Insulin Sensitivity as Homa at Start and End of HGH Treatment of Children with Congenital (C) Ighd and Mphd

Zvi Laron; Mona Shmalia; Rivka Kauli; Pnina Lilos

Background: Patients with congenital IGHD or MPHD develop adiposity already "in utero". The effects of growth hormone (GH) treatment on adipose tissue are controversial, many claiming that GH reduces body fat (1.2). In addition there are reports that long-term GH treatment causes glucose intolerance, insulin resistance, followed in some instances by diabetes (3).

Objective: To determine whether long-term hGH treatment of children with cIGHD or cMPHD, using the low recommended dose, causes insulin resistance.

Subjects: Forty patients with cIGHD (22M, 18F) and 46 patients with cMPHD (28M, 18F) were included in the study. The mean age at start of hGH was 7 and 10yrs respectively. The mean duration of treatment was 8.5 yrs.

Methods: This is a retrospective study. Data on weight, BMI, subscapular skinfold thickness (SF), was collected from Medical Records of our clinic. HOMA was calculated using the formula HOMA-IR = Glucose x Insulin ÷ 22.5. The dose of hGH was 33µg/kg/d. Statistical analysis was by ANOVA.

Results: Parallel data on weight, BMI, subscapular skinfold thickness (SF) was found in 35 patients with cIGHD, and in 37 patients with cMPHD.

The main results are shown in the Table.


	IGHD	MPHD
	Start	End	p	Start	End	p
Weight (kg)	15.6 ± 9.3	49.2 ± 16.6	<0.001	22.7 ± 9.4	38.9 ± 11.8	<0.001
SF (mm)	10.2 ± 6.1	15.2 ± 7.3	<0.001	11.7 ± 5.9	16.2 ± 7.5	0.001
HOMA	3.4 ± 3	1.6 ± 2.4	0.31	1.7 ± 1	1.3 ± 1.4	0.32

It is seen that in both groups the changes in weight and SF between initiation and end of treatment, were statistically significant denoting an increase of adipose in response to hGH.

HOMA was slightly elevate at the start of treatment in both groups and did not change significantly during treatment (norm:<2). The BMI measurements not contributory. Two patients developed diabetes between ages 39-50.

Conclusions: Despite a significant increase in adiposity, low dose long-term hGH treatment does not influence insulin sensitivity.

References: 1. Gotherstrom G, et al. A 10-year, prospective study of the metabolic effects of growth hormone replacement in adults. J Clinical Endocrinol Metab 2007;92(4):1442-1445.

2. Child CJ, et al. Prevalence and incidence of diabetes mellitus in GH-treated children and adolescents: analysis from the GeNeSIS observational research program. J Clini Endocrinol Metab. 2011;96(6):E1025-1034.

3. Lutski M, et al. Prevalence of diabetes among children treated with growth hormone in Israel. Diabetic Medicine 2019. Doi. 10.111/DME.13910.

ESPE Abstracts

P3-273