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      Growth Prediction Models, Concept and Use

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          Abstract

          There is a principal and qualitative difference between using regression results on data from groups of children, and using validated prediction models for individual children. Using accurate models, it is now possible to predict the growth response to growth hormone (GH) treatment in a slowly growing child with GH deficiency (GHD) or in a child with idiopathic short stature (ISS). The growth response to the standard dose of GH can be regarded as a bioassay for GH (i.e. the tissue GH responsiveness) and the information on this growth response can be used for different purposes: to decide about treatment or not, for monitoring, and for adjusting the GH dose in order to reach a defined goal for height. This last concept is now used in an ongoing prospective randomized GH dose-finding trial.

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          Catch-Up Growth after Childhood-Onset Substitution in Primary Hypothyroidism: Is It a Guide towards Optimal Growth Hormone Treatment in Idiopathic Growth Hormone Deficiency?

          Catch-up growth was analyzed in 20 prepubertal children with primary hypothyroidism (PH) starting treatment at an age of 4.4 (1.2–10.1) years and a height (HT) SD score (HT SDS) of –3.1 (±0.8). All patients were followed for at least 3 prepubertal years. HT velocity was 12.3 ± 2.3, 9.0 ± 1.8 and 7.5 ± 2.2 cm/year, and change in HT SDS was 1.60 ± 0.56, 0.57 ± 0.33 and 0.28 ± 0.38 during the 1st, 2nd and 3rd year, respectively. The 11 children followed to adult height reached a HT SDS of –0.11 ± 1.1, all within their target HT range. HT gain (ΔHT SDS) during the 1st year was correlated with the degree of catch-up growth (r 2 = 0.78, p < 0.001). While catch-up growth in childhood-onset PH is complete, this is not the case in GH deficiency (GHD). Based on the auxological characteristics of the patients with PH, HT velocities during the first 2 years were predicted applying prediction models devised for prepubertal children with idiopathic GHD. The modalities of GH treatment observed in the models were used to calculate predicted HT velocities of the PH patients. Observed HT velocities in PH were higher than predicted HT velocities during the 1st (10.67 ± 1.37 cm/year, p < 0.01) and 2nd (8.35 ± 0.86 cm/year, p = 0.128) year. The data show that catch-up potential in idiopathic GHD of childhood onset is reduced compared to PH. Since early catch-up as well as total HT recovery in children with GHD are often not reached by present treatment modalities, catch-up growth in PH may serve as a model towards optimizing GH treatment. The data suggest that initial GH doses of 1.0 IU/kg/week, rather than the presently recommended 0.6 IU/kg/week, need to be given in GHD in order to achieve the degree of early catch-up observed in PH and to consequently improve the final outcome.
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            Author and article information

            Journal
            HRE
            Horm Res Paediatr
            10.1159/issn.1663-2818
            Hormone Research in Paediatrics
            S. Karger AG
            978-3-8055-7429-7
            978-3-318-00854-8
            1663-2818
            1663-2826
            2002
            2002
            17 November 2004
            : 57
            : Suppl 2
            : 66-70
            Affiliations
            Gothenburg Pediatric Growth Research Center, Institute for the Health of Women and Children, Department of Pediatrics, Sahlgrenska Academy at Gothenburg University, Queen Silvia Children’s Hospital, Gothenburg, Sweden
            Article
            58104 Horm Res 2002;57(suppl 2):66–70
            10.1159/000058104
            12065931
            70ebc7c1-8841-4d28-bb45-78ab53767bdf
            © 2002 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            History
            Page count
            Figures: 6, References: 10, Pages: 5
            Categories
            Paper

            Endocrinology & Diabetes,Neurology,Nutrition & Dietetics,Sexual medicine,Internal medicine,Pharmacology & Pharmaceutical medicine
            GH deficiency,Children,GH treatment,Growth response,Tissue GH responsiveness,Short stature

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