ESPE2014 Poster Category 2 Growth (1) (13 abstracts)
Successful GH Treatment for Severe Growth Failure in Paediatric Patients with Anorexia Nervosa
Anne Fjellestad-Paulsen a, , Anne Bargiacchi b , Catherine Doyen b , Cecile Raverdy a , Jean-Claude Carel a, , Marie-France Leheuzey b & Juliane Leger a,
aPaediatric Endocrinology–Diabetology Department, Robert Debre Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris-Diderot, Paris, France; bPedopsychiatric Department, Robert Debre Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris-Diderot, Paris, France; cReference Center for Rare Endocrine Growth Diseases, Paris, France
Background: Anorexia nervosa (AN), a state of chronic nutritional deprivation prevalent in children and young adolescents, is associated with major changes to the hypothalamic–pituitary axis including the GH–IGF1 axis, thyroid function, hypercortisolemia, and hypogonadotropic–hypogonadism, with delayed puberty and a low growth velocity (GV) at a time critical for the pubertal growth spurt, potentially affecting adult height. The effects of supraphysiological human GH on GV are currently unknown.
Aim: To investigate the effect of hGH on GV in children with AN and profound growth impairment.
Method: Ten girls diagnosed with AN (DSM IV) at a median chronological age of 10.0 (8.5–11.1) years were treated for severe prolonged growth failure (GV< 2 cm/year for at least 18 months) at a median age of 13.3 (12.5–14.1) years and a bone age of 11.5 (10.0–12.0) years, Tanner stage I (n=7), II (n=1) or III (n=2), and 2.0 (1.0–2.3) years after the lowest SDS for BMI, with open-label GH (0.050 mg/kg per day), until adult height was achieved.
Results: A significant increase in GV directly attributed to GH therapy was observed in all children, resulting in adult height potential being reached, with no side effects. IGF1 concentration normalized without exceeding the reference ranges (166±71 vs 429±134 ng/ml, before and after 1 year of treatment) (Table 1).
| Baseline | +1 year | +2 years | Adult height | |
| GV (cm)/year | 1.5±1.2 | 7.8±2.4* | 5.8±3.3* | |
| Height (cm) | 141.7±8.9 | 149.3±8.1 | 153.2±7.5 | 161.8±4.4 |
| Height SDS | −2.2±1.3 | −1.6±1.3 | −1.3±1.4 | −0.3±0.8* |
| Height – target height SDS | −2.6±1.3 | −2.0±1.2 | −1.7±1.4 | −0.7±1.0* |
| *P<0.0001 vs baseline. | ||||
Conclusions: We report the first study on the efficacy of GH therapy in children with AN and a very low GV. A randomized controlled trial in a large cohort of children is now required to determine the ultimate impact of GH treatment.
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