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Sánchez Malo MJ, Hidalgo Sanz J, Ferrer Lozano M, Labarta Aizpún JI, de Arriba Muñoz A. Importance of Growth Factors and Bone Maturation Ratio in the Response to Growth Hormone Therapy. Endocr Pract 2024; 30:57-63. [PMID: 37923058 DOI: 10.1016/j.eprac.2023.10.131] [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: 09/19/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The aim was to identify the influence of insulin-like growth factor I (IGF-1), IGF-binding protein-3 (IGFBP-3), and bone age (BA)/chronological age (CA) ratio on the response to GH therapy after 1 and 2 years of treatment and upon reaching final height. METHODS Longitudinal, retrospective, observational study of 139 patients treated for idiopathic growth hormone deficiency. Variables examined during follow-up: (1) genetic background; (2) perinatal history; (3) anthropometry; (4) height velocity, BA, BA/CA and height prognosis; (5) analytical results (IGF-1, IGFBP-3). Final response variables: adult height (AH), AH with respect to target height, AH with respect to initial height prognosis, AH with respect to height at the start of treatment, and AH with respect to height at onset of puberty. RESULTS Lower pretreatment IGF-1 levels and a greater increase in IGF-1 at the end of treatment imply a better response (r = -0.405, P = .007 and r = 0.274, P = .014, respectively), as does a greater increase in IGFBP-3 after 2 years of treatment and at the end of treatment (r = 0.207, P = .035 and r = 0.259, P = .020, respectively). A lower BA/CA ratio pretreatment and at the onset of puberty results in a better response (r = -0.502, P = .000 and r = -0.548, P = .000, respectively), as does a lower increase in BA and BA/CA ratio after the 1 and 2 years of treatment (r = -0.337, P = .000 and r = -0.332, P = .000, respectively). CONCLUSION Low pretreatment IGF-1, a greater BA delay with respect to CA pretreatment and at the onset of puberty, a greater increase in IGFBP-3 after 2 years of treatment, and a lower increase in BA and BA/CA ratio after 1 and 2 years of treatment imply a better long-term response.
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Affiliation(s)
| | | | - Marta Ferrer Lozano
- Department of Pediatric Endocrinology, Miguel Servet University Hospital, Zaragoza, Spain
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Úbeda Trujillo RM, Escribano Sanz P, García Castellanos MT, de Arriba Muñoz A, Vara Callau M, Labarta Aizpún JI. Response to growth hormone treatment in patients with sufficient secretion. ENDOCRINOL DIAB NUTR 2023; 70:326-334. [PMID: 36443195 DOI: 10.1016/j.endien.2022.02.021] [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: 11/09/2021] [Accepted: 02/06/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND There are situations of short stature, with a normal stimulus test for GH, but decreased nocturnal secretion in which there could be a benefit with GH treatment. OBJETIVES To assess adult height and height gain in patients with neurosecretory dysfunction diagnosis treated with growth hormone. MATERIAL Y METHODS Longitudinal, retrospective and observational study including 61 patients treated with growth hormone after diagnosis of neurosecretory dysfunction who have already reached adult height. Variables such as adult height gain, growth rate, growth prognosis variation and IGF-I and IGFBP-3 were evaluated. Variables related to a good response in the first year have also been calculated, using the Index of responsiveness (IoR). RESULTS GH treatment produces an improvement in growth rate and height, observing an increase in adult height with respect to initial height of 1.15±0.60 SD, height with respect to genetic height of -0.015±0.62 SD and adult height with respect to the initial growth prognosis 0,74±1,13 DE. The IoR in the first year is associated with a greater increase in height in the first year (p=0.000), with a greater adult height (p=0.000) and with a greater gain in adult height compared to its initial height (p=0.039). CONCLUSIONS Patients with growth delay due to neurosecretory dysfunction of GH show a good response to treatment with rhGH, observing a significant height gain in their genetic size and improving their initial growth prognosis.
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Affiliation(s)
| | | | | | | | - Marta Vara Callau
- Hospital Universitario Materno-Infantil Miguel Servet, Zaragoza, Spain
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3
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Úbeda Trujillo RM, Escribano Sanz P, García Castellanos MT, de Arriba Muñoz A, Vara Callau M, Labarta Aizpún JI. Respuesta al tratamiento con hormona del crecimiento en pacientes con secreción suficiente. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sánchez Malo MJ, Hidalgo Sanz J, Hernández Tejedor C, García Ventura M, Ferrer Lozano M, Labarta Aizpún JI, de Arriba Muñoz A. Growth hormone deficit: Influence of puberty on the response to treatment. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 96:221-229. [DOI: 10.1016/j.anpede.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/03/2021] [Indexed: 10/19/2022] Open
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Campos-Martorell A, Fernández-Cancio M, Clemente León M, Mogas Viñals E, Fàbregas Martori A, Carrascosa Lezcano A, Yeste Fernández D. Seventy eight children born small for gestational age without catch-up growth treated with growth hormone from the prepubertal stage until adult height age. An evaluation of puberty and changes in the metabolic profile. ENDOCRINOL DIAB NUTR 2021; 68:612-620. [PMID: 34906341 DOI: 10.1016/j.endien.2021.11.024] [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: 07/19/2020] [Accepted: 01/02/2021] [Indexed: 06/14/2023]
Abstract
UNLABELLED A wide variation in height gain rate is observed in children small for gestational age (SGA) treated with growth hormone (GH). The aim of this study was to evaluate prepubertal and pubertal growth, height gain attained at adult age and to assess potential predictive factors in catch-up growth. Changes in metabolic profile were also analyzed. PATIENTS AND METHODS Seventy-eight children born SGA were treated with a GH median dose of 33.0±2.8mcg/kg/day at a mean age of 7.3±2.0 (boys) and 6.0±1.8 (girls). RESULTS Mean height (SDS) at GH onset was -3.31±0.7 for boys and -3.48±0.7 for girls. According to age at pubertal growth spurt onset patients were classified in their pubertal maturity group. Adult height attained expressed in SDS was -1.75±0.7 for boys and -1.69±1.0 for girls, both below the range of their mid-parental height. The greatest height gain occurred during the prepubertal period. Patients with greater height gain were lighter (p<0.001), shorter (p=0.005), and younger (p=0.02) at the start of GH, and also showed a greater increase in growth velocity during the first year on GH (p<0.001). SGA children started puberty at the same age and with the same distribution into pubertal maturity group as the reference population. No relevant GH-related adverse events were reported, including in the insulin resistance parameters evaluated. Differences were found in fasting plasma glucose values, but were without clinical relevance. IGF-I plasma values remained within the safety range. CONCLUSIONS GH therapy is safe and beneficial for SGA children. The response to GH therapy is widely heterogeneous, suggesting that GH should be started at a young age and the GH dose prescribed should be individualized. SGA children started puberty at the same age as the reference population. The only factor that predicts greater adult height is growth velocity during the first year of therapy.
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Affiliation(s)
- Ariadna Campos-Martorell
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain.
| | - Mónica Fernández-Cancio
- Vall d'Hebron Research Institut, Paediatric Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Clemente León
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Research Institut, Paediatric Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Eduard Mogas Viñals
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Anna Fàbregas Martori
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio Carrascosa Lezcano
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Research Institut, Paediatric Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Diego Yeste Fernández
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Research Institut, Paediatric Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
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Ariza-Jimenez AB, Leiva Gea I, Martinez-Aedo Ollero MJ, Lopez-Siguero JP. Isolated Growth Hormone Deficiency and Idiopathic Short Stature: Comparative Efficiency after Growth Hormone Treatment up to Adult Height. J Clin Med 2021; 10:jcm10214988. [PMID: 34768508 PMCID: PMC8585059 DOI: 10.3390/jcm10214988] [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] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/19/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Treatment with growth hormone (GH) is not approved for idiopathic short stature (ISS) in Europe. OBJECTIVES To compare the growth of children treated with isolated GH deficiency (IGHD) vs. ISS-treated and untreated children. METHODS A retrospective descriptive study of patients treated in the last 14 years for IGHD (Group A), in comparison with ISS-treated (Group B) and untreated (Group C) subjects. RESULTS Group A had 67 males, who showed a height gain of 1.24 SD. Group B had 30 boys, who showed a height gain of 1.47 SD. Group C had 42 boys, who showed an improvement of 0.37 SD. The final heights were -1.52 SD, -1.31 SD, and -2.03 SD, respectively. Group A and C did not reach their target heights (with differences of 0.27 SD and 0.59 SD, respectively). Group B surpassed their target height by 0.29 SD. CONCLUSIONS The final heights of the IGHD and treated ISS are similar. Treated groups were taller than untreated groups.
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Affiliation(s)
- Ana-Belen Ariza-Jimenez
- Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (M.J.M.-A.O.); (J.P.L.-S.)
- Correspondence: (A.-B.A.-J.); (I.L.G.)
| | - Isabel Leiva Gea
- Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (M.J.M.-A.O.); (J.P.L.-S.)
- Pediatric Research, Fundación Pública Andaluza Para la Investigación de Málaga en Biomedicina y Salud, 29010 Málaga, Spain
- Correspondence: (A.-B.A.-J.); (I.L.G.)
| | | | - Juan Pedro Lopez-Siguero
- Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (M.J.M.-A.O.); (J.P.L.-S.)
- Pediatric Research, Instituto de Investigación Biomédica de Málaga, 29010 Málaga, Spain
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Sánchez Malo MJ, Hidalgo Sanz J, Hernández Abadía R, Arlabán Carpintero L, Ferrer Lozano M, Labarta Aizpún JI, de Arriba Muñoz A. Growth hormone deficit. Does the first year of treatment influence adult height? ENDOCRINOL DIAB NUTR 2021; 68:534-541. [PMID: 34872636 DOI: 10.1016/j.endien.2021.11.013] [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: 05/31/2020] [Accepted: 10/09/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Short stature is the most frequent reason for Pediatric Endocrinology consultations and sometimes requires treatment with growth hormone. OBJECTIVE The possible correlation of a good response to any early response factor with a better final response was studied, and also whether there was a difference in response to treatment according to the type of deficit. PATIENTS AND METHODS This was a longitudinal, retrospective and observational study of 139 patients treated for idiopathic growth hormone deficiency up to adult height. There were good response criteria in the first year of treatment: a) an increase in growth rate ≥3 cm/year, b) a growth rate ≥1 standard deviation (SD), c) an increase in height ≥0.5 SD, d) an increase in height ≥0.3 SD. Study of the Index of Responsiveness to treatment in the first and second year. Final response variables: adult height with respect to target height, adult height with respect to initial growth prediction and adult height with respect to initial height at the start of treatment. The possible correlation of a good response to any of the early response factors with a better final response to treatment was studied, and also whether there was a difference in the response to treatment according to the type of deficit. RESULTS The treatment produced a gain in adult height with respect to genetic height of 0.06 ± 0.7 SD. Patients considered good responders in the first year of treatment presented a better final response (growth rate ≥3 cm: p = 0.000, growth rate ≥1 SD: p = 0.008, height gain ≥0.5 SD: p = 0.007, height gain ≥0.3 SD: p = 0.006), as well as patients with a severe deficit (p = 0.04). The index of responsiveness to treatment during the first year was associated with a better final response (r = 0.249, p = 0.003), with this correlation being maintained in the second year (r = 0.294, p = 0.01). CONCLUSIONS Growth hormone treatment increased height in the genetic target. The percentage of good responders varied depending on the criteria used. The response in the first year of treatment and a severe deficit were determining factors for achieving a good long-term response.
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Affiliation(s)
| | - Juan Hidalgo Sanz
- Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Marta Ferrer Lozano
- Unidad de Endocrinología Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, Spain
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8
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Campos-Martorell A, Fernández-Cancio M, Clemente León M, Mogas Viñals E, Fàbregas Martori A, Carrascosa Lezcano A, Yeste Fernández D. Seventy eight children born small for gestational age without catch-up growth treated with growth hormone from the prepubertal stage until adult height age. An evaluation of puberty and changes in the metabolic profile. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00111-7. [PMID: 34127440 DOI: 10.1016/j.endinu.2021.01.009] [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: 07/19/2020] [Revised: 12/16/2020] [Accepted: 01/02/2021] [Indexed: 10/21/2022]
Abstract
A wide variation in height gain rate is observed in children small for gestational age (SGA) treated with growth hormone (GH). The aim of this study was to evaluate prepubertal and pubertal growth, height gain attained at adult age and to assess potential predictive factors in catch-up growth. Changes in metabolic profile were also analyzed. PATIENTS AND METHODS Seventy-eight children born SGA were treated with a GH median dose of 33.0±2.8mcg/kg/day at a mean age of 7.3±2.0 (boys) and 6.0±1.8 (girls). RESULTS Mean height (SDS) at GH onset was -3.31±0.7 for boys and -3.48±0.7 for girls. According to age at pubertal growth spurt onset patients were classified in their pubertal maturity group. Adult height attained expressed in SDS was -1.75±0.7 for boys and -1.69±1.0 for girls, both below the range of their mid-parental height. The greatest height gain occurred during the prepubertal period. Patients with greater height gain were lighter (p<0.001), shorter (p=0.005), and younger (p=0.02) at the start of GH, and also showed a greater increase in growth velocity during the first year on GH (p<0.001). SGA children started puberty at the same age and with the same distribution into pubertal maturity group as the reference population. No relevant GH-related adverse events were reported, including in the insulin resistance parameters evaluated. Differences were found in fasting plasma glucose values, but were without clinical relevance. IGF-I plasma values remained within the safety range. CONCLUSIONS GH therapy is safe and beneficial for SGA children. The response to GH therapy is widely heterogeneous, suggesting that GH should be started at a young age and the GH dose prescribed should be individualized. SGA children started puberty at the same age as the reference population. The only factor that predicts greater adult height is growth velocity during the first year of therapy.
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Affiliation(s)
- Ariadna Campos-Martorell
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain.
| | - Mónica Fernández-Cancio
- Vall d'Hebron Research Institut, Paediatric Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Clemente León
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Research Institut, Paediatric Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Eduard Mogas Viñals
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Anna Fàbregas Martori
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio Carrascosa Lezcano
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Research Institut, Paediatric Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Diego Yeste Fernández
- Pediatric Endocrinology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Research Institut, Paediatric Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain; Autonomous University of Barcelona, Barcelona, Spain
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Sánchez Malo MJ, Hidalgo Sanz J, Hernández Tejedor C, García Ventura M, Ferrer Lozano M, Labarta Aizpún JI, de Arriba Muñoz A. [Growth hormone deficit: Influence of puberty on the response to treatment]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00171-5. [PMID: 33994327 DOI: 10.1016/j.anpedi.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/16/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Short stature is the most frequent reason for consultation in Pediatric Endocrinology consultations and sometimes requires treatment with growth hormone. The aim of the study was to analyze the response to treatment based on its onset in pubertal or prepubertal stages and to analyze the possible benefit of an early onset. PATIENTS AND METHODS Longitudinal, retrospective and observational study in 139 patients treated for idiopathic growth hormone deficiency up to adult height. MAIN VARIABLES STUDIED (a) genetic background: maternal, paternal and genetic height; (b) perinatal history; (c) anthropometry during follow-up and at pubertal onset: weight, height, body mass index; (d) variables during follow-up and at pubertal onset: growth rate, bone age and growth prognosis. Final response variables: adult height, adult height with respect to target height, adult height with respect to initial growth prediction, adult height with respect to initial height at the start of treatment and adult height with respect to height at pubertal onset. RESULTS Total pubertal gain was 0.84±0.6 SD. 61.9% of the patients started treatment with rhGH in prepuberty. The initiation of treatment in the prepubertal stage and a higher total pubertal gain are correlated with a better final height (P=.001 and r=0.507, P=.00, respectively). Furthermore, a longer duration of treatment in pre-puberty is correlated with a better final response (r=0.328, P=.00). CONCLUSIONS The start of treatment in the prepubertal stage and its longer duration during this period are determining factors to achieve a good long-term response. Total pubertal gain was greater in patients who started treatment in the pubertal stage.
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Affiliation(s)
| | - Juan Hidalgo Sanz
- Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - Marta Ferrer Lozano
- Unidad de Endocrinología Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, España
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Sánchez Malo MJ, Hidalgo Sanz J, Hernández Abadía R, Arlabán Carpintero L, Ferrer Lozano M, Labarta Aizpún JI, de Arriba Muñoz A. Growth hormone deficit. Does the first year of treatment influence adult height? ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00048-3. [PMID: 33771505 DOI: 10.1016/j.endinu.2020.10.012] [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: 05/31/2020] [Revised: 09/21/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Short stature is the most frequent reason for Pediatric Endocrinology consultations and sometimes requires treatment with growth hormone. OBJECTIVE The possible correlation of a good response to any early response factor with a better final response was studied, and also whether there was a difference in response to treatment according to the type of deficit. PATIENTS AND METHODS This was a longitudinal, retrospective and observational study of 139 patients treated for idiopathic growth hormone deficiency up to adult height. There were good response criteria in the first year of treatment: a) an increase in growth rate≥3cm / year, b) a growth rate≥1 standard deviation (SD), c) an increase in height≥0.5 SD, d) an increase in height≥0.3 SD. Study of the Index of Responsiveness to treatment in the first and second year. Final response variables: adult height with respect to target height, adult height with respect to initial growth prediction and adult height with respect to initial height at the start of treatment. The possible correlation of a good response to any of the early response factors with a better final response to treatment was studied, and also whether there was a difference in the response to treatment according to the type of deficit. RESULTS The treatment produced a gain in adult height with respect to genetic height of 0.06±0.7 SD. Patients considered good responders in the first year of treatment presented a better final response (growth rate≥3cm: p=0.000, growth rate≥1 SD: p=0.008, height gain≥0.5 SD: P=0.007, height gain≥0.3 SD: P=0.006), as well as patients with a severe deficit (P=0.04). The index of responsiveness to treatment during the first year was associated with a better final response (r=0.249, P=0.003), with this correlation being maintained in the second year (r=0.294, P=0.01). CONCLUSIONS Growth hormone treatment increased height in the genetic target. The percentage of good responders varied depending on the criteria used. The response in the first year of treatment and a severe deficit were determining factors for achieving a good long-term response.
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Affiliation(s)
| | - Juan Hidalgo Sanz
- Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - Marta Ferrer Lozano
- Unidad de Endocrinología Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, España
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Straetemans S, De Schepper J, Thomas M, Tenoutasse S, Beauloye V, Rooman R. Criteria for First-Year Growth Response to Growth Hormone Treatment in Prepubertal Children With Growth Hormone Deficiency: Do They Predict Poor Adult Height Outcome? Front Endocrinol (Lausanne) 2019; 10:792. [PMID: 31849835 PMCID: PMC6888254 DOI: 10.3389/fendo.2019.00792] [Citation(s) in RCA: 6] [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: 07/01/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: Several criteria for first-year growth response (FYGR) to growth hormone (GH) treatment have been proposed. We explored which FYGR criteria predicted best the final height outcome after GH treatment in prepubertal children with GH deficiency (GHD). Design and methods: Height data of 129 GHD children (83 boys) who attained adult height and had been treated with GH for at least 4 consecutive years with at least 1 year before pubertal onset, were retrieved from the Belgian GH Registry. The FYGR parameters were: (1) increase in height (ΔHt) SDS, (2) height velocity (HV) SDS, (3) ΔHV (cm/year), (4) index of responsiveness (IoR) in KIGS prediction models, (5) first-year HV SDS based on the KIGS expected HV curve (HV KIGS SDS), (6) near final adult height (nFAH) prediction after first-year GH treatment. Poor final height outcome (PFHO) criteria were: (1) total ΔHt SDS <1.0, (2) nFAH SDS <-2.0, (3) nFAH minus midparental height SDS <-1.3. ROC curve analyses were performed to define the optimal cut-off for FYGR parameters to predict PFHO. Only ROC curves with an area under the curve (AUC) of more than 70% were further analyzed. Results: Twelve, 22 and 10% of the children had respectively a total ΔHt SDS <1, nFAH SDS <-2, and nFAH minus midparental height SDS <-1.3. The AUC's ranged between 73 and 85%. The highest AUC was found for first-year ΔHt SDS to predict total ΔHt SDS <1, and predicted nFAH SDS to predict nFAH SDS <-2. The currently used FYGR criteria had low specificities and sensitivities to detect PFHO. To obtain a 95% specificity, the cut-off value (and sensitivity) of FYGR parameters were: ΔHt SDS <0.35 (40%), HV SDS <-0.85 (43%), ΔHV <1.3 cm/year (36%), IoR <-1.57 (17%), HV KIGS SDS <-0.83 (40%) to predict total ΔHt SDS <1; predicted nFAH SDS (with GH peak) <-1.94 (25%), predicted nFAH SDS (without GH peak) <-2.02 (25%) to predict nFAH SDS <-2. At these cut-offs, the amount of correctly diagnosed poor final responders equals the amount of false positives. Conclusion: First-year growth response criteria perform poorly as predictors of poor final height outcome after long-term GH treatment in prepubertal GHD children.
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Affiliation(s)
- Saartje Straetemans
- Department of Pediatric Endocrinology, Maastricht University Medical Center, Maastricht, Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
- *Correspondence: Saartje Straetemans
| | - Jean De Schepper
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
- Department of Pediatric Endocrinology, University Hospital Brussels, Brussels, Belgium
- Department of Pediatric Endocrinology, University Hospital Ghent, Ghent, Belgium
| | - Muriel Thomas
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
| | - Sylvie Tenoutasse
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
- Department of Pediatric Endocrinology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Beauloye
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
- Unité d'Endocrinologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Raoul Rooman
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
- PendoCon, Putte, Belgium
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Straetemans S, Thomas M, Craen M, Rooman R, De Schepper J. Poor growth response during the first year of growth hormone treatment in short prepubertal children with growth hormone deficiency and born small for gestational age: a comparison of different criteria. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2018; 2018:9. [PMID: 30377433 PMCID: PMC6196419 DOI: 10.1186/s13633-018-0064-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022]
Abstract
Background There is no consensus on the definition of poor growth response after the first year of growth hormone (GH) treatment. We determined the proportion of poor responders identified by different criteria in children with GH deficiency (GHD) and born small for gestational age (SGA). The second aim was to analyze the IGF-1 response in poor growth responders. Methods First-year height data of 171 SGA and 122 GHD children who remained prepubertal during the first GH treatment year were retrieved from the BESPEED database and analyzed. Criteria for poor first-year response/responsiveness were: change in height (∆Ht) SDS<0.3 or<0.5, height velocity (HV) SDS<0.5 or <1 based on the population reference, HV SDS<- 1 based on the KIGS expected HV curve (HV Ranke SDS), studentized residual (SR) <- 1 in the KIGS first-year prediction model. Results ∆Ht SDS<0.5 gave the highest percentage poor responders (37% SGA, 26% GHD). Although % poor responders were comparable for ∆Ht SDS<0.3, HV SDS<+ 0.5, HV SDS<+ 1, SR<- 1, and HV Ranke SDS<- 1, these criteria did not always identify the same patients as poor responders. Among the poor growth responders 24% SGA and 14% GHD patients had an IGF-1 increase < 40%. Conclusions The different response criteria yield high but comparable percentages poor responders, but identify different patients. This study does not provide evidence that one criterion is better than another. A limited IGF-1 generation is not the major reason for a poor growth response in the first year of GH treatment in SGA and GHD children. Trial registration Retrospectively registered.
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Affiliation(s)
- Saartje Straetemans
- 1Department of Pediatric Endocrinology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,2NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.,The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Muriel Thomas
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Margarita Craen
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Laarbeeklaan 101, 1090 Brussels, Belgium.,4Department of Pediatric Endocrinology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Raoul Rooman
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jean De Schepper
- The BElgian Society for PEdiatric Endocrinology and Diabetology (BESPEED), Laarbeeklaan 101, 1090 Brussels, Belgium.,4Department of Pediatric Endocrinology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.,5Department of Pediatric Endocrinology, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
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Crecimiento puberal de 1.453 niños sanos según la edad de inicio de la pubertad. Estudio longitudinal de Barcelona. An Pediatr (Barc) 2018; 89:144-152. [DOI: 10.1016/j.anpedi.2017.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/30/2017] [Accepted: 11/19/2017] [Indexed: 11/15/2022] Open
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Pubertal growth of 1,453 healthy children according to age at pubertal growth spurt onset. The Barcelona longitudinal growth study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Body mass index and tri-ponderal mass index of 1,453 healthy non-obese, non-undernourished millennial children. The Barcelona longitudinal growth study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gutiérrez-Abejón E, Campo-Ortega EP, Prieto-Matos P, Bahíllo-Curieses MP, Breñas-Villalón MT, Martín-Sobrino N. Clinical response to growth hormone in children with intrauterine growth retardation without catch-up growth in Castilla y León (Spain). ACTA ACUST UNITED AC 2018; 65:584-591. [PMID: 30143447 DOI: 10.1016/j.endinu.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/03/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Growth hormone (rhGH) is used in children with intrauterine growth retardation without catch-up growth. The Advisory Committee of Castilla y León was implemented in 2010 to watch for consistent application of the criteria for using rhGH. The aim is to assess anthropometric and clinical changes in children treated with growth hormone. PATIENTS AND METHODS A retrospective, longitudinal study of patients diagnosed with intrauterine growth retardation without catch-up growth in Castilla y León since 2010 who have received treatment for at least 3 years. Changes in anthropometric, clinical, and laboratory parameters were assessed. RESULTS Forty-three children with a mean age of 6.06 years (58.14%<5 years) were enrolled and treated with a mean dose of 0.038mg/kg/day. A significant increase was seen in height (-3.05 to -1.58SD). Both weight and BMI (14.51 to 15.80kg/m2) increased throughout the study. Growth rate peaked during the first year of treatment (0.74SD). IGF-1 levels increased throughout the study (99.96 to 392.88ng/mL). There were significant increases in glycosylated hemoglobin levels in the first year, and in basal blood glucose and insulin levels during the second year. The LDL/HDL ratio decreased during the study period (1.70 to 1.50). CONCLUSION Treatment with rhGH promotes growth in children with intrauterine growth retardation. Peak effect occurs in the first 12 months of treatment, and is greater when growth hormone is started before the age of 5 years.
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Affiliation(s)
- Eduardo Gutiérrez-Abejón
- Servicio de Concierto Farmacéutico y Otras Prestaciones, Dirección Técnica de Asistencia Farmacéutica, Dirección General de Asistencia Sanitaria, Gerencia Regional de Salud de Castilla y León, Valladolid, España.
| | - Eva P Campo-Ortega
- Servicio de Concierto Farmacéutico y Otras Prestaciones, Dirección Técnica de Asistencia Farmacéutica, Dirección General de Asistencia Sanitaria, Gerencia Regional de Salud de Castilla y León, Valladolid, España
| | - Pablo Prieto-Matos
- Servicio de Pediatría, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | | | - María T Breñas-Villalón
- Servicio de Concierto Farmacéutico y Otras Prestaciones, Dirección Técnica de Asistencia Farmacéutica, Dirección General de Asistencia Sanitaria, Gerencia Regional de Salud de Castilla y León, Valladolid, España
| | - Nieves Martín-Sobrino
- Dirección Técnica de Asistencia Farmacéutica, Dirección General de Asistencia Sanitaria. Gerencia Regional de Salud de Castilla y León, Valladolid, España
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Carrascosa A, Yeste D, Moreno-Galdó A, Gussinyé M, Ferrández Á, Clemente M, Fernández-Cancio M. [Body mass index and tri-ponderal mass index of 1,453 healthy non-obese, non-undernourished millennial children. The Barcelona longitudinal growth study]. An Pediatr (Barc) 2018; 89:137-143. [PMID: 29478880 DOI: 10.1016/j.anpedi.2017.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Body mass index-for age (BMI) and tri-ponderal mass index-for-age (TMI) values of healthy non-underweight, non-obese millennial children have not been reported until now. We aimed to obtain these values. SUBJECTS AND METHODS Longitudinal growth study (1995-2017) of 1,453 healthy non-underweight, non-obese millennial children, from birth (n = 477) or from 4 years of age (n = 976) to 18 years in girls and 19 years in boys (25,851 anthropometric measurements). RESULTS In each sex, mean BMI-for-age values increased from birth to one year, declined until 5and increased from then onwards. Mean TMI-for-age values decreased abruptly during the first 6years of age and slowly thereafter, in both sexes. Although, at some ages, mean BMI-for age values differed statistically between sexes, differences were scant and of poor clinical significance. The same occurred for TMI-for-age values. BMI-for-age cut-off values to define underweight status (-2 SD) were similar to those proposed by Cole and the WHO for both sexes. However, BMI-for-age cut-off values to define obesity (+2 SD) were lower in both sexes (1.0-5.3) than those proposed by Cole and similar to those proposed by the WHO until 12 in girls and 14 in boys and lower (1.0-4.8) from these ages onwards. CONCLUSIONS BMI-for-age and TMI-for-age values of healthy non-underweight, non-obese millennial children are provided. No clinically relevant differences were observed between sexes. These values may be used to measure underweight status and obesity in present pediatric populations and to evaluate the relationship between BMI-for-age and TMI-for-age in a clinical setting.
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Affiliation(s)
- Antonio Carrascosa
- Servicio de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron. Universidad Autónoma de Barcelona, Vall d'Hebron (Barcelona), España; CIBER de Enfermedades Raras (CIBERER) ISCIII.
| | - Diego Yeste
- Servicio de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron. Universidad Autónoma de Barcelona, Vall d'Hebron (Barcelona), España; CIBER de Enfermedades Raras (CIBERER) ISCIII
| | - Antonio Moreno-Galdó
- CIBER de Enfermedades Raras (CIBERER) ISCIII; Sección de Neumología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron. Universidad Autónoma de Barcelona, Vall d'Hebron (Barcelona), España
| | - Miquel Gussinyé
- Servicio de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron. Universidad Autónoma de Barcelona, Vall d'Hebron (Barcelona), España
| | | | - María Clemente
- Servicio de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron. Universidad Autónoma de Barcelona, Vall d'Hebron (Barcelona), España; CIBER de Enfermedades Raras (CIBERER) ISCIII
| | - Mónica Fernández-Cancio
- Servicio de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron. Universidad Autónoma de Barcelona, Vall d'Hebron (Barcelona), España; CIBER de Enfermedades Raras (CIBERER) ISCIII
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Sánchez Zahonero J, López García MJ. Estudio valenciano sobre tratamiento con hormona de crecimiento en pequeños para la edad gestacional. An Pediatr (Barc) 2017; 86:87-93. [DOI: 10.1016/j.anpedi.2016.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022] Open
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Study on growth hormone treatment in small for gestational age children. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Straetemans S, De Schepper J, Thomas M, Verlinde F, Rooman R. Validation of Prediction Models for Near Adult Height in Children with Idiopathic Growth Hormone Deficiency Treated with Growth Hormone: A Belgian Registry Study. Horm Res Paediatr 2016; 86:161-168. [PMID: 27598343 PMCID: PMC5296891 DOI: 10.1159/000448553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/19/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM To validate prediction models for near final adult height (nFAH) by Ranke et al. [Horm Res Paediatr 2013;79:51-67]. METHODS Height data of 127 (82 male) idiopathic growth hormone (GH)-deficient children, treated with GH until nFAH, were retrieved from the database of the Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED). nFAH was predicted after first-year GH treatment, applying prediction models by Ranke et al. Bland-Altman plots and Clarke error grid analyses were performed to assess clinical significance of the differences between observed and predicted nFAH. RESULTS In males, the predicted nFAH was higher than the observed nFAH (difference: 0.2 ± 0.7 SD; p < 0.01). In females, there was no significant difference. Bland-Altman analyses showed that the means of the differences between observed and predicted nFAH were close but not equal to zero, with overprediction for smaller heights and underprediction for taller heights. Clarke error grid analysis: in males, 59-61% of the predicted nFAH were within 0.5 SDS and 88% within 1.0 SDS from the observed nFAH; in females, 40-44% of the predicted nFAH were within 0.5 SDS and 76-78% within 1.0 SDS from the observed nFAH. CONCLUSION Ranke's models accurately predicted nFAH in females and overpredicted nFAH in males by about 1.5 cm. In most individuals, the predicted nFAH was within 1 SDS of observed nFAH. These models can be of help in giving realistic expectations of adult height. © 2016 S. Karger AG, Basel.
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Affiliation(s)
- Saartje Straetemans
- Department of Pediatric Endocrinology, University Hospital Maastricht, Maastricht, The Netherlands,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands,The Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium,*Dr. Saartje Straetemans, Department of Pediatrics, Maastricht University Medical Center P. Debyelaan 25 NL-6229 HX Maastricht (The Netherlands) E-Mail
| | - Jean De Schepper
- The Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium,Department of Pediatric Endocrinology, University Hospital Brussels, Brussels, Belgium,Department of Pediatric Endocrinology, University Hospital Ghent, Ghent, Belgium
| | - Muriel Thomas
- The Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
| | - Franciska Verlinde
- The Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
| | - Raoul Rooman
- The Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED), Brussels, Belgium
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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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Wit JM, Ranke MB, Albertsson-Wikland K, Carrascosa A, Rosenfeld RG, Van Buuren S, Kristrom B, Schoenau E, Audi L, Hokken-Koelega ACS, Bang P, Jung H, Blum WF, Silverman LA, Cohen P, Cianfarani S, Deal C, Clayton PE, de Graaff L, Dahlgren J, Kleintjens J, Roelants M. Personalized approach to growth hormone treatment: clinical use of growth prediction models. Horm Res Paediatr 2014; 79:257-70. [PMID: 23735882 DOI: 10.1159/000351025] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/02/2013] [Indexed: 11/19/2022] Open
Abstract
The goal of growth hormone (GH) treatment in a short child is to attain a fast catch-up growth toward the target height (TH) standard deviation score (SDS), followed by a maintenance phase, a proper pubertal height gain, and an adult height close to TH. The short-term response variable of GH treatment, first-year height velocity (HV) (cm/year or change in height SDS), can either be compared with GH response charts for diagnosis, age and gender, or with predicted HV based on prediction models. Three types of prediction models have been described: the Kabi International Growth Hormone Study models, the Gothenburg models and the Cologne model. With these models, 50-80% of the variance could be explained. When used prospectively, individualized dosing reduces the variation in growth response in comparison with a fixed dose per body weight. Insulin-like growth factor-I-based dose titration also led to a decrease in the variation. It is uncertain whether adding biochemical, genetic or proteomic markers may improve the accuracy of the prediction. Prediction models may lead to a more evidence-based approach to determine the GH dose regimen and may reduce the drug costs for GH treatment. There is a need for user-friendly software programs to make prediction models easily available in the clinic.
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Affiliation(s)
- J M Wit
- Department of Pediatrics, Leiden University Medical Center, NL-2300 Leiden, The Netherlands.
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Audí L, Carrascosa A. Clinical usefulness of growth hormone secretion elicited by acute stimulation tests. Clin Endocrinol (Oxf) 2013; 79:168-9. [PMID: 23442210 DOI: 10.1111/cen.12173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 02/17/2013] [Indexed: 12/01/2022]
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