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Linear Growth Response to Exogenous Growth Hormone in Children With Short Stature
I. David Schwartz, MD;
Cheng-Shih Hu, MS;
Dorothy I. Shulman, MD;
Allen W. Root, MD;
Barry B. Bercu, MD
Am J Dis Child. 1990;144(10):1092-1097.
Abstract
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• Response to growth hormone (GH) therapy was evaluated in 38 short children (28 males and 10 females; <1% in height for chronologic age [CA]) who were clinically categorized into three groups based on their endogenous mean 24-hour GH concentration (mean 24-hour GH) and peak GH response to two or more provocative agents (peak GH). All patients were treated with biosynthetic somatropin (human growth hormone) (0.15 to 0.30 mg/kg per week) injected subcutaneously three to seven times per week for a mean duration of 12.5 months. Group 1 consisted of 17 subjects (CA, 12.5 ± 2.9 years [mean ± SD]; bone age, 9.4± 2.9 years; height velocity [HV], 3.4 ± 1.8 cm/y; peak GH, 5.8± 2.6 µg/L; mean 24-hour GH, 1.7 ± 0.6 µg/L; and insulinlike growth factor–I, 0.40 ± 0.24 U/mL. Group 2 consisted of 10 subjects (CA, 11.7± 2.7 years; bone age, 9.2 ± 3.0 years; HV, 3.4 ± 1.6 cm/y; peak GH, 16.4 ± 5.2 µg/L; mean 24-hour GH, 1.7 ± 0.5 µg/L; and insulinlike growth factor–I, 0.49 ± 0.27 U/mL. Group 3 consisted of 11 subjects (CA, 12.7 ± 2.2 years; bone age, 10.2 ± 2.4 years; HV, 3.5 ± 1.5 cm/y; peak GH, 22.5 ± 8.6 µg/L; mean 24-hour GH, 3.8 ± 1.1 µg/L; and insulin-like growth factor–I, 1.07 ± 0.69 U/mL. Following administration of somatropin, an increase ( ) in HV of 2.0 cm/y or greater occurred in 94% (16/17) of the group 1 subjects (HV of 5.1 ± 2.6 cm/y), in 90% (9/10) of the group 2 subjects (HV of 4.3 ± 2.2 cm/y), and in 73% (8/11) of group 3 subjects (AHV of 3.7 ± 2.3 cm/y). However, regardless of provoked and/or endogenous GH secretory dynamics, 88% of the children whose pretreatment HV was 2.0 cm/y or less, 94% whose pretreatment HV was between 2.0 and 4.0 cm/y, and 79% whose pretreatment HV was greater than 4.0 cm/y increased their HVs to 2.0 cm/y or greater while they were receiving somatropin. Significant negative correlations were observed between HV and pretreatment HV (r= –.67), HV and GH concentration expressed as a 24-hour area under the curve (r = –.33), and HV and peak GH (r= –.34). In conclusion, 87% (33/38) of children with stature less than the first percentile, mean HV of 4.0 cm/y or less, and mean bone age of 2.7 years less than CA responded to 1 year of somatropin treatment with acceleration in HV regardless of their endogenous and/or provoked GH values.
(AJDC. 1990;144:1092-1097)
Author Affiliations
From the Section of Pediatric Endocrinology, University of South Florida College of Medicine and All Children's Hospital, St Petersburg, Fla.
Footnotes
Accepted for publication January 22, 1990.
Presented in part at the Annual Meetings of the Southern Society for Pediatric Research, New Orleans, La, February 4, 1988, and the Society for Pediatric Research, Washington, DC, May 3, 1988.
Reprint requests to Department of Pediatric Endocrinology, All Children's Hospital, 801 Sixth St S, PO Box 31020, St Petersburg, FL 33731-8920 (Dr Bercu).
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