Growth hormone (GH) treatment of children with idiopathic short children (ISS) with normal insulin-like growth factor-1 (IGF-1) versus those with low IGF-I at diagnosis.

Sohair Elsiddig; Ashraf Soliman; Nada Alaaraj; Ahmed Khalil; Hannah Ahmed

ISS is a condition in which the height is more than 2 SD below the corresponding mean height for age, sex and population, in whom no identifiable disorder is present. Some ISS patients may have varying degrees of IGF-1 deficiency. Recombinant GH treatment has been used by some authors with variable results. Theoretically, low IGF-I level at presentation may affect their response to GH therapy. The question is: do children with ISS and low IGF-I respond differently to GH therapy than those with normal IGF1 levels?

Aim: The effect of GH therapy (0.035 mg/kg/day) studied on linear growth and weight gain in children with ISS who have low IGF-I (IGF SDS < -1.5)(n = 12) versus those who have normal IGFI at presentation (n = 10) who did not receive GH therapy.

Results: At presentation, the HtSDS of the low IGFI group was statistically lower compared to the normal IGFI group. The age, BMI, BMISDS, peak GH response to clonidine provocation, and bone age didn’t differ between the two groups (Low vs normal IGFSDS). After a year of GH treatment IGFI increased significantly in both groups (P < 0.05), however, the IGFSDS was still lower in the low IGFI group. Both groups had significantly increased HtSDS that decreased the difference between their HtSDS and their mid-parental HtSDS. The increase in the HtSDS and daily weight gain was significantly higher in the low IGFI group. The IGFSDS, BMISDS, HtSDS and difference between HtSDS and mid-parental HtSDS were significantly higher in the treated group.

Conclusions: GH therapy improved linear growth and weight gain in ISS children. This improvement was better in those who had lower IGF1 at presentation compared to those with normal IGFI levels.

At presentation


	Age 1 yr	HtSDS	BMI	BMI SDS	MPHt(cm)	MPHSDS	HtSDS-MPHSDS	IGF-I	IGF1 SDS	Bone age	GH-P
ISS Normal IGFI	10.6	-2.06	16.7	-0.4	166	-0.94	-1.29	247	-0.04	-1.89	12.2
ISS low IGFI	10.3	-2.53	16.4	-0.7	168	-1.14	-1.54	101.4	-2.00	-1.15	14.4
p	0.4	0.02	0.23	0.3	0.32	0.362	0.235	0.004	< 0.001	0.0	0.09


	Age2	HtSDS2	BMI2	BMI SD2	WG g/d	duration mon	Delta BMI	Delta HtSDS	HTSDS2-MPHSDS	D-IGFSD
ISS Normal IGF1	11.2	-1.76	17.8	0.0	9.45	14.36	0.16	0.22	-0.90	1
ISS low IGF1	11.8	-1.96	18.1	-0.2	16.7	13.82	0.13	0.41	-1.05	1
p	0.12	0.02	0.29	0.38	0.03	0.06	0.41	0.04	0.09	0.44
After GH therapy

ESPE Abstracts

P2-264