Browse > Article
http://dx.doi.org/10.3345/kjp.2009.52.8.922

Growth responses to growth hormone therapy in children with attenuated growth who showed normal growth hormone response to stimulation tests  

Kim, Jae-Hyun (Department of Pediatrics, College of Medicine, Seoul National University)
Chung, Hye-Rim (Department of Pediatrics, Seoul National University Bundang Hospital)
Lee, Young-Ah (Department of Pediatrics, College of Medicine, Seoul National University)
Lee, Sun-Hee (Department of Pediatrics, College of Medicine, Seoul National University)
Kim, Ji-Hyun (Department of Pediatrics, College of Medicine, Seoul National University)
Shin, Choong-Ho (Department of Pediatrics, College of Medicine, Seoul National University)
Yang, Sei-Won (Department of Pediatrics, College of Medicine, Seoul National University)
Publication Information
Clinical and Experimental Pediatrics / v.52, no.8, 2009 , pp. 922-929 More about this Journal
Abstract
Purpose : The aim was to investigate the clinical characteristics and responses to growth hormone (GH) therapy in children with attenuated growth who showed normal GH responses to GH stimulation tests (GHST). Methods : The study included 39 patients with height velocity (HV) of less than 4 cm/yr and normal GHST results. Clinical characteristics of patients were analyzed retrospectively. Results : Eleven were born as small for gestational age (SGA) and 28 as appropriate for age (AGA). In the SGA group, the standard deviation score (SDS) of age and height measured at their first visit was significantly low. Sixteen patients were treated with GH and six of 23 without GH therapy were followed for 1 year after GHST. The mean (range) of HV was 7.7 (4.9 to 11.1) cm/yr in patients with GH therapy and 3.7 (2.7 to 4.5) cm/yr in those without GH therapy, which was statistically significant (P<0.001). In the GH-treated group, HV and difference in height SDS during the treatment increased significantly (P<0.001; P< 0.001, respectively). HV increased after 1 year of GH therapy in the SGA and AGA groups (SGA, P=0.043; AGA, P=0.003). The level of Insulin-like growth factor-I was significantly lower in GH-treated patients with height SDS <-3 than those with ${\geq}3$ (P=0.023). Conclusion : In children with growth failure and normal GHST, HV increases significantly by short-term GH therapy. The assessment of long-term effects of GH therapy is necessary. Moreover, further studies should be considered to evaluate the GH-IGF-I axis due to the possibility of GH insensitivity syndrome.
Keywords
Growth disorders; Growth hormone; Growth hormone insensitivity syndrome;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Saenger P. Partial growth hormone insensitivity-idiopathic short stature is not always idiopathic. Acta Paediatr 1999;88 suppl 428:S194-8   DOI
2 Bryant J, Baxter L, Cave CB, Milne R. Recombinant growth hormone for idiopathic short stature in children and adolescents. Cochrane Database Syst Rev 2007;(3):CD004440   PUBMED
3 Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2nd ed. California : Standford University Press, 1959:61-183
4 GH Research Society. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. J Clin Endocrinol Metab 2000;85:3990-3   DOI   ScienceOn
5 Savage MO, Rosenfeld R. Growth hormone insensitivity: a proposed revised classification. Acta Paediatr 1999;88 suppl 428:S182-4   DOI
6 Woods KA, Dastot F, Preece MA, Clark AJ, Postel-Vinay MC, Chatelain PG, et al. Phenotype:genotype relationships in growth hormone insensitivity syndrome. J Clin Endocrinol Metab 1997;82:3529-35   DOI   ScienceOn
7 Rosenfeld RG, Buckway C, Selva K, Pratt KL, Guevara- Aguirre J. Insulin-like growth factor (IGF) parameters and tools for efficacy: the IGF-I generation test in children. Horm Res 2004;62 suppl 1:S37-43   DOI   ScienceOn
8 Goddard AD, Covello R, Luoh SM, Clackson T, Attie KM, Gesundheit N, et al. Mutations of the growth hormone receptor in children with idiopathic short stature. the growth hormone insensitivity study group. N Engl J Med 1995;333: 1093-8   DOI   PUBMED   ScienceOn
9 Mahoney CP. Evaluating the child with short stature. Pediatr Clin North Am 1987;34:825-49   PUBMED
10 Laron Z, Pertzelan A, Mannheimer S. Genetic pituitary dwarfism with high serum concentration of growth hormone: a new inborn error of metabolism? Isr J Med Sci 1966;2:152-5   PUBMED
11 Marin G, Domené HM, Barnes KM, Blackwell BJ, Cassorla FG, Cutler GB Jr. The effects of estrogen priming and puberty on the growth hormone response to standardized treadmill exercise and arginine-insulin in normal girls and boys. J Clin Endocrinol Metab 1994;79:537-41   DOI   ScienceOn
12 Ghigo E, Bellone J, Aimaretti G, Bellone S, Loche S, Cappa M, et al. Reliability of provocative tests to assess growth hormone secretory status. Study in 472 normally growing children. J Clin Endocrinol Metab 1996;81:3323-7   DOI   ScienceOn
13 Chatelain P, Carrascosa A, Bona G, Ferrandez-Longas A, Sippell W. Growth hormone therapy for short children born small for gestational age. Horm Res 2007;68:300-9   DOI   ScienceOn
14 Walenkamp MJ, Wit JM. Genetic disorders in the growth hormone-insulin-like growth factor-I axis. Horm Res 2006; 66:221-30   DOI   ScienceOn
15 Marshall WA, Tanner JM. Variations in pattern of pubertal changes in boys. Arch Dis Child 1970;45:13-23   DOI   ScienceOn
16 Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291-303   DOI   ScienceOn
17 Korea Center for Disease Control and Prevention, The Korean Pediatric Society, The Committee for the Development of Growth Standard for Korean Children and Adolescents. 2007 Korean Children and Adolescents Growth Standard (commentary for the development of 2007 growth charts). [Government report online]. C: Division of Chronic Disease Surveillance; 2007 Nov. Available from: URL://www.cdc.go. kr/webcdc/
18 Lee KH. Growth assessment and diagnosis of growth disorders in childhood. Korean J Pediatr 2003;46:1171-7
19 Consensus statement on the diagnosis and treatment of chil-dren with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology Workshop. Cohen P, Rogol AD, Deal CL, Saenger P, Reiter EO, Ross JL, et al. J Clin Endocrinol Metab 2008;93:4210-7   DOI   ScienceOn
20 Blum WF, Cotterill AM, Postel-Vinay MC, Ranke MB, Savage MO, Wilton P. Improvement of diagnostic criteria in growth hormone insensitivity syndrome: solutions and pitfalls. Acta Paediatr 1994;83 suppl 399:S117-24   DOI
21 Hujeirat Y, Hess O, Shalev S, Tenenbaum-Rakover Y. Growth hormone receptor sequence changes do not play a role in determining height in children with idiopathic short stature. Horm Res 2006;65:210-6   PUBMED   ScienceOn
22 Zadik Z, Chalew SA, Kowarski A. Assessment of growth hormone secretion in normal stature children using 24-hour integrated concentration of GH and pharmacological stimulation. J Clin Endocrinol Metab 1990;71:932-6   DOI
23 Baxter L, Bryant J, Cave CB, Milne R. Recombinant growth hormone for children and adolescents with Turner syndrome. Cochrane Database Syst Rev 2007;(1):CD003887   PUBMED
24 Ranke MB. Diagnosis of growth hormone deficiency and growth hormone stimulation tests. In: Ranke MB, editor. Diagnostics of endocrine function in children and adolescents. 3rd ed. Basel: Karger, 2003:107-28
25 Saenger P, Czernichow P, Hughes I, Reiter EO. Small for gestational age: short stature and beyond. Endocr Rev 2007; 28:219-51   DOI   ScienceOn
26 Rosenfeld RG. Molecular mechanisms of IGF-I deficiency. Horm Res 2006;65 suppl 1:S15-20   DOI   ScienceOn
27 Martinelli CE, Sader Milani S, Previato JK, Figueira M, Rangel Montenegro AP, Miraki-Moud F, et al. Final height in patients with idiopathic short stature and high growth hormone responses to stimulation tests. Horm Res 2007;67: 224-30   DOI   ScienceOn