Our study shows that the most severely ill children with septic shock had signs of adrenal insufficiency. Bioavailable cortisol levels were not more informative on adrenal function than total cortisol levels. Besides disease severity, one single bolus of etomidate during intubation was related to decreased adrenal function and 11beta-hydroxylase activity. Decreased adrenal function was not related to decreased 21-hydroxylase activity. Based on our results, it seems of vital importance to take considerable caution using etomidate and consider combining its administration with glucocorticoids during intubation of children with septic shock.

At 6.5 yr after discontinuation of long-term GH treatment, Si, DI, fasting levels of glucose and insulin, body mass index, waist circumference, and IGF-I and IGFBP-3 levels were equivalent for GH-treated and untreated young SGA adults. Systolic and diastolic blood pressure and serum cholesterol were even lower in GH-treated subjects. These data are reassuring because they suggest that long-term GH treatment does not increase the risk for diabetes mellitus type 2 and MS in young adults.

Our study shows that high-dose GH treatment in short SGA children results in high serum GH and IGF-I levels in most children. We recommend monitoring IGF-I levels during GH therapy to ensure that these remain within the normal range.

Compared with normal-statured controls, short prepubertal SGA children had similar adiponectin and lower resistin levels. Two years of GH treatment had no effect on their adiponectin and resistin levels.

Body composition and fat distribution of previously GH-treated SGA adults was similar to that of untreated SGA-S adults. GH-induced catch-up growth has no unfavorable effect on FM and fat distribution compared with spontaneous catch-up growth. However, our study shows that SGA adults in general may have a different body composition than healthy AGA controls.

Aim: We determined whether subclassification of short small for gestational age (SGA) children according to birth anthropometrics could delineate different patterns in gestation, delivery, postnatal growth, response to growth hormone (GH) treatment and parental height. Methods: 201 short SGA children were divided into three groups, SGA_L, SGA_L+W and SGA_L+W+HC, according to birth length (L), weight (W) and head circumference (HC) ≤–2.00 standard deviation score (SDS). Results: SGA_L+W+HC children were born after the shortest gestational age and more often by caesarean section than SGA_L children (36.3 vs. 38.1 weeks, 68.4 vs. 24.4%). SGA_L+W children had an intermediate pattern and experienced most gestational hypertension (p = 0.01). At birth, SGA_L+W+HC children were shorter than SGA_L or SGA_L+W (–4.12 vs. –2.67 and –3.72 SDS, p ≤ 0.001). During the first 3 years of life, SGA_L+W+HC children exhibited an increased growth in height (0.98 SDS) and HC (1.28 SDS) than SGA_L (height, –0.06 SDS; HC, –0.30 SDS) and SGA_L+W (height, 0.62 SDS; HC, –0.31 SDS). However, HC SDS remained smaller for SGA_L+W+HC than the other groups at age 3. The groups did not differ in growth response during GH treatment. SGA_L children tended to have shorter parents and target height than SGA_L+W+HC children. Conclusions: Our study shows that subclassification of short SGA children might be a useful method for investigating SGA children as the subgroups revealed a different gestation, delivery and postnatal growth pattern. Response to GH treatment was not different between the groups.

Plasma MMP-9 levels and systolic BP SDS decreased to almost 50% of baseline values in the GH group but remained unchanged in untreated SGA controls. Our data indicate that GH has a positive effect on both MMP-9 levels and systolic BP SDS.

Short SGA girls lack the normal increase in GH levels seen in puberty and have reduced IGF-I and IGFBP-3 levels, which might explain their reduced pubertal growth spurt. GnRHa treatment led to a significant reduction in GH levels. Therefore, combining GnRHa treatment with GH treatment might improve adult height of short SGA girls.