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      Recomendaciones de la Sociedad Mexicana de Endocrinología Pediátrica, A. C., para el uso de hormona de crecimiento en niños y adolescentes Translated title: Mexican society for pediatric endocrinology's recommendations for the use of human biosynthetic growth hormone in children and adolescents

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          Abstract

          El objetivo del presente trabajo es señalar consideraciones puntuales que permitan: a) recordar los mecanismos básicos de la acción de la hormona de crecimiento; b) establecer la sospecha diagnóstica de deficiencia de hormona de crecimiento; c) evaluar la utilidad de diferentes estudios de laboratorio para confirmar su existencia; d) conocer las características físicas y químicas de los diferentes productos comerciales; e) preparar y utilizar los diferentes productos comerciales para asegurar su eficacia; f) determinar los objetivos generales del tratamiento con hormona de crecimiento; g) verificar las indicaciones formales para el uso de hormona de crecimiento; h) administrar la dosis adecuada con un horario y periodicidad óptimos; i) evaluar los parámetros de eficacia de la hormona de crecimiento; j) identificar los factores que modifican la acción de la hormona de crecimiento, k) reconocer y vigilar los parámetros de seguridad durante el tratamiento con hormona de crecimiento; l) definir el momento en que debe terminar el tratamiento con hormona de crecimiento.

          Translated abstract

          The aim of this paper is to present consensus guidelines for the diagnosis and treatment of children and adolescents with growth hormone deficiency, and to alert on several crucial points regarding the use of human biosynthetic growth hormone: a) the mechanism of action of natural human growth hormone; b) how to establish clinical suspicious of growth hormone deficiency; c) utility of different biochemical studies to confirm growth hormone deficiency; d) physical and chemical characteristics of the commercial kits of growth hormone; e) how to prepare and use the growth hormone kits to ensure their efficacy; f) general objectives of growth hormone treatment; g) formal indications for the use of human growth hormone; h) define dose, time and periodicity during treatment; i) efficacy parameters of growth hormone treatment; j) factors that modify the efficacy of growth hormone treatment; k) safety parameters during growth hormone treatment; l) when, how and in who stop the treatment with growth hormone.

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          Recommendations for the diagnosis and management of Turner syndrome.

          Comprehensive recommendations on the diagnosis of Turner syndrome (TS) and the care of affected individuals were published in 1994. In the light of recent advances in diagnosis and treatment of TS, an international multidisciplinary workshop was convened in March 2000, in Naples, Italy, in conjunction with the Fifth International Symposium on Turner Syndrome to update these recommendations. The present paper details the outcome from this workshop. The genetics and diagnosis of the syndrome are described, and practical treatment guidelines are presented.
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            Serum levels of insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) in healthy infants, children, and adolescents: the relation to IGF-I, IGF-II, IGFBP-1, IGFBP-2, age, sex, body mass index, and pubertal maturation.

            Circulating IGF-I and -II are bound to specific insulin-like growth factor (IGF)-binding proteins (IGFBPs), of which IGFBP-3 binds the majority of the IGFs. IGFBP-3 levels are regulated by GH and have been suggested to provide additional information on GH secretory capacity compared to IGF-I. However, the diagnostic value of IGFBP-3 is still controversial, perhaps because the quality of the available normative data for IGFBP-3 varies. It has recently been shown that a large number of individuals is required to establish reference ranges for IGF-I that take into account age, sex, body mass index (BMI), and pubertal stage. Therefore, we measured IGFBP-3, IGF-I, IGF-II, IGFBP-1, and IGFBP-2 levels by RIA in 907 healthy children to establish well characterized normative data on IGFBP-3 according to age, sex, and pubertal stage and to study the complex relationship between IGFs and their BPs in puberty. We found that IGFBP-3 levels increase with age in children, with maximal levels in puberty; girls experience peak values approximately 1 yr earlier than boys. Age, sex, height, BMI, and pubertal maturation were all important factors in determining the circulating levels of IGFBP-3, whereas IGF-I levels were unaffected by BMI. Comparison of IGFBP-3 with IGF-1 concentrations revealed that they did not exhibit the same developmental pattern in puberty. IGF-I levels increased to relatively higher levels than IGFBP-3, leading to an increasing molar ratio between IGF-I and IGFBP-3 in puberty, when growth velocity is high. Concomitantly, IGF-II and IGFBP-2 levels were unchanged throughout puberty, whereas IGFBP-1 levels declined with age in prepubertal children, with lowest values in puberty. There was a highly significant correlation between IGF-I and -II and IGFBP-3 on a molar basis (r = 0.84; P < 0.0001). Thus, we speculate that IGFBP-3 is pivotal for circulating IGF bioactivity and that the increase in the molar ratio between IGF-I and IGFBP-3 reflects an increase in free, biologically active IGF-I. In conclusion, we have provided normative data on a large group of healthy individuals and conclude that age, sex, height, BMI, and pubertal maturation have to be taken into account before a single IGFBP-3 value in a growth-retarded child can be evaluated properly.
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              Effect of growth hormone treatment on adult height of children with idiopathic short stature. Genentech Collaborative Group.

              Short-term administration of growth hormone to children with idiopathic short stature results in increases in growth rate and standard-deviation scores for height. However, the effect of long-term growth hormone therapy on adult height in these children is unknown. We studied 121 children with idiopathic short stature, all of whom had an initial height below the third percentile, low growth rates, and maximal stimulated serum concentrations of growth hormone of at least 10 microg per liter. The children were treated with growth hormone (0.3 mg per kilogram of body weight per week) for 2 to 10 years. Eighty of these children have reached adult height, with a bone age of at least 16 years in the boys and at least 14 years in the girls, and pubertal stage 4 or 5. The difference between the predicted adult height before treatment and achieved adult height was compared with the corresponding difference in three untreated normal or short-statured control groups. In the 80 children who have reached adult height, growth hormone treatment increased the mean standard-deviation score for height (number of standard deviations from the mean height for chronologic age) from -2.7 to -1.4. The mean (+/-SD) difference between predicted adult height before treatment and achieved adult height was +5.0+/-5.1 cm for boys and +5.9+/-5.2 cm for girls. The difference between predicted and achieved adult height among treated boys was 9.2 cm greater than the corresponding difference among untreated boys with initial standard-deviation scores of less than -2, and the difference among treated girls was 5.7 cm greater than the difference among untreated girls. Long-term administration of growth hormone to children with idiopathic short stature can increase adult height to a level above the predicted adult height and above the adult height of untreated historical control children.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                bmim
                Boletín médico del Hospital Infantil de México
                Bol. Med. Hosp. Infant. Mex.
                Instituto Nacional de Salud, Hospital Infantil de México Federico Gómez (México )
                1665-1146
                October 2005
                : 62
                : 5
                : 362-374
                Affiliations
                [1 ] Sociedad Mexicana de Endocrinología Pediátrica, A. C. Mexico
                Article
                S1665-11462005000500011
                aca2a580-5509-4101-97d1-2c0bd31b12e8

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                Pediatrics

                Pediatrics
                Growth hormone,pituitary,somatotropin,short stature,Hormona de crecimiento,somatropina,talla baja

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