ESPE2019 Poster Category 3 GH and IGFs (13 abstracts)
Factors Affecting Growth Response to Growth Hormone (GH) Therapy in Children with Short Stature and Normal GH and IGF-I Secretion and no Bone Age Delay
Ahmed Elawwa 1 , Ashraf Soliman 1 & Rania Elalaily 2
1University of Alexandria, Alexandria, Egypt. 2Primary Health Care, Doha, Qatar
Background: There are inconsistencies in the results reported in a small number of previous studies into growth hormone (GH) treatment of short children with idiopathic short stature (ISS.
Patients and Methods: Our study included 20 prepubertal (Tanner 1) or peri-pubertal (Tanner 2) children with short stature (HtSDS < -2) and/or HtSDS > 1SD below their mid parental height SD (MPHtSDS), slow Growth velocity( < -1), with normal Peak GH to provocation ( 15.58 +/- 6.95 ng/dl), normal IGF-ISDS (-0.9 +/- 0.6 ), Tanner 1 (n = 15, Tanner 2 = 3, Tanner 3 = 2) and no bone age delay. We treated all the children for 2.5 +/- 1.5 years with rhGH 0.4 mg/kg/day and assessed their linear growth at the end of this period in relation to different possible modifying factors.
Results: Our children on GH therapy increased their HtSDS by 0.77 +/- 0.5 at the end of the treatment period (2.5 +/- 1.5 years). The effects of different factors on their growth response are summarized in table.
| HtSDS – MPHtSDS before GH Therapy | HtSDS – MPHTSDS after GH therapy | HtSDS gain after GH therapy | |
| Ht SDS < -2.5 | -1.20 | -0.20*# | 0.98# |
| HtSDS >- 2.5 <-2 | -0.93 | -0.32* | 0.60 |
| More than 1SD below their MPHtSDS before GH therapy | -1.5 | -0.57*# | 0.88# |
| Less than 1SD below their MPHtSDS before GH therapy | -0.71 | -0.1* | 0.62 |
| IGF-I increment > 150% | -1.2 | -0.4* | 0.7 |
| IGF-I increment < 150% | -1.1 | -0.25* | 0.83 |
| GH response > 15 ng/dl | -1.13 | -0.29* | 0.8 |
| GH response < 15 ng/dl | -1.07 | -0.37* | 0.69 |
| Stayed prepubertal during therapy | -1.34 | -0.27* | 0.71 |
| Proceeded to Tanner 3 & 4 during therapy | -1.36 | -0.37* | 0.78 |
| Age < 9 years at the start of GH | -1.2 | -0.1*# | 1.1# |
| Age > 9 years at the start of GH | -1.04 | -0.45* | 0.58 |
| *=P<0.05 before vs after therapy, #= P < 0.05 comparing different groups | |||
Discussion: Children below 9 years with HtSDS < -2.5 and those whose HtSDS was 1SD or more below MPHtSDS grew better on GH therapy compared to older children and those with HtSDS > -2.5 and were less than 1SD from their MPHTSD.
Conclusion: Growth response to GH therapy in short children with normal GH-IGF-I axis, appears to be significantly better in those younger than 9 years, with HtSDS < -2.5 for the population and with HtSDS > 1SDS below their MPHTSDS.
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