Growth hormone deficiency: diagnosis and therapy in children

Bozzola, Mauro; Meazza, Cristina

doi:10.1586/eem.09.69

Cited by 7 publications

(7 citation statements)

References 80 publications

(46 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These patients exhibited short stature (height -1.76 ± 0.64 standard deviation score (SDS)), a body mass index (BMI) of -1.15 ± 2.52 SDS, and a bone age of 8.68 ± 3.42 years. Severe GHD (GH peak <5 ng/ml) was found in 28 patients, while partial GHD (GH peak <10 ng/ml) [3,10] was observed in 78 cases, with low IGF-I circulating values. Recombinant human GH was administered by daily subcutaneous injection at a dosage of 21 µg/kg in prepubertal and 25 µg/kg in pubertal patients.…”

Section: Patientsmentioning

confidence: 99%

Adherence to Growth Hormone Therapy: A Practical Approach

et al. 2014

View full text Add to dashboard Cite

Background: Early detection of suspected poor adherence to growth hormone (GH) therapy is crucial to achieve normal final height in GH-deficient (GHD) patients. Patients: 106 children (73 M, 33 F) with a median age of 10.47 ± 3.48 years (mean ± standard deviation score (SDS)) exhibited short stature (-1.76 ± 0.64 SDS) and a delayed bone age (8.68 ± 3.42 years). Severe GHD was found in 28, while partial GHD was seen in 78 cases, with low IGF-I values. Recombinant human GH was administered by daily subcutaneous injection at a dosage of 21 µg/kg in prepubertal and 25 µg/kg in pubertal patients. Results: Poor adherence was suspected in a number of patients, but clearly demonstrated in only 4 cases with persistent reduced height velocity in spite of a corrected therapeutic regimen. These patients admitted incomplete adherence to GH injections and clinical and anthropometric measurements revealed their poor response to therapy. Conclusions: To efficaciously improve adherence in GHD patients, it is mandatory to regularly interview patients; a non-aggressive approach might be utilized to ensure effective communication with patients and their parents.

show abstract

Section: Patientsmentioning

confidence: 99%

Adherence to Growth Hormone Therapy: A Practical Approach

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Indeed, no stimulation test is completely reliable, although for clinical practice the Insulin Tolerance Test (ITT) is the gold standard [29]. As summarized in Table 3, different pharmacological stimuli are used to measure GH secretion [41]. Sometimes, to improve specificity of the test, pharmacological stimuli may be combined, for example, the combination of GHRH and arginine.…”

Section: Provocative Gh Testingmentioning

confidence: 99%

Growth Hormone Deficiency: Diagnosis and Therapy in Children

Boiocchi¹,

Meazza²

2016

Restricted Growth - Clinical, Genetic and Molecular Aspects

Self Cite

View full text Add to dashboard Cite

Short stature has been defined as a height below the 2 standard deviation for age, sex and ethnicity. Growth hormone deficiency (GHD) represents a condition characterized by reduced GH secretion, isolated or associated with other pituitary hormone deficiencies. In a child with short stature and growth deceleration, after the exclusion of other causes of growth failure, the diagnosis of GHD has to be confirmed by measurement of GH secretion after at least two stimulation tests. Patients with GHD should be treated with rhGH as soon as possible, to obtain normalization of growth and normal final height. The catch-up growth in response to rhGH therapy is maximal during the first years and could be affected by many variables, such as birth-weight, age and height at start of treatment and of puberty, and duration of treatment. Overall, rhGH is believed to be safe and significant side-effects in children are very rare, including benign intracranial hypertension, hyperglycaemia, arthralgia and myalgia. Patients with childhood onset GHD are usually retested in late adolescence to confirm the GHD persistence and to continue of GH therapy. In conclusion, the present chapter provides useful and updated information about the diagnosis, treatment and follow-up of children with GHD.

show abstract

“…The pattern of GH induced growth consists of a first phase of accelerated growth, which allows the child to approach its target height in a number of years and is followed by a phase of maintenance growth where height velocity (HV) is normal. Several studies have evidenced that this GH induced growth acceleration diminishes rapidly, which is called the waning effect (2,3). This waning has been explained by a GH receptor desensitization, but its determinants have been poorly studied in children with GHD.…”

Section: Introductionmentioning

confidence: 99%

Is a Two-Year Growth Response to Growth Hormone Treatment a Better Predictor of Poor Adult Height Outcome Than a First-Year Growth Response in Prepubertal Children With Growth Hormone Deficiency?

Straetemans

Rooman²,

Schepper³

2021

Front. Endocrinol.

View full text Add to dashboard Cite

ObjectiveThe first year response to growth hormone (GH) treatment is related to the total height gain in GH treated children, but an individual poor first year response is a weak predictor of a poor total GH effect in GH deficient (GHD) children. We investigated whether an underwhelming growth response after 2 years might be a better predictor of poor adult height (AH) outcome after GH treatment in GHD children.Design and methodsHeight data of GHD children treated with GH for at least 4 consecutive years of which at least two prepubertal and who attained (near) (n)AH were retrieved from the Belgian Register for GH treated children (n = 110, 63% boys). In ROC analyses, the change in height (ΔHt) SDS after the first and second GH treatment years were tested as predictors of poor AH outcome defined as: (1) nAH SDS <−2.0, or (2) nAH SDS minus mid-parental height SDS <−1.3, or (3) total ΔHt SDS <1.0. The cut-offs for ΔHt SDS and its sensitivity at a 95% specificity level to detect poor AH outcome were determined.ResultsEleven percent of the cohort had a total ΔHt SDS <1.0. ROC curve testing of first and second years ΔHt SDS as a predictor for total ΔHt SDS <1.0 had an AUC >70%. First-year ΔHt SDS <0.41 correctly identified 42% of the patients with poor AH outcome at a 95% specificity level, resulting in respectively 5/12 (4.6%) correctly identified poor final responders and 5/98 (4.5%) misclassified good final responders (ratio 1.0). ΔHt SDS after 2 prepubertal years had a cut-off level of 0.65 and a sensitivity of 50% at a 95% specificity level, resulting in respectively 6/12 (5.5%) correctly identified poor final responders and 5/98 (4.5%) misclassified good final responders (ratio 1.2).ConclusionIn GHD children the growth response after 2 prepubertal years of GH treatment did not meaningfully improve the prediction of poor AH outcome after GH treatment compared to first-year growth response parameters. Therefore, the decision to re-evaluate the diagnosis or adapt the GH dose in case of poor response after 1 year should not be postponed for another year.

show abstract

Growth hormone deficiency: diagnosis and therapy in children

Cited by 7 publications

References 80 publications

Adherence to Growth Hormone Therapy: A Practical Approach

Adherence to Growth Hormone Therapy: A Practical Approach

Growth Hormone Deficiency: Diagnosis and Therapy in Children

Is a Two-Year Growth Response to Growth Hormone Treatment a Better Predictor of Poor Adult Height Outcome Than a First-Year Growth Response in Prepubertal Children With Growth Hormone Deficiency?

Contact Info

Product

Resources

About