ESPE Abstracts (2019) 92 P2-174

Empirical Change of Practice in Treatment of Growth Hormone Deficient Patients in Order to Improve 1st Year Height Outcome

Kamelia Rankova, Sonya Galcheva, Vilchelm Mladenov, Veselin Boyadzhiev, Yana Bocheva, Nikolinka Yordanova, Yulia Bazdarska, Violeta Iotova

"Dept of pediatrics, Medical University -Varna", 1 "Hr. Smirnenski" Str., Varna 9010, Bulgaria

Growth hormone (GH) has been used for the treatment of short stature due to GH deficiency (GHD) for over 60 years. Height velocity (HV) in the first year of therapy is well studied and its crucial importance for growth outcome in subsequent years is confirmed.

Objectives: The aim of this study is to assess the responsiveness to GH treatment in GHD patients of a newly established treatment center before and after change in starting GH dose.

Design: All 55 children (age range 1-18 years, 76.3% boys, a total of 3186 follow-up patient months) diagnosed with isolated or multiple non-organic GHD, treated at a tertiary University pediatric endocrinology center in the period 2011-2018, were included in the study. Patients started GH therapy at a mean age of 7.7±3.7 years, and were followed up for at least one full year.

Results: With mean starting GH dose of 0.029±0.007 mg/kg/d and mean GH dose for the 1st year of 0.031±0.011 mg/kg/d (2011-2016), the achieved height gain for the 1st year of treatment was 8.9±2.3 cm. In order to improve the 1st year growth response, new practice with higher initial GH dose was introduced since the beginning of 2017 (mean 0.030±0.02 mg/kg/d). For the period 2017-2018, 71.4% patients started with GH dose >0.030 mg/kg/d, compared to 34% in the previous period (2011-2016). This lead to increased height gain (9.5±1.0 cm) for the 1st year of treatment. Overall, ΔSDSheight>1.0 for the 1st year had 29.7% of all treated children in 2011-2016, while in 2017-2018 these were significantly more - 42.8% (P<0.01). No adverse effects of the treatment were seen since 2011. Initially, 36.2% of all patients showed ΔSDSheight≤0.5 for the 1st year, while in 2016-2017, these decreased to 25%.

Conclusion: Our data support the evidence that the starting GH dose is important for the 1st year growth response (catch-up growth) and thus, for achieving adequate treatment results in GHD patients with no increased side effects.

Keywords: growth hormone, growth response, catch-up growth

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