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Özen S, Ata A, Darendeliler F. The Impact of the CEDD-NET on the Evaluation of Rare Disorders: A Multicenter Scientific Research Platform in the Field of Pediatric Endocrinology. J Clin Res Pediatr Endocrinol 2022; 14:216-220. [PMID: 35135182 PMCID: PMC9176080 DOI: 10.4274/jcrpe.galenos.2022.2021-11-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The database http://cedd.saglik-network.org (CEDD-NET) has been operating since 2013 in Turkey. All pediatric endocrinologists can propose projects to this network. The aim of our study was to determine the impact of CEDD-NET on the transformation of multicenter studies into scientific publications and assess the academic characteristics of the studies that have been transcribed into publication. METHODS All the studies that were opened to patient admission on the website between August 26, 2013 and March 1, 2021 were reviewed. RESULTS A total of 30 studies were accepted and opened for data entry. The median data collection period was 12 (1.5-24) months, while the median number of researchers participated was 23 (3-180), the median number of cases was 120 (26-192). The average cost was $2113 (1370-3118). Out of 30 studies, data entry was completed for 27. Sixteen publications were produced from 14 studies, 13 ot them have not published yet. The median time from the end of data entry to publication of the study was 686 (168-1608) days. While the median impact factor of the journals in which the studies were published was 1.803 (1.278-5.399), the median number of citations was 6.5 (0-49), and cited by 99 times in Web of Science indexed journals in total. CONCLUSION CEDD-NET appears to be productive and effective as all the publications are of high quality that have been published in the Q1-Q2 categories. This study demonstrated the benefits and necessity of establishing nationwide databases, even covering more than one country, in specialized branches, such as pediatric endocrinology where rare diseases are of concern.
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Affiliation(s)
- Samim Özen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey,* Address for Correspondence: Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey Phone: +90 232 390 12 30 E-mail:,
| | - Aysun Ata
- University of Health Sciences Turkey, Adana City Training and Research Hospital, Clinic of Pediatric Endocrinology, Adana, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Attia AIMM, Atef A, Badawi N, Abdou M, Yassin S, Helmy E, Ibrahim HAA. Growth Velocity and Economic Aspects of Human Growth Hormone Treatment in an Egyptian Cohort with Multiple Pituitary Hormone Deficiency: A Retrospective Minireview. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background: Multiple pituitary hormone deficiency (MPHD) is a chronic lifelong disease. Human recombinant growth hormone (hGH) treatment is the optimal therapy for short stature in children with growth hormone (GH) deficiency in patients with MPHD and can effectively increase growth velocity (GV) to attain adult heights within the target range. Objective: to assess the GV during hGH treatment of children with MPHD, to analyze the characteristics of patients and to investigate the possible factors that might affect their height gain. Methods: Data from 18 (8 females) children and adolescents with MPHD with GH, thyroid stimulating hormone, gonadotropin and adrenocorticotropic hormone deficiencies were collected. Subjects were divided into groups: 12 pubescent patients and 6 pre-pubescent patients. Anthropometric measurements were reported regularly for one year. Results: age at onset of study was 13.44±4.66 years. CT and MRI findings were positive in 77.8 %. Peak GH levels after Clonidine and Insulin were 4.06±2.61 and 5.39±4.2 ng/ml respectively. GH was received in a dose of 0.95±0.5 mg/day. Height gain during the period of the study was 3.5±0.47cm /year. The predicted adult height at the first and last visits and delta predicted adult height between the first and last visits were 155.78±10.159, 156.71±7.22 and 0.93±4.64 cm respectively. The cost in dollars was identified using Markov cost-effectiveness simulation model as 98.87±52.4 dollars per one cm height gain, with a total of 346.07±183.42 US dollars/patient/year. For a hGH dose of 0.02±0.01 mg/kg/d (0.95±0.5mg/day). There was a positive correlation between height gain during the study period and both the height SDS at presentation and dose of GH mg/kg/d. Conclusion: the height gain and the cost were higher amongst females than males with MPHD. Height at presentation and hGH dose seemed to be an effective predictor for height gain in patients with MPHD.
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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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Kida A, Nakada Y, Kitano H, Ueno Y. Extreme mini-puberty in an extremely low-birth-weight infant. Pediatr Int 2021; 63:1245-1247. [PMID: 34219336 DOI: 10.1111/ped.14586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ayako Kida
- Department of Neonatology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Yuya Nakada
- Department of Neonatology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Hiroyuki Kitano
- Department of Neonatology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
| | - Yasuhisa Ueno
- Department of Neonatology, Ishikawa Prefectural Central Hospital, Kanazawa City, Ishikawa Prefecture, Japan
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Ranke MB. Short and Long-Term Effects of Growth Hormone in Children and Adolescents With GH Deficiency. Front Endocrinol (Lausanne) 2021; 12:720419. [PMID: 34539573 PMCID: PMC8440916 DOI: 10.3389/fendo.2021.720419] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023] Open
Abstract
The syndrome of impaired GH secretion (GH deficiency) in childhood and adolescence had been identified at the end of the 19th century. Its non-acquired variant (naGHD) is, at childhood onset, a rare syndrome of multiple etiologies, predominantly characterized by severe and permanent growth failure culminating in short stature. It is still difficult to diagnose GHD and, in particular, to ascertain impaired GH secretion in comparison to levels in normally-growing children. The debate on what constitutes an optimal diagnostic process continues. Treatment of the GH deficit via replacement with cadaveric pituitary human GH (pit-hGH) had first been demonstrated in 1958, and opened an era of therapeutic possibilities, albeit for a limited number of patients. In 1985, the era of recombinant hGH (r-hGH) began: unlimited supply meant that substantial long-term experience could be gained, with greater focus on efficacy, safety and costs. However, even today, the results of current treatment regimes indicate that there is still a substantial fraction of children who do not achieve adult height within the normal range. Renewed evaluation of height outcomes in childhood-onset naGHD is required for a better understanding of the underlying causes, whereby the role of various factors - diagnostics, treatment modalities, mode of treatment evaluation - during the important phases of child growth - infancy, childhood and puberty - are further explored.
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Affiliation(s)
- Michael B. Ranke
- Children’s Hospital, University of Tuebingen, Tuebingen, Germany
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Becker M, Hesse V. Minipuberty: Why Does it Happen? Horm Res Paediatr 2021; 93:76-84. [PMID: 32599600 DOI: 10.1159/000508329] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/30/2020] [Indexed: 11/19/2022] Open
Abstract
Minipuberty describes the transient sex-specific activation of the hypothalamic-pituitary-gonadal (HPG) axis during the first 6 months of life in boys and during the first 2 years in girls. It leads to a rise of luteinizing hormone, follicle-stimulating hormone, estradiol, and testosterone. The existence of minipuberty has been known for >40 years, but we still do not fully understand why it takes place. Current thinking suggests that it is an essential imprinting period for different body functions. Firstly, minipuberty plays an important role in genital organ development; testosterone influences penile growth, the number of Sertoli cells, and spermatogenesis. Secondly, it seems to influence the infant's body composition; testosterone likely has an imprinting effect on BMI and body weight of boys and growth velocity in the first 6 months of life. Thirdly, it affects cognitive functions; testosterone has an impact on language organization in the infant brain and estradiol affects laryngeal sound production and baby babbling. There are inconsistent findings concerning the impact of minipuberty on sex-specific playing behavior. Minipuberty is an interesting field of research, and further studies in this area will teach us more about this exciting period of human development.
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Affiliation(s)
- Marianne Becker
- Pediatric Endocrinology and Diabetology (DECCP), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg,
| | - Volker Hesse
- DEUZWEG German Center for Growth, Development and Health Promotion in Childhood and Adolescence, Berlin, Germany
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Ferreira LL, Aguilar Ticona JP, Silveira-Mattos PS, Arriaga MB, Moscato TB, Conceição GC, dos Santos AC, Costa F, Alves CA, Antonini SR. Clinical and Biochemical Features of Hypopituitarism Among Brazilian Children With Zika Virus-Induced Microcephaly. JAMA Netw Open 2021; 4:e219878. [PMID: 33983398 PMCID: PMC8120328 DOI: 10.1001/jamanetworkopen.2021.9878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The Zika virus infects progenitor neuron cells, disrupts cerebral development, and, in mice, drives hypothalamic defects. Patients with microcephaly caused by congenital Zika infection present with midline cerebral defects, which may result in hypopituitarism. OBJECTIVE To analyze postnatal growth and the presence of clinical and biochemical features associated with hypopituitarism in children with congenital Zika infections. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study at 2 public referral hospitals in Bahia, Brazil, specializing in the treatment of congenital Zika infection, clinical data and growth parameters of 65 patients with the infection were evaluated. Data were analyzed from April 2017 through July 2018. EXPOSURE Congenital Zika infection. MAIN OUTCOMES AND MEASURES Length, weight, and head circumference were measured at birth and during follow up (ie, at 27 months of life) for each patient. Basal levels of free thyroxine, thyrotropin, cortisol, corticotropin, prolactin, insulin-like growth factor 1, insulin-like growth factor binding protein 3, urine and plasma osmolality, electrolytes, glucose, and insulin were evaluated at the age of 26 months to 28 months. All patients underwent central nervous system computed tomography scans and ophthalmic and otoacoustic evaluations at the time of this investigation or had done so previously. RESULTS Among 65 patients (38 [58.4%] male; median [interquartile range] age at enrollment, 27 [26-28] months), 61 patients presented with severe brain defects (93.8%), including corpus callosum agenesis or hypoplasia (ie, midline brain defects; 25 patients [38.5%]) and optic nerve atrophy (38 patients [58.5%]). Most patients presented with severe neurodevelopmental delay (62 of 64 patients [96.9%]). Past or present clinical signs of hypopituitarism were rare, occurring in 3 patients (4.6%). Severe microcephaly, compared with mild or moderate microcephaly, was associated with a shorter length by median (interquartile range) z score at birth (-1.9 [-2.5 to -1.0] vs -0.3 [-1.0 to 0]; P < .001), but this difference did not persist at 27 months (-1.6 [-2.3 to -0.3] vs -2.9 [-4.0 to -1.2]; P = .06). Growth hormone deficiency or hypothyroidism were not observed in any patients, and glucose and insulin levels were within reference ranges for all patients. Low cortisol levels (ie, below 3.9 µg/dL) were observed in 4 patients (6.2%). These 4 patients presented with low (ie, below 7.2 pg/mL) or inappropriately low (ie, below 30 pg/mL) corticotropin levels. Low corticotropin levels (ie, below 7.2 pg/mL) were observed in 6 patients (9.2%). Diabetes insipidus was evaluated in 21 patients; it was confirmed in 1 patient (4.8%) and suggested in 3 patients (14.3%). CONCLUSIONS AND RELEVANCE This study found that congenital Zika infection with microcephaly was associated with midline brain defects and optic nerve atrophy. Children with congenital Zika infections presented with prenatal growth impairments with a lack of postnatal catch-up, as shown by persistent short length from birth until 27 months; these impairments were not associated with growth hormone deficiency. Patients also presented with severe developmental delay that was not associated with hypothyroidism, while central adrenal insufficiency and diabetes insipidus occurred in some patients.
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Affiliation(s)
- Leda L. Ferreira
- Programa de Pós-graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Hospital University Hospital Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Juan P. Aguilar Ticona
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Paulo S. Silveira-Mattos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Bahia, Brazil
| | - María B. Arriaga
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Bahia, Brazil
| | - Thaisa B. Moscato
- Associação de Pais e Amigos dos Excepcionais, Salvador, Bahia, Brazil
| | | | - Antonio Carlos dos Santos
- Department of Medical Imaging, Hematology and Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Federico Costa
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Crésio A.D. Alves
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Bahia, Brazil
| | - Sonir R. Antonini
- Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
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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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Abstract
Growth hormone deficiency (GHD) is a rare but treatable cause of short stature. The diagnosis requires a careful evaluation of clinical history, physical examination and appropriate interpretation of longitudinal growth, with specific features for each period of life. Other clinical findings, in addition to growth failure, may be present and can be related to the etiology and to associated hormone deficiencies. Despite more than 50 years since the first reports of provocative tests of growth hormone (GH) secretion for the diagnosis of GHD, the interpretation of the results remains a matter of debate. When GHD is confirmed, GH treatment is recommended. Treatment is effective and safe, but requires daily injections during many years, which can affect adherence. At the end of longitudinal growth, during the transition phase, it might be necessary to re-evaluate GH secretion. This review summarizes and updates the recent information related to GHD in children, as well the recommendations for treatment.
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Affiliation(s)
- Margaret C S Boguszewski
- Department of Pediatrics, Endocrine Division (SEMPR), University Hospital, Federal University of Parana, Curitiba, Brazil.
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Identification of Oliver-McFarlane syndrome caused by novel compound heterozygous variants of PNPLA6. Gene 2020; 761:145027. [DOI: 10.1016/j.gene.2020.145027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/16/2020] [Accepted: 08/01/2020] [Indexed: 02/07/2023]
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Quitmann J, Bloemeke J, Silva N, Bullinger M, Witt S, Akkurt I, Dunstheimer D, Vogel C, Böttcher V, Kuhnle Krahl U, Bettendorf M, Schönau E, Fricke-Otto S, Keller A, Mohnike K, Dörr HG. Quality of Life of Short-Statured Children Born Small for Gestational Age or Idiopathic Growth Hormone Deficiency Within 1 Year of Growth Hormone Treatment. Front Pediatr 2019; 7:164. [PMID: 31111024 PMCID: PMC6501464 DOI: 10.3389/fped.2019.00164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/09/2019] [Indexed: 11/13/2022] Open
Abstract
Aside from clinical endpoints like height gain, health-related quality of life has also become an important outcome indicator in the medical field. However, the data on short stature and health-related quality of life is inconsistent. Therefore, we examined changes in health-related quality of life in German children with idiopathic growth hormone deficiency or children born small for gestational age before and after 12 months of human growth hormone treatment. Children with idiopathic short stature without treatment served as a comparison group. At baseline, health-related quality of life data of 154 patients with idiopathic growth hormone deficiency (n = 65), born small for gestational age (n = 58), and idiopathic short stature (n = 31) and one parent each was collected. Of these, 130 completed health-related quality of life assessments after 1-year of human growth hormone treatment. Outcome measures included the Quality of Life in Short Stature Youth questionnaire, as well as clinical and sociodemographic data. Our results showed that the physical, social, and emotional health-related quality of life of children treated with human growth hormone significantly increased, while untreated patients with idiopathic short stature reported a decrease in these domains. Along with this, a statistically significant increase in height in the treated group can be observed, while the slight increase in the untreated group was not significant. In conclusion, the results showed that human growth hormone treatment may have a positive effect not only on height but also in improving patient-reported health-related quality of life of children with idiopathic growth hormone deficiency and children born small for gestational age.
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Affiliation(s)
- Julia Quitmann
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janika Bloemeke
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Neuza Silva
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Faculty of Psychology and Education Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Monika Bullinger
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Witt
- Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ilker Akkurt
- Children and Adolescent Endocrinology, MVZ am AKK GmbH, Hamburg, Germany
| | | | - Christian Vogel
- Clinic for Children and Adolescent Medicine, Chemnitz Hospital, Chemnitz, Germany
| | | | | | - Markus Bettendorf
- Center for Children and Adolescent Medicine, University Clinic of Heidelberg, Heidelberg, Germany
| | - Eckhard Schönau
- Pediatric Endocrinology, University Clinic of Cologne, Cologne, Germany
| | - Susanne Fricke-Otto
- Center for Children and Adolescent Medicine, HELIOS Hospital, Krefeld, Germany
| | | | - Klaus Mohnike
- University Children's Clinic, Otto von Geuricke University, Magdeburg, Germany
| | - Helmuth-Günther Dörr
- Clinic for Children and Adolescents, Erlangen-Nürnberg Universtiy, Erlangen, Germany
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