Evaluating First Year Response and Final Height to Growth Hormone Treatment in Growth Hormone Deficiency Based on Peak GH Levels on Testing

Saygin Abali; Serpil Bas; Azad Akbarzade; Zeynep Atay; Belma Haliloglu; Tulay Guran; Serap Turan; Abdullah Bereket

Background: Diagnosis of GH deficiency (GHD) is a complicated issue especially in isolated GH deficiency. Auxological evaluation, IGFI, IGFBP3 levels and GH response to provocative testing are all considered in the diagnosis. However, cut-off values for GH levels at stimulation tests are controversial. We aimed to evaluate the response to rhGH treatment in patients with different GH peak levels in stimulation test.

Objective: We aimed to evaluate the response to rhGH treatment in patients with different GH peak levels in stimulation test.

Method: 149 patients (60F) with GHD who had been followed for minimum of 1-year with rhGH therapy were included in this retrospective study. Patients with chronic illness and Turner syndrome were excluded. Patients were divided into two groups according to peak GH level under 5 ng/dl (Group I) and 5–10 ng/dl (Group II).

Results: The mean age at beginning of rhGH therapy was 11.6±3.5 years, the mean height standard deviation score (SDS) was −2.9±1.2. The ratio of SGA born patients (6.7% vs. 19.4%) and the having normal pituitary MRI (44.1% vs. 83.8%) were significantly higher in group 2 (P<0.05). At the beginning of the therapy; there was no significant difference in chronological age (CA) (11.3±3.9 vs. 11.7±3.1) and “Δ CA-BA was (2.8±2.0 vs 2.4±1.6) in group I and II respectively. Height SDS (−3.4±1.4 vs −3.0±0.9, P=0.034) and IGF1 SDS (−1.52±0.87 vs −0.94±0.55, P<0.001) were lower in group I. BMI SDS levels were higher in group I (0.27±1.43 vs −0.47±1.37, P=0.002). Although lower rhGH doses were given in group I (30.0±5.4 vs 34.5±4.9, P<0.001), the first year response was better in this group (Change in height SDS +1.0±0.7 vs +0.6±0.3, P<0.001). At the end of first year, BMI SDS was reduced in group I (0.27±1.43 vs −0.04±1.40, P:0.015); but not changed in group II (−0.47±1.37 vs −0.39±1.10, P=0.360). First year height response had a negative correlation with peak GH level (r:−0.479, P<0.001) and with IGF SDS (r:−0.340, P<0.001). The final/near final height was available in 57 patients and final height SDS was −1.2±0.7 and −1.4±0.8 in group I and II, respectively (Table). Total gain of height (Final height SDS-Initial height SDS) was significantly higher (2.7 vs 1.5 SDS) in group I and group II respectively.


Final/Near Final	Group I (n:21)	Group II (n:36)
Initial height SDS*	−4.0±1.9	−2.9±0.7
PAH SDS at initiation	−1.7±1.1	−1.2±1.0
MPH SDS	−1.3±0.7	−1.3±0.8
Final height (FH) SDS	−1.2±0.7	−1.4±0.8
FH SDS – Initial Ht SDS*	2.7±1.7	1.5±0.7
FH SDS – MPH SDS	0.2±0.9	−0.2±1.0
FH SDS – PAH SDS*	0.5±1.1	−0.2±1.2
*P<0.001.

Conclusion: In GHD, patients with peak GH levels under 5 ng/dl had better first year response and final height gain with rhGH treatment.

ESPE Abstracts

P3-969