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      Early growth hormone treatment start in childhood growth hormone deficiency improves near adult height: analysis from NordiNet® International Outcome Study

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          To investigate the effect of age at growth hormone (GH) treatment start on near adult height (NAH) in children with isolated GH deficiency (GHD).


          NordiNet® International Outcome Study (IOS) (Nbib960128), a non-interventional, multicentre study, evaluates the long-term effectiveness and safety of Norditropin® (somatropin) (Novo Nordisk A/S) in the real-life clinical setting.


          Patients ( n = 172) treated to NAH (height at ≥18 years, or height velocity <2 cm/year at ≥16 (boys) or ≥15 (girls) years) were grouped by age (years) at treatment start (early (girls, <8; boys, <9), intermediate (girls, 8–10; boys, 9–11) or late (girls, >10; boys, >11)) and GHD severity (<3 ng/mL or 3 to ≤10 ng/mL). Multiple regression analysis was used to evaluate the effect of age at treatment start (as a categorical and continuous variable) on NAH standard deviation score (SDS).


          Age at treatment start had a marked effect on NAH SDS; NAH SDS achieved by patients starting treatment early ( n = 40 (boys, 70.0%); least squares mean (standard error) −0.76 (0.14)) exceeded that achieved by those starting later (intermediate, n = 42 (boys, 57.1%); −1.14 (0.15); late, n = 90 (boys, 68.9%); −1.21 (0.10)). Multiple regression analysis showed a significant association between NAH SDS and age at treatment start ( P < 0.0242), baseline height SDS (HSDS) ( P < 0.0001), target HSDS ( P < 0.0001), and GHD severity ( P = 0.0012). Most (78.5%) patients achieved a normal NAH irrespective of age at treatment start.


          Early initiation of GH treatment in children with isolated GHD improves their chance of achieving their genetic height potential.

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          Most cited references 18

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          Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. GH Research Society.

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            Standards for children's height at ages 2-9 years allowing for heights of parents.

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              Growth and pubertal development in children and adolescents: effects of diet and physical activity.

              The longitudinal growth of an individual child is a dynamic statement of the general health of that child. Measurements should be performed often and accurately to detect alterations from physiologic growth. Although any single point on the growth chart is not very informative, when several growth points are plotted over time, it should become apparent whether that individual's growth is average, a variant of the norm, or pathologic. Somatic growth and maturation are influenced by several factors that act independently or in concert to modify an individual's genetic growth potential. Linear growth within the first 2 y of life generally decelerates but then remains relatively constant throughout childhood until the onset of the pubertal growth spurt. Because of the wide variation among individuals in the timing of the pubertal growth spurt, there is a wide range of physiologic variations in normal growth. Nutritional status and heavy exercise training are only 2 of the major influences on the linear growth of children. In the United States, nutritional deficits result from self-induced restriction of energy intake. That single factor, added to the marked energy expenditure of training and competition for some sports, and in concert with the self-selection of certain body types, makes it difficult to identify the individual factors responsible for the slow linear growth of some adolescent athletes, for example, those who partake in gymnastics, dance, or wrestling.

                Author and article information

                Eur J Endocrinol
                Eur. J. Endocrinol
                European Journal of Endocrinology
                Bioscientifica Ltd (Bristol )
                November 2017
                03 August 2017
                : 177
                : 5
                : 421-429
                [1 ]Endocrinologie Gynécologie Diabétologie Pédiatriques Hôpital Universitaire Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Université Paris Descartes, INSERM U1016, Institut IMAGINE, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Paris, France
                [2 ]Department of Endocrinology Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
                [3 ]Department of Pediatric Endocrinology University Children’s Hospital, University Medical Center Ljubljana, and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
                [4 ]Global Medical Affairs Novo Nordisk Health Care AG, Zürich, Switzerland
                [5 ]Epidemiology Novo Nordisk A/S, Søborg, Denmark
                [6 ]Department of Pediatric Endocrinology University Children’s Hospital, Saarland University Medical Center, Homburg, Germany
                Author notes
                Correspondence should be addressed to M Polak; Email: michel.polak@ 123456nck.aphp.fr
                © 2017 The authors

                This work is licensed under a Creative Commons Attribution 3.0 Unported License.

                Clinical Study

                Endocrinology & Diabetes


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