Plasma growth hormone concentration after a single intramuscular injection of human growth hormone

Conventional and nonconventional uses of growth hormone

Although GH has been available as a therapeutic agent for the GH-deficient child for more than 30 years, the conditions of its use have yet to be optimized. The availability of biosynthetic material has provided researchers with the opportunity to develop the protocols necessary to begin to finally answer the most fundamental questions pertaining to dose, frequency, and duration of treatment. It has also permitted the initiation of prospective trials in a large number of conditions that result in childhood short stature, with the expectation that some or many of them will be treated effectively and safely. Finally, it has opened the door to an entire spectrum of potentially new uses of GH and other growth factors for so-called nonconventional indications. That these have implications that range from the short-term rapid healing of a burn graft site, to the more efficient induction of ovulation, to the long-term preservation of lean body mass has excited the interest of investigators in many fields of medicine and physiology. Thus, the recent progress reported in this paper is really the beginning of the new research that will take place with GH and growth factors.

Treatment of growth hormone deficiency

According to the results reported in the literature and from our own experience, the following recommendations for the treatment of children with GHD can be given: In order to start GH replacement therapy in early childhood the diagnosis of GHD should be made as early as possible. The growth hormone dose during prepubertal age should not fall short of 12 IU/m2 per week. During spontaneous or induced puberty, the dose needs to be increased, possibly by a factor of two. Daily subcutaneous injections appear most suitable. Treatment with growth hormone releasing factors in cases with hypothalamic GHD, although a promising alternative to the treatment with hGH (Thorner et al, 1985), must be considered experimental at this point. Thyroxine replacement at a daily dose of 75-100 micrograms/m2 should be given in cases of secondary hypothyroidism. Glucocorticoid replacement, if required, should be given at low doses (e.g. hydrocortisone 10 (to 15) mg/m2 per day in divided doses). In cases with additional gonadotropin deficiency, sex steroids (or anabolic steroids) should be given with frequent monitoring of bone maturity not before the age of 13 in girls or 15 years in boys. In boys depot testosterone starting at low doses (e.g. 50-100 mg/month i.m.) will induce a puberty-like increment in height velocity. Since the effect of oestrogens--even in low doses--on growth is uncertain, their administration before achievement of near-normal adult height should be avoided. With the advancement of diagnostic techniques and with the experience in treatment accumulated over the past 25 years, patients with GHD need no longer become dwarfs.

Alloimmune neonatal thrombocytopenia and hydrocephalus. Platelet antigen Zwa, ABO-antigens and HLA-antigens in mothers to infants with hydrocephalus

In 27 mothers to infants with hydrocephalus determinations of platelet antigen Zwa, HLA-typing and ABO-typing were performed in order to evaluate whether undiagnosed alloimmune neonatal thrombocytopenia (AINT) could be an aetiological factor in hydrocephalus. All mothers were Zwa-positive, and the frequency of HLA-antigens and ABO-antigens was as in the normal population. Though sporadic cases of hydrocephalus following AINT are reported, this is not a common cause of intracranial haemorrhage and hydrocephalus.

Use of growth hormone-gel

We evaluated the efficacy of a depot preparation of growth hormone (GH) in a 15% gelatin solution (GH-gel) in the treatment of 15 growth hormone-deficient children. The studies were designed to see if prolonging absorption of GH to achieve lower more physiological concentrations of GH in plasma would decrease the frequency of injection, reduce the amount of GH needed for effective therapeutic response, and improve the response to long-term treatment. We found that after a single dose of GH-gel the plasma concentrations of GH were lower than those achieved after the standard aqueous preparation. The preparation was efficacious in promoting growth and our 1st study of 6 patients suggested that GH-gel given twice a week had a growth response equal to that of the three-times a week aqueous schedule. However both schedules resulted in the frequently observed decreased growth rate during the second treatment year. Our 2nd study, attempting to ameliorate this waning effect by using the GH-gel preparation twice a week in a weight-adjusted dose during the entire second year did not resolve the problem. Thus, GH in depot gel results in more physiological plasma concentrations of GH and may be beneficial in reducing the quantity of hormone needed and the injection frequency but it does not offer a solution to the waning response to the long-term administration of GH.