Criteria for recognition of the growth-inefficient child who may respond to treatment with growth hormone

Article Abstract:

Adequate growth hormone (GH) is needed for normal growth. Short children with a known deficiency in GH have been successfully treated with GH therapy. Limited supplies of human-derived GH treatments were previously reserved for GH-deficient children. However, with the advent of commercially prepared synthetic GH, therapy can now be offered to children who are not deficient in GH. However, GH is a potent agent with many adverse side effects and therefore not without risk. Furthermore, the long-term growth responses and final adult heights attained after GH therapy are not known. The use of GH therapy in otherwise normal children who are simply short is controversial. In addition, the diagnosis of GH deficiencies by current testing methods is unreliable. To see which short children can benefit from GH therapy, a test for spontaneous release of GH was performed on 104 short children. The children were classified with either classic GH deficiency (10 children), nonclassic deficiency (31 children) or normal short stature (63 children). Children with blood concentrations of GH of less than three micrograms per liter with nonclassic GH deficiency were shown to benefit from six to 24 months of GH therapy. The 24-hour method of determining GH secretion was useful in identifying children that would benefit from GH therapy. This test showed reductions in GH among children whose growth rates were impaired, regardless of how they responded to provocative testing to stimulate GH secretion. Short stature alone was not sufficient criteria for GH therapy selection. Prospective candidates for GH therapy should be determined by qualified pediatric endocrinologists. (Consumer Summary produced by Reliance Medical Information, Inc.)

Growth disorders

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Linear growth response to exogenous growth hormone in children with short stature

Article Abstract:

Successful treatment has been achieved with hormone therapy for children of very short stature. The use of a synthesized human growth hormone (GH) is known to accelerate growth, but the identification of those individuals who will benefit the most from this therapy is less clear. Typically, the level of naturally occurring hormone is tested in these children, which is used to calculate how much supplementation is needed to achieve a therapeutic response. Prior studies have indicated that there usually exists a spectrum of abnormalities, and therefore, a heterogeneous group of GH production and secretion deficits in children of short stature. A group of 38 short children was selected and classified according to average levels of endogenous 24-hour production of GH and the peak GH response to agents which elicit GH production. Also, the linear growth of the children was compared with their chronological age. All of the patients, who ranged in chronological age from 7 to 17, were given GH therapy three to seven times a week for an average of 12.5 months. The pretreatment endogenous or provoked GH values did not have a significant effect on response to treatment. The majority of the children (87 percent), who had an average bone age of 2.7 years less than chronological age, an average growth of less than 4.0 centimeters per year, and whose height was under the first percentile, responded to GH therapy with increases in height velocity. Although long-term follow-up is needed to determine overall outcome, the height velocity seemed to be a critical determining factor in the response to treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Metabolic regulation, Growth (Physiology), Growth regulators, Stature, Short, Short stature

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