Final Height in Idiopathic Growth Hormone(GH) Deficient Children Treated with GH

Lee, Byung Churl

Abstract

PURPOSE: Improved adult height is a major goal in the treatment of children with short stature due to GH deficiency(GHD). The purpose of this study was to evaluate final height in idiopathic GH deficient children after long-term GH treatment.
METHODS
GHD was diagnosed in 9 male patients by at least two stimulation tests(maximum GH level< OR =5ng/ml). Other pituitary functions were evaluated by standard tests. All patients had multiple pituitary hormone deficiencies, aged 8.9-14(11.4+/-2.0)years at the start of GH treatment. GH, 0.45-0.7IU/kg/week in 3-7 divided doses, was given. Treatment ended when height velocity was less than 2cm/year and/or bone age of at least 16 years was reached. The mean length of treatment was 7.1+/-1.5(6-10)years. Predicted adult height(PAH) was determined by the method of Bayley-Pinneau. Target height(TH) was calculated by(father's height+mother's height+13)/2 and expressed as a standard deviation score(SDS) by Korean standard. Final height(FH) was determined at follow-up visits after GH treatment withdrawal and was defined as growth rate of less than 1cm/year and bone age of 18 years. Standard auxologic assessment was determined at the baseline and at every 6 months after initial GH therapy.
RESULTS
Mean final height and height SDS of patients were 165.9+/-5.2cm and -0.4+/-0.3. Final height was not significantly lesser than their target height(168.2+/-3.3cm) and predicted adult height(170.0+/-3.6cm). Mean final height SDS was significantly improved to -0.4+/-0.3 as compared to -3.8+/-0.9 of mean height SDS at starting age of GH treatment. The highest height increment was observed in the first year of treatment, with a gradual decrease in the following years. Total pubertal growth was 17.4+/-4.3cm and mean age of onset of puberty was 15.6+/-1.2 years. Unwanted serious adverse events were not observed in all patients.
CONCLUSION
Early diagnosis of GHD and continuous treatment with optimal doses of GH to near adult height should improve the outcome in children with short stature due to GHD.