The growth of 26 short normal prepubertal children (mean age 8-4, height velocity standard deviation score for chronological age between +0-4 and -0-8) was studied for two years. Sixteen children were treated with somatrem (methionyl growth hormone) during the second year, and the remaining 10 children served as controls. During one year of treatment the height velocity standard deviation score for chronological age increased from the pretreatment mean of -044 (SD 0.33) to +2*20 (1.03). These values represented a change in height velocity from a pretreatment mean of 5-3 cm/year (range 4.6-6.9) to 7-4 cm/year (range 5-7-9-9). In the control group the height velocity standard deviation score was unchanged. Bone age advanced by 0-75 (0-33) years in the treated group compared with 0-70 (0.18) years in the control group. There was a significant increase in the height standard deviation score for bone age (0-63 (0.55)) in the treated group.Multiple regression analysis of predictive factors contributing to the change in height velocity standard deviation score over the first year of treatment showed that the dose of growth hormone and pretreatment height velocity standard deviation score were important, together yielding a regression correlation coefficient of 0-80. The only metabolic side effect of treatment was an increase in fasting insulin concentration, which may be an important mediator of the anabolic effects of growth hormone. Treatment had no effect on thyroid function, blood pressure, or glucose tolerance. At the end of the treatment year seven of the 16 treated children had developed antibodies to growth hormone, but they were present in low titre with low binding capacity and in no child was growth attenuated.Biosynthetic growth hormone improved the height velocity of children growing along or parallel to the third height centile, but the effects on height prognosis need to be assessed over a longer period.
IntroductionWe have recently shown an asymptomatic relation between the height velocity of short prepubertal children and the amount of growth hormone secreted over 24 hours.' The implication of this relation was, firstly, that children growing poorly and secreting little growth hormone would respond best to growth hormone treatment, a hypothesis well tested and proved by experience with human growth hormone treatment2 3; and, secondly, short children growing with a normal growth velocity would also respond, albeit to a lesser extent.The second hypothesis has not been tested to any extent owing to limited supplies of human growth hormone. Several groups have reported a beneficial effect of exogenous growth hormone in short "normal" children, but the definition of normality was based predominantly on the biochemical response to pharmacological testing with little account taken of the children's growth rate.49 If children are not to gain or lose height compared with their peers then they must grow with a 50th centile height velocity.'0 In practice, as children growing along or parallel to the third...