ABSTRACT
BACKGROUND AND OBJECTIVE: Growth hormone treatment in children with idiopathic short stature (ISS) leads to growth acceleration in the first years, but the effect on final height is still poorly documented. We therefore studied the long-term effect of GH therapy in children with idiopathic short stature. DESIGN: We have treated 27 prepubertal children with ISS with recombinant human GH (rhGH) in an initial dosage of 2 IU/m2 body surface/day subcutaneously, which was doubled either after the first year if the height velocity increment was less than 2 cm/year, or thereafter if height velocity fell below the P50 for bone age. Growth and bone maturation of the treatment group (ISS group, n = 21) were compared to those of an untreated control group with ISS (ISS controls, n = 27) and of a group of rhGH treated children with isolated GH deficiency (GHD group, n = 7). RESULTS: In 9 patients of the ISS group still on treatment, height standard deviation score (HSDS) for chronological age increased from -3.8 +/- 0.7 to -2.3 +/- 0.9 (mean +/- standard deviation) over 6 years, while in matched ISS controls HSDS for age did not change. HSDS for age in the GHD group increased from -3.9 +/- 0.6 to -1.8 +/- 0.7 after 4 years, significantly more than the ISS group. Bone maturation was accelerated in the ISS and GHD groups. HSDS for bone age and predicted adult height did not change in either group. Final height in 12 children of the ISS group was -2.6 +/- 1.0 SDS. In the untreated controls final height was similar. A low integrated GH concentration over 24 hours, a low GH peak to provocative stimuli, and minimal initial BA delay predicted a favourable outcome. CONCLUSION: rhGH treatment in this group of children with idiopathic short stature did not increase average final height. Part of the heterogeneity of the response can be attributed to the variation in endogenous GH secretion and initial bone age delay.
Subject(s)
Growth Disorders/drug therapy , Growth Hormone/therapeutic use , Body Height/drug effects , Bone Development/drug effects , Child , Female , Follow-Up Studies , Growth Disorders/blood , Growth Hormone/blood , Humans , Insulin-Like Growth Factor I/analysis , Male , Predictive Value of Tests , Prospective Studies , Puberty , Recombinant Proteins/therapeutic use , Treatment OutcomeABSTRACT
Girls with Turner syndrome were divided according to age (group A 6-12 years, and group B 12-19 years) and human growth hormone (GH) dose regimen (A1 and B1, three injections/week; A2 and B2, six injections/week). All groups responded to GH, 24 IU/m2/week, with an increase in height velocity, though in the older girls, the response was comparatively poor. Therefore, the dose regimens in groups B1 and B2 were increased to 36 IU/m2/week given as six injections in both groups. This change resulted in an increase in height velocity only in group B1. During the first 2 years only, the height velocity was greater in group A2 than group A1. The conclusion is that a regimen of six injections/week is more effective than one of three injections/week in terms of initial height gain and change in predicted adult height. In girls with Turner syndrome aged over 16 years, GH therapy has no significant effect.
Subject(s)
Body Height/drug effects , Growth Hormone/therapeutic use , Growth/drug effects , Turner Syndrome/drug therapy , Adolescent , Age Factors , Bone Development/drug effects , Child , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Growth Hormone/administration & dosage , Humans , Injections, Subcutaneous , Recombinant Proteins/administration & dosage , Recombinant Proteins/therapeutic useABSTRACT
Abnormalities of immune status, particularly a high prevalence (about 50%) of thyroid autoantibodies, have been reported before in Turner syndrome. Results are conflicting as regards other abnormalities of immune function. Growth hormone (GH) has immunomodulatory effects, but results of its effects on GH-deficient children are inconsistent. In this study, 42 girls with Turner syndrome, aged 7.3-19 years, are investigated before, during and after 4 years of human GH therapy. Girls over 12 years old also received ethinyl oestradiol. The prevalence of antithyroid antibodies was 16.7% initially, 35.3% after 24-45 months and 48% after 4 years of therapy though, as there was no control group, it was difficult to conclude that GH was enhancing their appearance. Hypothyroidism was extremely uncommon, and the growth response was no different in those who had the antibodies from those who had not. There were no dramatic increases in prevalence of any of the other antibodies investigated, though the prevalence of parietal cell antibodies was higher than expected.
Subject(s)
Autoantibodies/blood , Growth Hormone/therapeutic use , Turner Syndrome/drug therapy , Adolescent , Adrenal Cortex/immunology , Adult , Antibodies, Antinuclear/blood , Body Height , Child , Female , Follow-Up Studies , Growth Hormone/immunology , Hemoglobins/analysis , Humans , Immunoglobulins/blood , Islets of Langerhans/immunology , Isoantibodies/biosynthesis , Leukocyte Count , Prospective Studies , Recombinant Proteins/immunology , Recombinant Proteins/therapeutic use , T-Lymphocytes/immunology , Thyroid Gland/immunology , Thyrotropin/blood , Thyroxine/blood , Turner Syndrome/immunologyABSTRACT
The validity of a questionnaire on medical drug use during pregnancy was tested against information collected 7 years previously (in 1983-1984) at the University Hospital of Nijmegen, the Netherlands. The study population consisted of women with high-risk pregnancies. The sensitivity for drug categories varied between 0% and 80%. The sensitivity was highest for drugs used during labor (77%) and was extremely low (0%) for some drug categories. Personal characteristics thought to influence the sensitivity, such as parity of the mother and method of data collection (postal questionnaire or personal interview), showed no statistically significant effect. The newly developed questionnaire needs further improvement.
