Short Children and Growth Hormone

PEDIATRICS ◽  
1984 ◽  
Vol 73 (1) ◽  
pp. 112-113
Author(s):  
KENNETH C. COPELAND

To the Editor.— The article by Bright et al1 was a provocative description of two subjects with short stature, normal growth hormone (GH) responses to provocative testing, and low somatomedin-C (SM-C) concentrations, which increased after administration of GH. The authors conclude that the short stature in these individuals may be due to a biologically inactive GH molecule or to decreased dose responsiveness to GH of SM-producing cells. Their data also seem compatible with a third possibility: normal short children respond to GH administration with increases in SM-C plasma concentrations and growth rates.

PEDIATRICS ◽  
1983 ◽  
Vol 71 (4) ◽  
pp. 576-580
Author(s):  
C. M. Bright ◽  
A. D. Rogol ◽  
A. J. Johanson ◽  
R. M. Blizzard

Two prepubertal males with low somatomedin-C concentrations in their sera, but normal growth hormone concentrations, had positive metabolic responses when human growth hormone was administered. An accelerated velocity of growth accompanied the longterm administration of growth hormone. This response was dependent upon the administration of exogenous hormone inasmuch as linear growth was subnormal both before and after administration of growth hormone. The extreme short stature in these individuals may be secondary to a biologically inactive growth hormone molecule that is immunologically reactive or to a decreased dose responsiveness of the cells that produce somatomedin when exposed to the usual concentrations of endogenous growth hormone.


PEDIATRICS ◽  
1998 ◽  
Vol 102 (Supplement_3) ◽  
pp. 524-526
Author(s):  
Raymond L. Hintz

The use of auxologic measurements in the diagnosis of short stature in children has a long history in pediatric endocrinology, and they have even been used as the primary criteria in selecting children for growth hormone (GH) therapy. Certainly, an abnormality in the control of growth is more likely in short children than in children of normal stature. However, most studies have shown little or no value of auxologic criteria in differentiating short children who have classic growth hormone deficiency (GHD) from short children who do not. In National Cooperative Growth Study Substudy VI, in more than 6000 children being assessed for short stature, the overall mean height SD score was −2.5 ± 1.1 and the body mass index standard deviation score was −0.5 ± 1.4. However, there were no significant differences in these measures between the patients who were found subsequently to have GHD and those who were not. There also was no consistent difference in the growth rates between the patients with classic GHD and those short children without a diagnosis of GHD. This probably reflects the fact that we are dealing with a selected population of children who were referred for short stature and are further selecting those who are the shortest for additional investigation. Growth factor measurements have been somewhat more useful in selecting patients with GHD and have been proposed as primary diagnostic criteria. However, in National Cooperative Growth Study Substudy VI, only small differences in the levels of insulin-like growth factor I and insulin-like growth factor binding protein 3 were seen between the patients who were selected for GH treatment and those who were not. Many studies indicate that the primary value of growth factor measurements is to exclude patients who are unlikely to have GHD or to identify those patients in whom an expedited work-up should be performed. The diagnosis of GHD remains difficult and must be based on all of the data possible and the best judgment of an experienced clinician. Even under ideal circumstances, errors of both overdiagnosis and underdiagnosis of GHD still are likely.


1992 ◽  
Vol 151 (5) ◽  
pp. 321-325 ◽  
Author(s):  
T. Momoi ◽  
C. Yamanaka ◽  
M. Kobayashi ◽  
T. Haruta ◽  
H. Sasaki ◽  
...  

1995 ◽  
Vol 133 (4) ◽  
pp. 425-429 ◽  
Author(s):  
J Bellone ◽  
L Ghizzoni ◽  
G Aimaretti ◽  
C Volta ◽  
MF Boghen ◽  
...  

Bellone J, Ghizzoni L, Aimaretti G, Volta C, Boghen MF, Bernasconi S, Ghigo E. Growth hormonereleasing effect of oral growth hormone-releasing peptide 6 (GHRP-6) administration in children with short stature. Eur J Endocrinol 1995;133:425–9. ISSN 0804–4643 Growth hormone-releasing peptide 6 (GHRP-6) is a synthetic hexapeptide with a potent GH-releasing activity after intravenous, subcutaneous, Intranasal and oral administration in man. Previous data showed its activity also in some patients with GH deficiency. The aim of our study was to verify the GH-releasing activity of oral GHRP-6 administration on GH secretion in children with normal short stature. The effect of oral GHRP-6 (300 μg/kg) was compared with that of the maximally effective dose of intravenous GH-releasing hormone (GHRH-29, 1 μg/kg). As the GHRH-induced GH rise in children is potentiated by arginine (ARG), even when administered by oral route at low dose (4 g), we studied also the interaction of oral GHRP-6 and ARG administration. We studied 13 children (nine boys and four girls aged 6.2–10.5 years, pubertal stage I) with normal short stature (height less than –2 sd score; height velocity more than –2 sd score; normal bone age; insulin-like growth factor I > 70 μg/l), In a first group of children (N = 7), oral GHRP-6 administration induced a GH response (mean ± sem, peak at 60 min vs baseline: 18.8 ±3.0 vs 1.1 ± 0.3 μg/l, p < 0.0006; area under curve: 1527.3 ± 263.9 μgl−1 h) which was similar to that elicited by GHRH (peak at 45 min vs baseline: 20.8 ±4.5 vs 2.2±0.9 μg/l, p <0.007; area under curve: 1429.4 ± 248.2 μgl−1 h−1). In a second group of children (N = 6), the GH response to oral GHRP-6 administration (peak at 75 min vs baseline: 18.5 ±5.1 vs 1.5 ± 0.6 μg/l, p < 0.01; area under curve: 1598.5 ± 289.3 μgl−1 h−1) was not modified by co-administration of oral ARG (peak at 90 min vs baseline: 15.2 ±5.6 vs 0.9±0.3 μg/l, p < 0.002; area under curve: 1327.8 ± 193.2 μgl−1 h−1). The amount of GH released and the timing of the somatotrope response after the oral administration of GHRP-6 were similar in the two groups. In conclusion, the present data show that in normal short children the oral administration of GHRP-6 is able to increase GH secretion to an extent similar to that observed after intravenous administration of the maximally effective GHRH dose. Moreover, in contrast to GHRH, the effect of GHRP-6 is not enhanced by low-dose oral ARG. As this amino acid likely acts via inhibition of hypothalamic somatostatin release, our data suggest that a decrease in the somatostatinergic activity does not improve the GH-releasing effect of GHRP-6 in childhood, at variance with that observed after GHRH. Our results suggest that GHRP-6 could be clinically useful to stimulate GH secretion in short children. E Ghigo, Divisione di Endocrinologia, Ospedale Molinette, C. so. AM Dogliotti 14, 10126 Torino, Italy


1995 ◽  
Vol 42 (4) ◽  
pp. 365-372 ◽  
Author(s):  
Jan-Maarten Wit ◽  
Bart Boersma ◽  
Sabine M. P. F. Muinck Keizer-Schrama ◽  
Henrlët E. Nienhuls ◽  
Wilma Oostdijk ◽  
...  

2016 ◽  
Vol 102 (5) ◽  
pp. 1458-1467 ◽  
Author(s):  
Manouk van der Steen ◽  
Rolph Pfundt ◽  
Stephan J.W.H. Maas ◽  
Willie M. Bakker-van Waarde ◽  
Roelof J. Odink ◽  
...  

Abstract Background: Some children born small for gestational age (SGA) show advanced bone age (BA) maturation during growth hormone (GH) treatment. ACAN gene mutations have been described in children with short stature and advanced BA. Objective: To determine the presence of ACAN gene mutations in short SGA children with advanced BA and assess the response to GH treatment. Methods: BA assessment in 290 GH-treated SGA children. ACAN sequencing in 29 children with advanced BA ≥0.5 years compared with calendar age. Results: Four of 29 SGA children with advanced BA had an ACAN gene mutation (13.8%). Mutations were related to additional characteristics: midface hypoplasia (P = 0.003), joint problems (P = 0.010), and broad great toes (P = 0.003). Children with one or fewer additional characteristic had no mutation. Of children with two additional characteristics, 50% had a mutation. Of children with three additional characteristics, 100% had a mutation. All GH-treated children with a mutation received gonadotropin-releasing hormone analog (GnRHa) treatment for 2 years from onset of puberty. At adult height, one girl was 5 cm taller than her mother and one boy was 8 cm taller than his father with the same ACAN gene mutation. Conclusion: This study expands the differential diagnosis of genetic variants in children born SGA and proposes a clinical scoring system for identifying subjects most likely to have an ACAN gene mutation. ACAN sequencing should be considered in children born SGA with persistent short stature, advanced BA, and midface hypoplasia, joint problems, or broad great toes. Our findings suggest that children with an ACAN gene mutation benefit from GH treatment with 2 years of GnRHa.


PEDIATRICS ◽  
1985 ◽  
Vol 76 (3) ◽  
pp. 355-360
Author(s):  
Zvi Zadik ◽  
Stuart A. Chalew ◽  
Salvatore Raiti ◽  
A. Avinoam Kowarski

The 24-hour integrated concentration of growth hormone from 46 children of normal stature was compared with that of 90 short children. Nineteen of the short children had classic growth hormone deficiency by standard pharmacologic growth hormone stimulation tests. Seventy-one children had normal growth hormone responses to stimulation. The mean integrated concentration of growth hormone for children with normal stature (6.6 ± 1.9 ng/mL) was greater than the mean value for those with normal stimulated growth hormone (3.8 ± 2.3 ng/mL) and greater than the mean value for those with growth hormone deficiency (1.6 ± 0.6 ng/mL); differences between groups were all statistically significant (P &lt; .0001). Forty-five percent of children with normal stimulated growth hormone responses had integrated concentration of growth hormone within the range of values for the group with growth hormone deficiency; this finding may provide the explanation for their poor growth. Thus, patients with normal growth hormone responses have a spectrum of spontaneous growth hormone secretion ranging from normal to impaired. Recent reports indicate that children with normal growth hormone responses who have very low integrated concentration of growth hormone may have the potential to improve their growth with growth hormone therapy. Therefore, use of the integrated concentration of growth hormone may be a more effective method than standard pharmacologic stimulation tests for determining which short children are potentially able to respond to growth hormone therapy.


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