Growth Hormone Treatment in Non‐Growth Hormone‐Deficient Children: Effects of Stopping Treatment

Abstract

the General Infirmary, Leeds, the John Radcliffe Hospital, Oxford and the Childrens Hospital. Birmingham, UK). Growth hormone treatment in non-growth hormonedeficient children: effects o f stopping treatment. Acta Paediatr . %and [Suppl] 366: 32. 1990.Overnight physiological growth hormone (CH) secretion was evaluated in 95 short, prepubertal children (73 boys, 22 girls). A l l the children were below the 3 r d centile for height and achieved CH levels greater than 15 mU/I following pharmacological stimulation. The mean average CH level waq 7.1 m(J/l and the mean sum o f pulse amplitudes 80.4 mU11. No relationship was found between age. height o r height velocity and any o f the parameters o f G H secretion. The group was randomized to receive placebo, G H or remain under observation for the first 6 months and then all patients received G H treatment for a further 6 months. Those treated with GH, 0.27 I t i / k g (0.1 mglkg) three times weekly, in the first phase. demonstrated a mean increase in height velocity SDS o f 3.24. There was no difference in growth response between the placebo o r observation groups. In the second 6-month period. all children received GH according to the same dose regimen: they were then observed for a further 6 months following its discoiltinuation. In the 6 months following withdrawal o f GH. all groups showed a significant fall in height velocity SDS, which returned to pretreatment levels, without demonstrating 'catch-down' growth. Repeat sampling of overnight G H secretion within 3 days o f discontinuing G H showed normal secretory patterns with a small redurtion in mean peak amplitude. These results suggest that short children without classic G H insufficiency respond well to exogenous GH in the short term and return to pretreatment height velocities afterwards. Consequently. it may be possible to increase final adult height in such children by GH treatment. Key W O~S : Shun stature. growrh hormone teeretion, growth hormone treatment.

GH dependence and GH withdrawal syndrome in GH treatment of short normal children: evidence from growth and cardiac output

“…The dose used in the present study was similar (14) or lower than the other reports (4,15,16). It was given by us as a daily subcutaneous injection and as 3 times weekly intramuscular (14) or subcutaneous (15,16) injections in the previous reports. In the mechanism of deceleration of growth the dose is, therefore, of no importance, but the daily schedule of injections might be meaningful.…”

“…Chalew et al (15) observed deceleration of growth in 5 out of 11 patients. Ackland et al (16) showed a fall in growth velocity to pretreatment values after 6 months of GH therapy and did not observe any deceleration of growth. The discrepancy of results with the present report, where all children showed deceleration of growth, seems to rest with the daily GH dose for a much longer treatment period.…”

“…Although spontaneous secretion of GH was not measured, normal levels of IGF-I and IGFBP-3 reflect an intact GH-IGF-I axis. Indeed, it was reported that exogenous GH therapy for as long as 12 months did not interfere with the endogenous pulsatile secretion of GH (16,21), although these two protocols used 3 times weekly GH injections. Subcutaneous administration of daily GH results in an unphysiological serum GH profile, with peak levels at 4 h, and slow disappearance over the course of 12-24 h. This pattern can be regarded as continuous administration of GH, rather than the physiological pulses, with a frequency of eight per day.…”

Clinical effectiveness and cost-effectiveness of growth hormone in children: a systematic review and economic evaluation

“…The studies had small sample sizes, and only three studies 38,42,43 included more than 50 participants. Inclusion criteria for participants were broadly similar, specifying short normal children less than the 3rd percentile in height, with no chronic illness or dysmorphic syndromes.…”

“…Inclusion criteria for participants were broadly similar, specifying short normal children less than the 3rd percentile in height, with no chronic illness or dysmorphic syndromes. Five studies 23,[38][39][40]43 included children who were prepubertal, and two studies 37,41 had pubertal children, one of which included girls only. 37 Six of the trials 23,37-41 compared GH-treated children with untreated controls, with an additional treatment group receiving luteinising hormone-releasing hormone analogue (LHRHa) to delay puberty in one trial, 41 and an additional group of patients who did not give consent to randomisation in another trial.…”