ESPE Abstracts (2019) 92 P3-138

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 Elawwa1, Ashraf Soliman1, Rania Elalaily2

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 TherapyHtSDS – MPHTSDS after GH therapyHtSDS 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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