ABSTRACT
BACKGROUND: Recombinant human growth hormone (rhGH) availability has allowed the treatment of a greater number of growth disorders. It is important to get an insight into the clinical characteristics of the paediatric population before rhGH treatment. METHODS: An observational, retrospective and multicentre study was conducted to evaluate the patients' baseline characteristics prior to rhGH therapy. RESULTS: A total of 1404 patients (53.8% males) aged 0.5-17.3 years were included. Clinical conditions were as follows: GH deficiency (GHD), 66.0%; small for gestational age (SGA), 29.7%; and Turner syndrome (TS), 4.3%. Male gender was predominant in most growth disorders; age at diagnosis was higher in GHD patients; therapy with rhGH started at lower chronological age in SGA and TS groups. CONCLUSION: The baseline characteristics of the population to be treated with rhGH were similar to those reported in other growth databases. Delayed age at treatment initiation should increase the awareness of these disorders among general paediatricians and entice them to refer children suspected of having these disorders to a specialist.
Subject(s)
Attitude to Health , Databases, Factual , Dwarfism/drug therapy , Growth Disorders/drug therapy , Human Growth Hormone/therapeutic use , Infant, Small for Gestational Age/growth & development , Turner Syndrome/drug therapy , Adolescent , Body Height , Child , Child, Preschool , Dwarfism/diagnosis , Dwarfism/epidemiology , Female , Follow-Up Studies , Growth Disorders/diagnosis , Growth Disorders/epidemiology , Humans , Infant , Male , Prognosis , Recombinant Proteins/therapeutic use , Retrospective Studies , Spain/epidemiology , Turner Syndrome/diagnosis , Turner Syndrome/epidemiologyABSTRACT
BACKGROUND: The metabolic syndrome (MS) is associated with insulin resistance (IR), a systemic low-grade inflammatory state and endothelial dysfunction. These disorders may arise at a very early age in obese children. This study aimed to investigate the relationship between endothelial dysfunction and both IR and inflammation in prepubertal obese children. METHODS AND RESULTS: Von Willebrand factor (vWF) and soluble intercellular adhesion molecule-1 (sICAM-1) levels were measured in 46 obese prepubertal children aged 6-9, and in 46 non-obese, age-and sex-matched controls; the possible association of these levels with MS, various inflammatory biomarkers and plasminogen activator inhibitor-1 (PAI-1) was analyzed. Obese children displayed significantly elevated values for sICAM-1 (P=0.008), vWF (P=0.034), insulin (P=0.006), homeostasis model assessment for IR (HOMA-IR; P=0.003), C-reactive protein (CRP) (P<0.001), PAI-1 (P=0.002) and leptin (P<0.001). Nonsignificant differences were found in interleukin 6 (IL-6) levels. In the obese group, sICAM-1 showed a positive correlation with insulin (P=0.013), HOMA-IR (P=0.015), CRP (P=0.020), IL-6 (P=0.023) and PAI-1 (P=0.015). Corrected for age and sex, insulin, HOMA-IR, IL-6 and CPR were found to be independent predictive factors for sICAM-1. CONCLUSIONS: Prepubertal obese children displayed alterations indicative of endothelial dysfunction as well as disorders typical of MS. An association was established between endothelial dysfunction, IR, inflammation and inappropriate fibrinolysis in the children studied.
