Early treatment gives best GH response even in infancy

Eleanor McDermid
J Pediatr Endocrinol Metab 2017; Advance online publication
01 February 2018

medwireNews: The benefits of prompt growth hormone (GH) treatment are apparent even in patients diagnosed as deficient at a very young age, a study suggests.

The researchers also found that treatment response differed according to whether the patients had multiple pituitary hormone deficiency (MPHD) or isolated GH deficiency (IGHD). And they investigated the effect of mini-puberty, finding some evidence of better growth in patients without hypogonadotropic hypogonadism.

Age was associated with treatment response even among the very young patients in this study, who received GH at an average dose of 42 μg/kg per day from an average age of 12.4 months. The children (n=67) gained more height/length during the first than second year of treatment, at respective averages of 15.0 and 10.4 cm.

The 24 children who started treatment by the age of 12 months had markedly better growth during the first year of treatment than the 34 who started treatment between 12 and 36 months of age, increasing their height/length by 17.6 versus 12.8 cm. Growth during the second year of treatment also tended to favour those who started younger, although the difference was smaller, at 12.4 versus 9.9 cm.

Fifty of the children had MPHD and were diagnosed younger, on average, than the 17 with IGHD, so treatment was started younger, at 11.6 versus 14.8 months. Children with MPDH gained significantly more height than those with IGHD during their first year of GH treatment, gaining an average of 15.5 versus 13.6 cm. Their treatment responses did not differ during the second year, however.

Among patients with available data, 25 had hypogonadotropic hypogonadism, defined as cryptorchidism and micropenis at the age of 6 months, as well as low basal gonadotropin and testosterone levels in the mini-pubertal period. Growth among these patients did not significantly differ from that in the 22 patients without hypogonadism; however, the change in average length/height standard deviation score was 1.3 and 2.0, respectively, favouring the group without hypogonadism.

Change in bodyweight during the first year also favoured patients with a normal mini-puberty, report Semra Çetinkaya (Health Sciences University, Ankara, Turkey) and study co-authors in the Journal of Pediatric Endocrinology and Metabolism.

In addition, the researchers say that they found a correlation between GH dose and growth response, although only during the second year of treatment. This shows the importance of optimising GH dose, especially after the first year, they observe.

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