Adult Height after Growth Hormone Treatment at Pubertal Onset in Short Adolescents Born Small for Gestational Age: Results from a Belgian Registry-Based Study

Abstract

Objectives Information on the efficacy of GH treatment in short SGA children starting their treatment in adolescence is limited. Therefore, adult height (AH), total height gain, and pubertal height gain were evaluated in short SGA children who started GH treatment at pubertal onset. Patient and Methods Growth data of 47 short SGA adolescents (22 boys) who started GH treatment at pubertal onset (PUB group) were compared with results from 27 short SGA patients (11 boys) who started GH therapy at least 1 year before pubertal onset (PrePUB group). Results The PUB group achieved a mean (±SD) total height gain of 0.8 ± 0.7 SDS and an AH of −2.5 ± 0.7 SDS after 4.1 ± 1.1 years of GH treatment with a dosage of 41.8 ± 8.4 μg/kg/day. These results were comparable with those in the PrePUB group, which was treated for a longer duration (5.8 ± 2.1 years), resulting in a total height gain of 1.1 ± 0.7 SDS and an AH of −2.1 ± 1.0 SDS. Multiple regression analysis showed a significantly lower height gain in pubertal patients, females, and patients weighing less at start of GH treatment. An AH above −2 SDS and above the parent-specific lower limit of height was, respectively, reached in 28% and 70% of PUB and 44% and 67% of PrePUB patients (NS). AH SDS was positively correlated with the height SDS at start of GH. Conclusions Short SGA adolescents starting GH therapy at an early pubertal stage have a modest and variable height gain. A normal AH can be expected in one third of the patients, especially in those with a smaller height deficit at onset of GH treatment.

Factors influencing height gain in children born small for gestational age treated with recombinant growth hormone: what extent is puberty involved?

“…However, other studies, such as that of Beisti, 16 found a smaller difference in genetic height as a factor associated with AH gain. The difference between the sexes observed in our study in terms of HG is not described in the literature; in fact, in the Belgian study, 18 a lower AH and HG was observed in girls compared with boys. This last study showed a positive correlation between AH and height at the beginning of treatment, a result similar to that obtained in our sample.…”

Determinants of Final Height in Patients Born Small for Gestational Age Treated with Recombinant Growth Hormone

“…Consistent with these studies, we found an average height gain of 0.7 SD (±1.0) in treated SGA children. In addition, we were able to confirm that rhGH treatment allowed SGA children to reach a final height of between −0.9 and −2.1 SD, that is, within the normal range for the majority of patients [15-17, 21, 31, 32]. Mairoara and Cianfarani [33] in 2009 reported a meta-analysis including 29 studies showing the efficacy of rhGH for improving adult height.…”

Adherence and growth outcomes in children with growth disorders: results from the Easypod™ Connect Observational Study (ECOS) in Indonesia, Singapore, and Taiwan

“…Better response is seen when GH is initiated pre-pubertally. 1,[4][5][6]30 Thus, the full pattern of catch-up growth could not be fully assessed in this study.…”

“…[1][2][3] Treatment is aimed to improve linear growth, metabolic parameters, and adult height; outcomes are improved by early start and long treatment duration. [4][5][6][7] Motivation for long-term commitment to regular injections by patients and/or caregivers may decrease over time as continuous daily subcutaneous injections may be perceived to be burdensome, with less obvious treatment benefits. [8][9][10][11] Poor adherence to GH therapy is reported to be common, with consequent decrease in efficacy outcomes.…”