Growth Hormone Deficiency During the Transition Phase

2010 ◽  
Vol 8 (2) ◽  
pp. 112
Author(s):  
Antonio F Radicioni ◽  
Matteo Spaziani ◽  
Gilda Ruga ◽  
Simona Granato ◽  
Natascia Tahani ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Bone Density ◽  
Muscle Mass ◽  
Transition Period ◽  
Negative Impact ◽  
Final Height ◽  
Hormone Deficiency ◽  
Gh Therapy ◽  
Provocative Test ◽  
Cardiovascular Morbidity And Mortality

The growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis has several roles. While achievement of a satisfactory height is probably the most important and well-known, it is now clear that it also affects body composition, metabolism, muscle mass and bone density during the transition period. Recombinant-growth hormone (Rec-GH) therapy is normally administered to GH-deficient children to achieve a reasonable final height. Retesting with a provocative test (insulin tolerance test or growth-hormone-releasing hormone + arginine test) is necessary during the transition period, after measuring IGF-1 levels. If the patient is still GH-deficient, rec-GH therapy should be restarted at 0.2–0.5 mg/day up to a final dosage of 0.8–1.0 mg/day (albeit there is no general consensus on the dosage). In fact, there is widespread literature evidence of the negative impact of GH-deficiency during the transition period, which provokes increased visceral fat and waist/hip ratio, decreased muscle mass and bone density and increased cardiovascular morbidity and mortality.

Growth Hormone Deficiency During the Transition Phase

2012 ◽  
Vol 08 (02) ◽  
pp. 118
Author(s):  
Antonio F Radicioni ◽  
Matteo Spaziani ◽  
Gilda Ruga ◽  
Simona Granato ◽  
Natascia Tahani ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Bone Density ◽  
Muscle Mass ◽  
Transition Period ◽  
Negative Impact ◽  
Final Height ◽  
Hormone Deficiency ◽  
Gh Therapy ◽  
Provocative Test ◽  
Cardiovascular Morbidity And Mortality

The growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis has several roles. While achievement of a satisfactory height is probably the most important and well-known, it is now clear that it also affects body composition, metabolism, muscle mass, and bone density during the transition period. Recombinant-growth hormone (Rec-GH) therapy is normally administered to GH-deficient children to achieve a reasonable final height. Retesting with a provocative test (insulin tolerance test or growth-hormone-releasing hormone + arginine test) is necessary during the transition period, after measuring IGF-1 levels. If the patient is still GH-deficient, rec-GH therapy should be restarted at 0.2–0.5 mg/day up to a final dosage of 0.8–1.0 mg/day (albeit there is no general consensus on the dosage). In fact, there is widespread literature evidence of the negative impact of GH-deficiency during the transition period, which provokes increased visceral fat and waist/hip ratio, decreased muscle mass and bone density and increased cardiovascular morbidity and mortality.

scholarly journals Growth Hormone (GH) Therapy During the Transition Period: Should We Think About Early Retesting in Patients with Idiopathic and Isolated GH Deficiency?

2019 ◽  
Vol 16 (3) ◽  
pp. 307 ◽  
Author(s):  
Laura Penta ◽  
Marta Cofini ◽  
Laura Lucchetti ◽  
Letizia Zenzeri ◽  
Alberto Leonardi ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Transition Period ◽  
Gh Deficiency ◽  
Serum Insulin ◽  
Final Height ◽  
Pubertal Development ◽  
Standard Deviation Score ◽  
Pubertal Stage ◽  
Provocative Test ◽  
Transition Age

To investigate growth hormone (GH) secretion at the transition age, retesting of all subjects who have undergone GH replacement therapy is recommended when linear growth and pubertal development are complete to distinguish between transitional and persistent GH deficiency (GHD). Early retesting of children with idiopathic and isolated GHD (i.e., before the achievement of final height and/or the adult pubertal stage) can avoid possible over-treatment. Here, we report data from our population with idiopathic and isolated GHD to encourage changes in the management and timing of retesting. We recruited 31 patients (19 males) with idiopathic GHD who received recombinant GH (rGH) for at least 2 years. All of the patients were retested at the transition age at least 3 months after rGH discontinuation. Permanent GHD was defined as a GH peak of <19 ng/mL after administration of growth hormone–releasing hormone (GHRH) + arginine as a provocative test. Permanent GHD was confirmed in only five of 31 patients (16.13%). None of these patients presented low serum insulin-like growth factor (IGF)-1 levels (<−2 standard deviation score (SDS)). Only one male patient with an IGF-1 serum level lower than −2 SDS showed a normal GH stimulation response, with a GH peak of 44.99 ng/mL. Few patients with idiopathic and isolated GHD demonstrated persistence of the deficit when retested at the transition age, suggesting that the timing of retesting should be anticipated to avoid overtreatment.

scholarly journals THE AMINO-TERMINAL PROPEPTIDE OF TYPE I PROCOLLAGEN IN GROWTH HORMONE-DEFICIENT PATIENTS DURING TRANSITION PERIOD

2016 ◽  
Vol 65 (3) ◽  
pp. 271-275
Author(s):  
Mariana Costache-Outas ◽  
◽  
Andra Caragheorgheopol ◽  
Camelia Procopiuc ◽  
Cristina Dumitrescu ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Type I Collagen ◽  
Transition Period ◽  
Final Height ◽  
Threshold Value ◽  
Hormone Deficiency ◽  
Type I ◽  
Strong Positive Correlation ◽  
Amino Terminal ◽  
Significant Difference

Introduction. Bone mineral accretion continues beyond the attainment of final height during the transition period. Growth hormone deficiency (GHD) appears to have a significant effect on collagen turnover during childhood and less during adulthood. Amino-terminal pro-peptide of type I collagen (P1NP) is a marker of bone formation with low intra-individual when comparing to IGF1. Material and method. We evaluated 17 male patients diagnosed with GHD during childhood, after retesting GH axis in their transition period after at least 3 months from GH withdrawal. We correlate concentrations of P1NP and IGF1. We determined the predictive value for P1NP in identifying persistent GHD. Results. We found a strong positive correlation between IGF-1 and P1NP in the group of patients who maintained GH deficiency as young adults (r = 0.72, CI [0.02 to 0.94], p = 0.046). A threshold value for the P1NP of - 0.66 SDS predicts persistence of GHD with a sensitivity of 62.5% CI [24.5 to 91.5], specificity 75% CI [47.6 to 92.7] and AUC = 0.719 CI [0.5 0881]. We did not find a significant difference when we compared the AUC for the two parameters (p = 0.29). Conclusion. During the transition period, when the growth velocity is not available anymore, the dynamics of P1NP may be useful in quantifying the effectiveness of GH replacement therapy.

Issues in the Transition From Childhood to Adult Growth Hormone Therapy

PEDIATRICS ◽  
1999 ◽  
Vol 104 (Supplement_5) ◽  
pp. 1004-1010
Author(s):  
David B. Allen
Keyword(s):  
Growth Hormone ◽  
Replacement Therapy ◽  
Blood Lipid ◽  
Hormone Deficiency ◽  
Late Adolescent ◽  
Gh Therapy ◽  
Gh Treatment ◽  
Beneficial Effects ◽  
Gh Replacement ◽  
Adult Growth

The consequences of severe growth hormone deficiency (GHD) in adults and the beneficial effects of GH replacement therapy are clear. However, the majority of children who have a diagnosis of GHD and who are treated with GH do not have permanent GHD and will not require treatment during adulthood. Several issues must be considered in selecting candidates for adult GH treatment and transitioning their care from pediatrics to adult medicine. Counseling about possible lifelong treatment should focus on children with panhypopituitarism and those with severe isolated GHD that is associated with central nervous system abnormalities. When to terminate growth-promoting GH therapy should be guided by balancing the high cost of late-adolescent treatment with the attainment of reasonable statural goals. Retesting for GH secretion is appropriate for all candidates for adult GH therapy; the GH axis can be tested within weeks after the cessation of treatment, but confirming an emerging adult GHD state with body composition, blood lipid, and quality-of-life assessments may require 1 year or more of observation. Selecting patients for lifelong adult GH replacement therapy will present diagnostic, therapeutic, and ethical problems similar to those in treating childhood GHD. The experience and expertise of pediatric endocrinologists in diagnosing and treating GHD should be offered and used in identifying and transitioning appropriate patients to adult GH therapy.

scholarly journals Significance of Direct Confirmation of Growth Hormone Insensitivity for the Diagnosis of Primary IGF-I Deficiency

2020 ◽  
Vol 9 (1) ◽  
pp. 240
Author(s):  
Joanna Smyczyńska ◽  
Urszula Smyczyńska ◽  
Maciej Hilczer ◽  
Renata Stawerska ◽  
Andrzej Lewiński
Keyword(s):  
Growth Hormone ◽  
Final Height ◽  
Standard Deviation Score ◽  
Height Velocity ◽  
Gh Therapy ◽  
Significant Difference ◽  
Igf I ◽  
Growth Hormone Insensitivity ◽  
Stimulation Tests ◽  
Direct Confirmation

Primary insulin-like growth factor-I (IGF-I) deficiency is a synonym of growth hormone (GH) insensitivity (GHI), however the necessity of direct confirmation of GH resistance by IGF-I generation test (IGF-GT) is discussed. GHI may disturb intrauterine growth, nevertheless short children born small for gestational age (SGA) are treated with GH. We tested the hypothesis that children with appropriate birth size (AGA), height standard deviation score (SDS) <−3.0, GH peak in stimulation tests (stimGH) ≥10.0 µg/L, IGF-I <2.5 centile, and excluded GHI may benefit during GH therapy. The analysis comprised 21 AGA children compared with 6 SGA and 20 GH-deficient ones, with height SDS and IGF-I as in the studied group. All patients were treated with GH up to final height (FH). Height velocity, IGF-I, and IGF binding protein-3 (IGFBP-3) concentrations before and during first year of treatment were assessed. Effectiveness of therapy was better in GHD than in IGF-I deficiency (IGFD), with no significant difference between SGA and AGA groups. All but two AGA children responded well to GH. Pretreatment IGF-I and increase of height velocity (HV) during therapy but not the result of IGF-GT correlated with FH. As most AGA children with apparent severe IGFD benefit during GH therapy, direct confirmation of GHI seems necessary to diagnose true primary IGFD in them.

Final height of patients with idiopathic growth hormone deficiency after long-term growth hormone treatment

1989 ◽  
Vol 120 (4) ◽  
pp. 409-415 ◽  
Author(s):  
Itsuro Hibi ◽  
Toshiaki Tanaka ◽  
_ _
Keyword(s):  
Growth Hormone ◽  
Standard Deviation ◽  
Growth Hormone Deficiency ◽  
Final Height ◽  
Standard Deviation Score ◽  
Hormone Deficiency ◽  
Chronological Age ◽  
Deviation Score ◽  
Idiopathic Growth Hormone Deficiency ◽  
Group A

Abstract. One hundred and 8 patients with idiopathic growth hormone deficiency with spontaneous pubertal maturation (group A), were followed until they reached their final height after hGH treatment lasting between 2 and 11.1 (average 5.5) years. Their standard deviation scores of final height averaged 3.3 sd below the population mean, which was significantly lower than 1.1 standard deviation below the mean in 29 GH deficient patients without spontaneous puberty (group B) who were treated with hGH and sex hormones. The presence of gonadal function was found to be unbeneficial for final height. The final height of the patients in both groups was not related to either 1) age at the start of hGH treatment, 2) age at the onset of puberty, or 3) the duration of hGH treatment. It was, however, significantly related to the standard deviation score of height at the start of hGH treatment in both groups and to that of height at the onset of puberty in group A. The findings demonstrated that earlier introduction of hGH treatment resulted in earlier onset of puberty in group A, because the chronological age at the onset of puberty was positively correlated to the chronological age at the start of hGH treatment. It was also confirmed that the later puberty began, the taller the final height in GH deficient patients who had the same degree of standard deviation score of height for chronological age before puberty.

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