ESPE Abstracts (2014) 82 P-D-2-1-455

The Effect of Long Term GH Therapy in Discordant Twins Where One Twin is Born Small for Gestational Age: A Case Control Study

Johannes Letshwitia, Elaine O’Mullanea,b, Hilary Hoeyb & Edna Rochea,b

aThe National Children’s Hospital, Tallaght Hospital, Dublin 24, Ireland; bUniversity of Dublin, Trinity College, Dublin 2, Ireland

Background: The positive effect of GH therapy in small for gestational age (SGA) singletons has been shown in previous studies. Little is known about twin growth and GH treatment where only one twin is born SGA.

Objective and hypotheses: We present data from two set of twins where one was appropriate for gestational age (control) and the other twin was SGA (treatment).

Method: Twin pair 1: male monochorionic diamniotic (MCDA) twins born at 33 weeks gestation. Twin 1 (control) birth weight (BW) 1.5 kg (−1.15 S.D.). Twin 2 (GH treated) BW 1 kg (−2.93 S.D.). Pre-GH treatment Twin 2 had peak GH of 15.3 mU/l, normal IGF1, height velocity 6.0 cm/years and height of 100.8 cm (−2.55 S.D.). The control twin’s corresponding height was 103.7 cm (−0.8 S.D.). GH therapy was commenced at 6 years. Twin pair 2: male dichorionic diamniotic (DCDA) twins born at 35 weeks gestation. Birth weight of control and SGA twin (Twin 2) were 2.3 kg (−0.89 S.D.) and 1.62 kg (−2.96 S.D.) respectively. Pre-GH treatment Twin 2 had peak GH level of 17.9 (μg/l), normal IGF1, height velocity 5.8 cm/years and height 98.8 cm (−2.94 S.D.). The corresponding height of the control twin was 106.3 cm (−1.36 S.D.). GH treatment was commenced at 5.5 years.

Results: Twin pair 1: at age 13.5 years, height was 157.4 cm (−0.04 S.D.) and 151.1 cm (−0.8 S.D.) for the SGA and control twin respectively. Twin pair 2: at 10 years of age Twin 2 measured 131.4 cm (−1.11 S.D.) and the control twin 130.3 cm (−1.29 S.D.).

Conclusion: These cases demonstrate the value of GH therapy on catch up and maintenance of growth over time. Further research on the varying growth between twins including genetic factors is required.

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