vivo.
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Affiliation(s)
- P L Chang
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Cheng WT, Chen BC, Chiou ST, Chen CM. Use of nonautologous microencapsulated fibroblasts in growth hormone gene therapy to improve growth of midget swine. Hum Gene Ther 1998; 9:1995-2003. [PMID: 9759927 DOI: 10.1089/hum.1998.9.14-1995] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of the present study was to investigate the expression activity, both in vitro and in vivo, of the porcine growth hormone complementary DNA (pGH cDNA) in porcine fetal fibroblast (PFF) cells. The pGH gene had been constructed inside the bicistronic retroviral vector PSN and subsequently transfected into PFF cells further encapsulated with immunoprotective microcapsules. This would provide a way to evaluate the improvement in growth performance of Tao-Yuan swine by the use of nonautologous microencapsulated fibroblasts carrying the pGH cDNA via the technique of somatic gene therapy. Results from Southern blot analysis confirmed that the full length of the pGH cDNA was completely integrated into the genome of the PFF cells after they had been infected one to four times using a PSN retroviral vector. Moreover, Northern blot analysis showed that high transcription activity was present in clones infected twice, and exogenous pGH secretion was found when the pGH-infected PFF had been further cultured for 48 hr in vitro and subjected to immunoblot assay. Encapsulation of the pGH-PFF with an alginate-poly-L-lysine-alginate membrane did not show any deterioration in their proliferation and survival both in vitro and in vivo. The pGH gene in encapsulated recombinant fibroblasts was fully expressed after it had been transplanted into the peritoneal cavity of the Tao-Yuan swine, and reverse transcription-polymerase chain reaction (RT-PCR) analysis was performed on the microcapsules retrieved 1 month later. The feasibility of pGH gene therapy to improve midget Tao-Yuan swine growth enhancement is further supported by the fact that transplantation of the encapsulated recombinant fibroblast cells resulted in a much more significant increase in weight gain than in those swine in either the age-matched untreated control group or in those that had been transplanted with uncapsulated recombinant PFF cells (10.56 +/- 1.01 kg versus 6.95 +/- 0.94 and 5.27 +/- 1.30 kg; p < 0.05). These experimental data suggest that growth hormone gene therapy did provide an alternative approach for growth improvement in midget Tao-Yuan swine.
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Affiliation(s)
- W T Cheng
- Department of Animal Science, National Taiwan University, Taipei, Republic of China
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27
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Ilveskoski I, Saarinen UM, Wiklund T, Sipilä I, Mäkipernaa A, Perkkiö M, Lanning M, Salmi TT, Pihko H. Growth impairment and growth hormone therapy in children treated for malignant brain tumours. Eur J Pediatr 1997; 156:764-9. [PMID: 9365064 DOI: 10.1007/s004310050708] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Eighty-two children with malignant brain tumours were treated according to the "8 in 1" chemotherapy protocol in Finland during 1986 to 1993. Thirty-seven with brain tumours not involving the hypothalamic-pituitary region are still alive and tumour-free. The growth and response to growth hormone (GH) therapy in these children was analysed. Children who received craniospinal irradiation had the most severe loss of height SDS, being -1.07 within 3 years of the diagnosis. Even children with no irradiation to the hypothalamic-pituitary axis had a mean change in height SDS of -0.5 after 3 years. Fifteen of 23 children who received craniospinal irradiation and two out of eight children who received cranial irradiation have received GH therapy. A catch-up growth response to the daily GH therapy with the mean dose of 0.7 IU/kg per week was complete in 3 years (+1.87 SDS), irrespective of craniospinal irradiation, in children who were treated at prepubertal age but was seen in none of the children who had reached pubertal age. CONCLUSION Growth impairment and GH deficiency are common in children treated for malignant brain tumours. The response to GH therapy is good in prepubertal children in terms of increased growth velocity, although the final height is not yet known.
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Affiliation(s)
- I Ilveskoski
- Children's Hospital, University of Helsinki, Finland
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28
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Schmitt K, Blümel P, Waldhör T, Lassi M, Tulzer G, Frisch H. Short- and long-term (final height) data in children with normal variant short stature treated with growth hormone. Eur J Pediatr 1997; 156:680-3. [PMID: 9296529 DOI: 10.1007/s004310050689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Seventeen children with normal variant short stature and a predicted height below -2 SDS were treated with growth hormone (GH) six times a week for a period of 5 years. Patients were randomly selected to receive three different doses of GH, group 1 (n = 6) 3 IU/m2 per day, group 2 (n = 6) 4.5 IU/m2 per day and group 3 (n=5) 3 IU/m2 per day in the 1st year and 4.5 IU/m2 per day thereafter. There was a significant increase in height after 1 and 2 years for all patients and for all subgroups. However, this increase was not dependent on GH dose. The decrease in height velocity during the 2nd year was not prevented by the increase of GH dose in group 3. The change of predicted height after 2 years was +0.75 SDS (according to Tanner Whitehouse). Fourteen children have been treated for 4 years and 8 children for 5 years without a further change in height prediction. Nine patients have reached final height which was 2.4 cm (+0.41 SDS) above pretreatment height prediction. Final height was nearly identical to predicted height after 1 year of therapy. CONCLUSION An increment in height prediction was observed during the first 2 years of GH treatment and maintained thereafter. However, there was only a minor increase in final height over predicted height which does not justify the general use of GH in children with normal variant short stature.
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Abstract
GH is normally secreted in a pulsatile fashion. When GH is deficient, dwarfism is the result in both rodents and humans. An adenoviral vector containing the rat GH complementary DNA was used to induce constitutive GH expression in hepatocytes of GH-deficient lit/lit mice. Elevated serum GH increased circulating insulin-like growth factor I concentrations, corrected the growth deficiency, and normalized body composition. The results indicate that correction of the dwarf phenotype can be achieved by constitutive expression of GH at an ectopic site by gene transfer.
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Affiliation(s)
- T M Hahn
- Department of Cell Biology, Baylor College of Medicine, Houston, Texas 77030, USA
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30
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Butenandt O. [Growth hormone therapy in childhood. Growth hormone therapy in small children without growth hormone deficiency]. Fortschr Med 1996; 114:201-4. [PMID: 8767930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The availability of unlimited amounts of recombinant human growth hormone (rhGH) has now made it possible to investigate its growth-promoting effect in children in whom growth hormone production is not deficient. In girls suffering from the Ullrich Turner syndrome, treatment with rhGH increases final height by some 6 to 8 cm. An increase in growth rate has also been observed in children with renal insufficiency, and in children with intrauterine growth retardation. Favourable results have also been reported in children receiving glucocorticoids for such chronic conditions as rheumatoid arthritis, and in youngsters with hypochondroplasia. In a further group of children with various disorders an improvement in the growth rate has been observed, although nothing can yet be said about the outcome in terms of final height. To achieve an increase in growth rate, pharmacological doses of growth hormone higher than those used in children with growth hormone deficiency are necessary. For this reason, the risk of unwanted side effects might be higher than in the latter.
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Affiliation(s)
- O Butenandt
- Kinderklinik im Dr. von Haunerschen Kinderspital, Universitat München
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31
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Berthet F, Siegrist CA, Ozsahin H, Tuchschmid P, Eich G, Superti-Furga A, Seger RA. Bone marrow transplantation in cartilage-hair hypoplasia: correction of the immunodeficiency but not of the chondrodysplasia. Eur J Pediatr 1996; 155:286-90. [PMID: 8777921 DOI: 10.1007/bf02002714] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED We diagnosed cartilage-hair hypoplasia (CHH) in a female child with prenatal-onset short stature, metaphyseal chondrodysplasia, and severe combined immunodeficiency leading to recurrent, severe respiratory tract infections. The patient required several hospital admissions during her 1st year of life and failed to thrive in spite of antimicrobial therapy and hypercaloric nutrition. Bone marrow transplantation (BMT) from an HLA-identical sister was performed at age 16 months after conditioning with busulphan and cyclophosphamide, using 9 x 10(8) nucleated bone marrow cells/kg body weight. Graft-versus-host disease prophylaxis consisted of cyclosporine and methotrexate. The post-transplantation period was uneventful. She developed full and sustained chimerism as demonstrated by DNA analysis of granulocytes and mononucleated cells on days 44, 69 and 455 post BMT. Cellular immunity was completely reconstituted at 4 months, humoral immunity at 15 months post BMT. The patient is alive and well 24 months post BMT without medication, but the radiological osseous changes persist, and longitudinal growth remains markedly below the 10th percentile for CHH standards; her height at age 3 years 4 months is 66 cm. CONCLUSION In this patient with unusually severe CHH, bone-marrow transplantation has fully corrected the immune deficiency but has had no influence on the course of the chondrodysplasia.
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Affiliation(s)
- F Berthet
- Division of Immunology and Hematology, University Children's Hospital, Zurich, Switzerland
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32
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Abstract
Growth responses to growth hormone (GH) treatment in Noonan syndrome are compared with those in short children with the other growth disorders. The responses in Noonan syndrome are much less than those in children with GH deficiency, a little less than those in children with non-endocrine short stature and almost the same as those in children with Turner syndrome. As it is speculated that GH induces puberty earlier that expected in Noonan Syndrome, the efficiency of GH treatment for final height in Noonan syndrome is not promising.
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Affiliation(s)
- T Tanaka
- Department of Endocrinology and Metabolism, National Children's Medical Research Center, Tokyo, Japan
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33
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Frankel SA. Psychological complications of short stature in childhood. Some implications of the role of visual comparisons in normal and pathological development. Psychoanal Study Child 1996; 51:455-74. [PMID: 9029971 DOI: 10.1080/00797308.1996.11822441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study examines the effect of short stature on the emotional development of a subgroup of children who were treated in psychoanalysis and psychotherapy. These children became capable of making accurate comparisons of body size in early latency as a result of advances in cognitive development. Recognizing their comparative smallness left them feeling vulnerable and humiliated. They responded with envy and rage toward normally endowed children and vindictively used their intellect to outwit and defeat others. They acted as if their suffering exempted them from ordinary social rules and expectations. Their preoccupation also resulted in arrests in cognitive and social development. Their distrust and intention to deceive and defeat posed particular problems for treatment. This outcome suggests that visual comparisons of size during early latency are implicated in pathological, and therefore in normal, development. Parallels are suggested between the subjective experiences of children in this group and the experiences of children with other kinds of physical deviations and compromising life circumstances.
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34
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Sherman L, Wilson DP. How short is too short? Compr Ther 1995; 21:610-5. [PMID: 8565432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A review of growth parameters should be a routine part of pediatric care. Children and parents need to be helped in understanding normal growth and development. Variations in growth should be explained, and concerns of parents and children openly discussed. Age appropriate educational materials are often helpful. Children with abnormal growth should be referred promptly for definitive diagnosis, selection of treatable candidates, and monitoring.
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Affiliation(s)
- L Sherman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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35
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Crepaz R, Pitscheider W, Radetti G, Paganini C, Gentili L, Morini G, Braito E, Mengarda G. Cardiovascular effects of high-dose growth hormone treatment in growth hormone-deficient children. Pediatr Cardiol 1995; 16:223-7. [PMID: 8524706 DOI: 10.1007/bf00795711] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Growth hormone (GH) hypersecretion is associated with an increased incidence of cardiac hypertrophy and subclinical abnormalities of left ventricular (LV) function. The unlimited availability of biosynthetic GH has led to progressively increased dosage when treating GH-deficient children, raising the question of its cardiovascular effects during long-term therapy. We compared 22 children (8 girls, 14 boys), mean age 12.1 years (range 3-17 years) with GH deficiency who were receiving chronic GH treatment (GH group) with 22 normal controls matched for sex and body size in order to evaluate: (1) LV volume, mass, and systolic function by two-dimensional guided M-mode echocardiography; (2) LV diastolic function by pulsed-wave Doppler sampling of the transmitral flow; and (3) cardiac output and systemic vascular resistance by Doppler echocardiography. All patients had been on chronic GH therapy for 13.8 +/- 7.6 months (range 5-30 months) with an average dose of 0.95 +/- 0.12 IU/kg per week (range 0.69-1.17 IU/kg per week). Blood pressure did not differ between the two groups. LV volume, mass, ejection fraction, and mean velocity of circumferential shortening did not differ significantly between the GH group and controls; nor did the peak- and end-systolic meridional stress. All patients had a normal contractile state as estimated by the relation between mean velocity of circumferential shortening and end-systolic meridional stress. The LV filling parameters did not differ between the two groups, and there was no difference in cardiac index and systemic vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Crepaz
- Department of Cardiology, General Hospital of Bolzano, Italy
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36
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Haffner D, Wühl E, Blum WF, Schaefer F, Mehls O. Disproportionate growth following long-term growth hormone treatment in short children with X-linked hypophosphataemia. Eur J Pediatr 1995; 154:610-3. [PMID: 7588957 DOI: 10.1007/bf02079060] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
UNLABELLED Three short prepubertal children with X-linked hypophosphataemia were treated with 1 IU recombinant human growth hormone (rhGH)/kg per week sc in addition to calcitriol and phosphate supplementation over a period of 3 years. Improvement of height standard deviation score (SDS) ranged from 1.0-1.7 SD based on an increase in sitting height of 1.5-2.9 SD, whereas subischial leg length improved only slightly by 0.3-0.9 SD. In all three patients, renal phosphate threshold concentration increased slightly and transient hyperparathyroidism was noted. CONCLUSION Treatment of stunted children with X-linked hypophosphataemia is effective in improving growth velocity, but appears to aggravate the pre-existent disproportionate stature of such children.
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Affiliation(s)
- D Haffner
- Sektion für Pädiatrische Nephrologie, Universitäts-Kinderklinik, Heidelberg, Germany
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37
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Kelnar CJ, Tanaka T. Is there a place for short bursts of growth hormone treatment in short children without significant growth hormone deficiency? Acta Paediatr Suppl 1994; 406:67-9. [PMID: 7734814 DOI: 10.1111/j.1651-2227.1994.tb13427.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- C J Kelnar
- Department of Child Life and Health, University of Edinburgh, UK
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38
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Affiliation(s)
- S Pantelakis
- Aghia Sophia Children's Hospital, Athens, Greece
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39
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Ranke MB, Lindberg A. Growth hormone treatment of idiopathic short stature: analysis of the database from KIGS, the Kabi Pharmacia International Growth Study. Acta Paediatr Suppl 1994; 406:18-23; discussion 24. [PMID: 7734807 DOI: 10.1111/j.1651-2227.1994.tb13415.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Within the Kabi Pharmacia International Growth Study (KIGS) database, there is information on 1017 (700 male/317 female) patients with idiopathic short stature (ISS). These patients were started on recombinant human growth hormone (GH) at a median age of 10.8 years, a bone age of -1.8 SDS, a height of -2.6 SDS and a predicted adult height (PAH) (Bailey-Pinneau method) of -2.5 SDS. The median dose of GH was 0.6 IU/kg body weight/week and the frequency of injections was six/week. According to the relationship with target height the patients were classified into 'familial short stature (FSS)' (height SDS > target height SDS -1.28) and into 'non-FSS' (height SDS < target height SDS -1.28). During the first year of GH treatment there was an overall increment in the median height velocity from 4.4 to 7.4 cm/year. Over 3 years of GH treatment, cross-sectional analysis demonstrated an overall increment in median PAH of 1.2 SDS. There was a positive correlation between gain in PAH and the GH dose (n = 202, r = 0.18, p < 0.01) during the first year. Longitudinal analysis in 84 patients showed an overall increment of PAH of 0.7 SDS over 2 years of treatment. When applying the KIGS first-year prediction model for patients with idiopathic GH deficiency on cohorts of prepubertal children with FSS and non-FSS, a lower responsiveness to GH in the non-FSS group was observed. It is concluded that higher than substitutive doses of GH are required for the long-term improvement of growth in ISS.
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Affiliation(s)
- M B Ranke
- Section of Paediatric Endocrinology, University Children's Hospital, Tübingen, Germany
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40
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Johannsson G, Rosén T, Lönn L, Bengtsson BA. Effects of recombinant human growth hormone on adipose tissue in adults with growth hormone deficiency. Acta Paediatr Suppl 1994; 406:60-3; discussion 64. [PMID: 7734813 DOI: 10.1111/j.1651-2227.1994.tb13425.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G Johannsson
- Research Centre for Endocrinology and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
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41
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Abstract
Biohybrid implants represent a new class of medical device in which living cells, supported in a hydrogel matrix, and surrounded by a semipermiable membrane, produce and deliver therapeutic reagents to specific sites within a host. First proposed in the mid-1970s for diabetes, this treatment modality has progressed rapidly in the past four years and is now being investigated not just for endocrine disorders but also for alleviation of chronic pain, treatment of neurodegenerative disorders, and delivery of neurotrophic factors to sites within the blood brain barrier, and as a practical alternative to conventional ex vivo.
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Affiliation(s)
- M J Lysaght
- CytoTherapeutics, Inc., Providence, Rhode Island 02906
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42
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Abstract
OBJECTIVE Reversibility of GH insufficiency with a change of environment is characteristic of psychosocial dwarfism, and excludes an organic endocrinopathy. However, the change in GH pulsatility has not previously been described. We therefore wished to study spontaneous GH secretion before and after change to a more favourable environment in 11 children with psychosocial deprivation and short stature in order to evaluate if separation from the families can modify their patterns of GH secretion. PATIENTS AND DESIGN We describe 11 prepubertal children (6 M and 5 F; 2.2-13.5 years of age) who had growth failure and psychosocial deprivation. They were diagnosed by a multidisciplinary team as having environmental growth failure after admission to hospital for 3 weeks. Six of them were discovered to have been sexually abused. During the uninterrupted hospital admission parental access was restricted. Three sets of 18-hour GH profiles were performed on each child, except one child who had only two, during the 3-week admission. MEASUREMENTS Pulse analysis of GH profiles was by Fourier transformation. RESULTS On the first day of admission spontaneous GH secretion demonstrated a spectrum of abnormalities in the pattern of basal values, pulse frequency and pulse amplitude. Such GH insufficiency showed reversibility during the 3 weeks in hospital. Indeed, there was a significant increase in GH secretion which was amplitude modulated without any significant modification in pulse frequency. CONCLUSION Our data indicate that there is abnormal physiological GH secretion in children with psychosocial deprivation, which is associated with growth failure. Despite a pathological situation, each child retained his own characteristic pattern of GH pulsatility. The pattern of reversibility of abnormal GH pulsatility provides information for the mechanism of the control of GH secretion.
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43
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Stabler B, Clopper RR, Siegel PT, Stoppani C, Compton PG, Underwood LE. Academic achievement and psychological adjustment in short children. The National Cooperative Growth Study. J Dev Behav Pediatr 1994; 15:1-6. [PMID: 8195431 DOI: 10.1097/00004703-199402000-00001] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Limited information is available on the educational and behavioral functioning of short children. Through 27 participating medical centers, we administered a battery of psychologic tests to 166 children referred for growth hormone (GH) treatment (5 to 16 years) who were below the third percentile for height (mean height = -2.7 SD). The sample consisted of 86 children with isolated growth-hormone deficiency (GHD) and 80 children with idiopathic short stature (ISS). Despite average intelligence, absence of significant family dysfunction, and advantaged social background, a large number of children had academic underachievement. Both groups showed significant discrepancy (p < .01) between IQ and achievement scores in reading (6%), spelling (10%), and arithmetic (13%) and a higher-than-expected rate of behavior problems (GHD, 12%, p < .0001; ISS, 10%, p < .0001). Behavior problems included elevated rates of internalizing behavior (e.g., anxiety, somatic complaints) and externalizing behavior (e.g., impulsive, distractable, attention-seeking). Social competence was reduced in school-related activities for GHD patients (6%, p < .03). The high frequency of underachievement, behavior problems, and reduced social competency in these children suggests that short stature itself may predispose them to some of their difficulties. Alternately, parents of short, underachieving children may be more likely to seek help. In addition, some problems may be caused by factors related to specific diagnoses.
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Affiliation(s)
- B Stabler
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill 27599-7160
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44
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Eshet R, Klinger B, Silbergeld A, Laron Z. Modulation of insulin like growth factor I (IGF-I) binding sites on erythrocytes by IGF-I treatment in patients with Laron syndrome (LS). Regul Pept 1993; 48:233-9. [PMID: 8265812 DOI: 10.1016/0167-0115(93)90352-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The in vivo regulation of IGF-I binding sites was evaluated using erythrocytes (RBC) from 8 patients with Laron syndrome (LS), before and after IGF-I treatment (120-150 micrograms/kg/day s.c.). Basal fasting IGF-I averaged 20.48 +/- 2.06 nmol/l (mean +/- S.E.M.) in the control group as compared to 4.72 +/- 0.84 nmol/l in the 8 LS patients (P = 0.0001). After 1 week of IGF-I treatment serum IGF-I levels increased to 6.53 +/- 1.58 nmol/l (a mean difference of 1.81 +/- 0.95, P = 0.05) and after 1 month of treatment to 14.37 +/- 4.56 nmol/l (a mean difference of 9.37 +/- 4.42, P = 0.03). Concomitantly, we found a significant decrease in the number of high affinity IGF-I binding sites, from 5.74 +/- 0.86 sites/cell (mean +/- S.E.M.) in the non-treated state to 2.29 +/- 0.64 sites/cell and 2.17 +/- 0.53 sites/cell after 1 week and 1 month of treatment, respectively (a mean difference of -3.44 +/- 0.94, P = 0.004 and -3.58 +/- 0.79, P = 0.002, respectively), values similar to those found in the control group. These data demonstrate that replacement treatment of LS patients with IGF-I down regulates its specific receptors. We propose IGF-I binding to RBC as a test to determine the responsiveness of patients considered for long term IGF-I treatment.
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Affiliation(s)
- R Eshet
- Endocrine and Diabetes Research Unit, Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University
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45
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Abstract
Insulin-like growth factor-I (IGF-I) is a single-chain polypeptide which has multiple metabolic actions and effects on the differentiation and proliferation of a wide variety of cell types. IGF-I has endocrine, paracrine and autocrine actions and is bound in the circulation to a complex system of binding proteins which alter its bioavailability and activity. Thus its physiology is complex and is altered in a number of pathological states. This review will discuss these states and the actual and proposed therapeutic applications of recombinant human IGF-I (rhIGF-I).
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Affiliation(s)
- K S Langford
- Academic Department of Medicine, King's College School of Medicine and Dentistry, London, UK
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46
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47
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Abstract
The mystique of bone dysplasias is gradually vanishing. A short historical overview introduces the subject of short stature. The pathogenesis and controversial classification of skeletal dysplasias are discussed and summarized in two tables; the use of different imaging modalities is laid out along the sequential diagnostic approach and review of common orthopedic complications. References to such advances in treatment as bone marrow transplantation, bone lengthening, and the encouraging positive effect of growth hormone therapy complete this updated revision.
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Affiliation(s)
- R Dominguez
- Department of Pediatric Radiology, Children's Medical Center of Dallas, TX 75235
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48
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Haraldsson A, van der Burgt CJ, Weemaes CM, Otten B, Bakkeren JA, Stoelinga GB. Antibody deficiency and isolated growth hormone deficiency in a girl with Mulibrey nanism. Eur J Pediatr 1993; 152:509-12. [PMID: 8335020 DOI: 10.1007/bf01955061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A combination of humoral immunodeficiency and isolated growth hormone deficiency was observed in a girl with Mulibrey nanism. The humoral immunodeficiency consisted of subnormal concentration of serum IgG, in particular IgG2 and IgG4, and low concentration of serum IgM. Serum IgA and IgD were elevated, IgE was absent. Antibody response in vivo was very low or absent and opsonization in vitro was defective. Total B-cell number was low. In addition, the serum kappa/lambda light chain ratios within the immunoglobulin classes G, A, and M were abnormal. The defective antibody response may be linked to the abnormal kappa/lambda light chain ratios. Endocrine functions were normal except for isolated growth hormone deficiency. Therapy with human growth hormone resulted in increased growth velocity but did not improve humoral immune functions.
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Affiliation(s)
- A Haraldsson
- Department of Paediatrics, University Hospital Nijmegen, The Netherlands
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49
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Kruse K. [Growth hormone treatment of small children with normal growth hormone secretion]. Monatsschr Kinderheilkd 1993; 141:438. [PMID: 8326967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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de Kerdanet M, Seveno T, Lecornu M. [Growth retardation of psychosocial origin. Clinical and biological aspects in four cases]. Pediatrie 1993; 48:783-787. [PMID: 8058437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Four cases of psychosocial dwarfism are reported. The growth follow-up of these four children does not fit to the classical description of rapid improvement once separated from their defective or careless family. This illustrates the difficulties for some children to adapt themselves to a foster family and the need to refer them to an institutional center in order to solve their different somatic, nutritional and psychological problems, together with those of their family. In such cases the important growth retardation and hormonal changes may hide severe psychopathological troubles such as hyperkinetic syndrome, anxiety and, possibly, depression.
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Affiliation(s)
- M de Kerdanet
- Service d'endocrinologie pédiatrique, hôpital Sud, CHR de Rennes, France
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