Elsevier

The Lancet

Volume 348, Issue 9019, 6 July 1996, Pages 13-16
The Lancet

Articles
Final height of short normal children treated with growth hormone

https://doi.org/10.1016/S0140-6736(96)01038-0Get rights and content

Summary

Background

Short-term studies have demonstrated acceleration of growth rate following administration of biosynthetic human growth hormone (r-hGH) to short normal children. We describe the effect of such treatment on final height.

Methods

This was an open study of consecutive referrals to a growth disorder clinic from which 16 short children (height standard deviation score [SDS] −2·17 [range −1·8 to −3·3]; height velocity SDS −0·44 [0·33]; peak serum GH response to stimulation 27·9 mU/L [9·2] were treated with r-hGH, and 7 short children who declined treatment (height SDS −2·34 [0·61]; height velocity SDS −0·36 [0·28]; peak serum GH response 28·2 mU/L [6·8]) acted as an observation group. Subcutaneous r-hGH dose ranged between 12·2 and 21·0 U/m2 per week (0·02–0·04 mg/kg per day) for the first 2 years of treatment and 20 U/m2 per week thereafter. 3 untreated children were lost to long-term follow-up.

Findings

r-hGH significantly increased the difference in final height compared with pretreatment predicted height (+0·42 SDS [0·79], p=0·03) but this change was not significantly greater than that of the observation group (+0·16 SDS [0·20]). Treatment had no effect on the timing of puberty. Boys progressed slightly faster through puberty, associated with an acceleration in bone-age maturation. No untoward effects on glucose metabolism were observed. Long-term therapy did not alter body-fat distribution or blood pressure.

Interpretation

Long-term therapy in this group of children appears safe but the small increment in final height, approximately 2·8 cm in boys and 2·5 cm in girls, does not justify the widespread use of r-hGH for short normal children.

Introduction

Growth rate is related asymptotically to the amount of growth hormone (GH) secreted.1 This function predicts that the smallest children growing most slowly and secreting least GH would respond best to exogenous GH.2 Short children secreting sufficient GH to maintain near-normal growth velocity should grow faster with exogenous GH, although the response would be less, dose-for-dose, than those with GH insufficiency. Growth acceleration after administration of exogenous GH has been reported in heterogeneous populations of short children almost uniformly growing poorly. The definition of normality was based on the results of GH secretion tests, which may be suspect.3 We have reported first-year results of treatment with biosynthetic human GH (r-hGH) in children with normal pretreatment growth rates and normal responses to physiological and pharmacological testing.4 Here we report final heights in these children after daily teatment with r-hGH for 4–9 years and in an untreated observation group.

Section snippets

Participants

Details of the participants and the inclusion and exclusion criteria have been reported.4

16 children were treated with r-hGH and 10 children, whose families did not wish to proceed with the treatment, formed the observation group. The main reason for declining intervention was the need for frequent r-hGH injections.

Assessments

Standard growth asseessments were made every 3–4 months. Coefficients of variation in height measurements were 0·1 and 0·05% at heights of 120 and 150 cm, respectively. Bone age was

Results

Of the 16 children enrolled, 15 have attained final height (no growth or growth velocity <0·5 cm per year with adult bone maturation) after a median of 7·5 years' (range 4–9) treatment with r-hGH. In the remaining individual, final height SDS calculated as presently predicted height SDS has been used but exclusion of these data does not influence the results. The 7 children in the observation group have all attained final height. There were no significant differences in anthropometric status

Discussion

Our data demonstrate that treatment of short children with normal pretreatment growth rates with r-hGH increased stature by approximately 2·8 cm in boys and 2·5 cm in girls, which moved the children slightly closer to the target height dictated by their parents. These results do not support results from short-term studies but are in keeping with those reported by Loche et al10 and in children who were growing slowly but appeared to have an adequate GH secretory status.11

We used patients as

References (18)

There are more references available in the full text version of this article.

Cited by (0)

View full text