Growth Velocity, Final Height and Bone Mineral Metabolism of Short Children Treated Long Term with Growth Hormone

Lanes, Roberto
July 2000
Current Pharmaceutical Biotechnology;Jul2000, Vol. 1 Issue 1, p33
Academic Journal
Since human recombinant growth hormone (GH) became available a large number of short GH deficient and GH-sufficient children have been treated with growth hormone. Growth hormone deficient patients have been followed to final height and several studies have shown that even when treated with GH from very early on in life they tend to end up shorter than their target height. There is, however, a clear increase in their growth velocities particularly during the first 4-5 years of GH therapy so that patients end up with a height-SD score of aproximately -0.8. Recent studies have demonstrated decreased bone mineral densities (BMD) in children with growth hormone deficiency, both by areal and volumetric analysis. Therapy with growth hormone clearly increases their BMD with an increase in bone formation markers, as will be reviewed in detail. Growth hormone therapy of non-growth hormone deficient short children has increased their growth velocity short term, particularly in girls with Turners syndrome and in children with chronic renal insuficiency. Recent final height data by Rosenfeld et al. and by Swedish and Dutch groups have demonstrated a gain of 8-12 cm in girls with Turners syndrome treated with GH or with a combination of GH and oxandrolone. Neely et al. and we have demonstrated that growth hormone treated prepubertal age girls and adolescents with Turners syndrome have normal BMD and Shaw et al. has suggested that they have normal BMD despite GH or estrogen therapy. However, we found the BMD of a group of previously GH treated young women with Turners syndrome on estrogen replacement to be decreased compared to both age and gender matched controls and to controls of the same weight and pubertal status. Growth hormone therapy increases the growth velocity and the final height of children with chronic renal insuficiency, particularly in prepubertal children treated with GH before dialysis. We have demonstrated how the BMD of these patients, which at baseline is low when compared to healthy age matched controls, but normal when compared to height and bone age matched controls, increases with growth hormone treatment significantly, moreso than in untreated uremic controls or in untreated healthy controls paired for height and bone age. Short, slowly growing, non growth hormone deficient patients (idiopathic short stature) have been treated for prolonged periods of time with GH. We and others have demonstrated a clear increase in their growth velocity short term, but improvement of their final height remains unclear and controversial. After 4-8 years of GH treatment, Hintz et al. have found a 5-6 cm increase in final height compared to the predicted adult height before beginning therapy, but most patients did not reach their target heights. Other studies, however, have found no improvement in final height and Kawai et al. even suggests that GH therapy diminishes the final height of treated children due to an earlier puberty and a shorter pubertal growth spurt. We, have found decreased BMD in children with idiopathic short stature when compared to controls of their same height and bone age with a significant increase in BMD following 12 months of GH and with an increase in bone turnover as measured by bone formation and resorption markers. Recent short term studies in patients with hypophosphatemic rickets and osteogenesis imperfecta treated with rhGH have also yielded similar results which will be specified in the review. Some 10-20percent of children born with intrauterine growth retardation (IUGR) end up short and we had already demonstrated 20 years ago how 2 years of GH therapy were capable of increasing their growth velocities significantly with an improvement of their height-SD scores. Recent studies mainly from Europe have corroborated this data long term, so that IUGR children have been shown by de Zegher et al. to increase their growth velocities and their height for age after 6 years of treatment, entering into the low normal centiles of their growth curves for age. Long term studies of these children to final height will be necessary to determine the usefulness and safety of this form of therapy.


Related Articles

  • Short- and long-term (final height) data in children with normal variant short stature treated with growth hormone. Schmitt, K.; Blümel, P.; Waldhör, T.; Lassi, M.; Tulzer, G.; Frisch, H. // European Journal of Pediatrics;1997, Vol. 156 Issue 9, p680 

    Seventeen children with normal variant short stature and a predicted height below -2 SDS were treated with growth hormone (GH) six times a week for a period of 5 years. Patients were randomly selected to receive three different doses of GH, group 1 (n=6) 3␣IU/m[sup 2 ] per day, group 2...

  • Extensions of Logical Analysis of Data for growth hormone deficiency diagnoses. Lemaire, Pierre // Annals of Operations Research;Jun2011, Vol. 186 Issue 1, p199 

    We propose two extensions of the Logical Analysis of Data (LAD) methodology, designed in the context of diagnosing growth hormone deficiencies. On the one hand, combinatorial regression extends the standard methodology from classification problems to regression problems; it permits to predict...

  • PAEDIATRIC RHEUMATOLOGY.  // Current Medical Literature: Rheumatology;2004, Vol. 23 Issue 1, p17 

    Presents a clinician's note on the study "Growth hormone improves height in patients with Juvenile Idiopathic Arthritis: 4-year data of a controlled study," conducted by S. Bechtold, et al, and published in a 2003 issue of the "Journal of Pediatrics." Growth disturbance experienced by children...

  • ask the experts.  // Woman's Day (Australia Edition);3/10/2003, p56 

    Offers advice on child growth and growth hormone treatment. Development of self-confidence; Food types for children; Reasons for a child's short stature.

  • Not ready for prime time. Gumus, Pinar; Chalew, Stuart // Journal of Pediatric Endocrinology & Metabolism;Jan/Feb2011, Vol. 24 Issue 1/2, p5 

    The article asserts that pharmacologic growth hormone (GH) stimulation testing is not a reliable indicator of subsequent clinical growth response to GH therapy among poorly growing children. It points out that many idiopathic short stature (ISS) patients with low spontaneous levels of GH often...

  • Growth Hormone Neurosecretory Dysfunction in a Boy with Hypohidrotic/Anhidrotic Ectodermal Dysplasia: Definition of Short Stature, Molecular Characterization and Long-term hGH Replacement Treatment to Final Height. Stagi, S.; Lapi, E.; Sani, I.; Bindi, G.; Quaranta, M. R.; Salti, R.; Chiarelli, F. // Journal of Pediatric Endocrinology & Metabolism;Sep2009, Vol. 22 Issue 9, p853 

    The article evaluates the response of a boy with anhidrotic/hypohidrotic ectodermal dysplasia or Christ-Siemens-Touraine (CST) syndrome and growth hormone (GH) neurosecretory dysfunction to long term human growth hormone (hGH) replacement treatment up to final height. It provides a background of...

  • Idiopathic Short Stature. Lee, Mary M. // New England Journal of Medicine;6/15/2006, Vol. 354 Issue 24, p2576 

    The article presents the case of a 12 year old boy who is below average height for his age and weight. His physical examination is normal, with no signs of puberty, no systemic disease, and no skeletal dysplasia. The author discusses whether growth hormone therapy is indicated. Until recently...

  • GROWTH HORMONE AND CALCIUM FOR GOOD BONE MINERAL DENSITY IN MEN.  // Total Health;Mar/Apr2003, Vol. 25 Issue 2, p12 

    Presents the results of a study on the effect of growth hormone injection therapy on men with idiopathic osteoporosis. Impact of the therapy on bone density; Risks associated with the therapy; Definition of idiopathic osteoporosis.

  • GROWTH HORMONE AND GROWTH FACTORS.  // Current Medical Literature: Pediatrics;2005, Vol. 18 Issue 1, p14 

    Discusses two pediatrics-related research on growth hormones and growth factors. Final height in growth hormone-treated short children born small for gestational age; Growth hormone treatment to final height in children with idiopathic short stature.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics