Acute and Long-Term Responsiveness to Growth Hormone in Children with Short Stature

Abstract

Acute and long-term responsiveness to human growth hormone (HGH) has been studied in 25 short children. Five had hypopituitarism; 10 had no demonstrable endocrinopathy; 4 were above the 97th percentile for weight but below the 3rd percentile for height; and 6 were small-for-date. When treated with thyroid hormone as well as HGH, 4 of the 5 hypopituitary patients grew significantly. However, 7 of the nonhypopituitary patients with normal or high levels of endogenous HGH (35%) also grew with HGH treatment. Prior to HGH treatment, this group grew at an average rate of 3.4 cm/yr; with HGH, this rate increased to 8.8 cm/yr. Acute responses to HGH did not correlate well with long-term response. Reassessment of the criteria used to select patients for treatment is discussed. Speculation

Growth Response to Growth-Hormone Administration during the Decelerating Phase of the Pubertal Growth Spurt in Short Normal Children

“…The earliest studies by Tanner et al [ 1 ] did not report a response. Grunt et al [2] reported a 3.4 cm/year increase in growth rate in 4 of 10 normal children given pit-hGH. Rudman et al [3] identified subgroups among short children growing <2.5 cm/year who responded well to hGH treatment.…”

“…Several groups have reported a beneficial effect on height velocity (HV) of exogenous GH in short 'normal' children, all these trials being conducted in young prepu bertal children [1][2][3][4][5][6][7][8]. In children with pubertal develop ment, the effects of hGH are difficult to assess due to the inter-individual variability of the pubertal growth spurt.…”

Considerations Related to the Use of Recombinant Human Growth Hormone in Children

“…49,50 Moreover, some children who are not GH-deficient, including girls with Turner's syndrome and children with idiopathic short stature, respond to GH therapy with accelerated growth velocity. [33][34][35] Currently available data indicate that final height (versus predicted height) is improved with GH treatment in patients with Turner's syndrome. 33 Pediatricians must address directly whether GH therapy is acceptable for any children who do not fulfill the "classic" description of GH deficiency, and, if so, for which ones.…”

Whole Body Nitrogen Kinetics and Their Relationship to Growth in Short Children Treated with Recombinant Human Growth Hormone

“…For this reason, before the availability of a growth hormone RIA, improvement in nitrogen balance after growth hormone administration was used routinely for diagnosis of growth hormone deficiency and for assessment of therapeutic response (1 3-22). Even after the measurement of plasma growth hormone concentration became practical, testing the subject's nitrogen retention response to growth hormone administration remained a clinical and investigative tool (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38).…”