Background: Anorexia nervosa (AN), a state of chronic nutritional deprivation prevalent in children and young adolescents, is associated with major changes to the hypothalamicpituitary axis including the GHIGF1 axis, thyroid function, hypercortisolemia, and hypogonadotropichypogonadism, 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 (8.511.1) years were treated for severe prolonged growth failure (GV< 2 cm/year for at least 18 months) at a median age of 13.3 (12.514.1) years and a bone age of 11.5 (10.012.0) years, Tanner stage I (n=7), II (n=1) or III (n=2), and 2.0 (1.02.3) 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|
|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.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology