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      Towards Optimal Treatment with Growth Hormone in Short Children and Adolescents: Evidence and Theses

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          Treatment with growth hormone (GH) has become standard practice for replacement in GH-deficient children or pharmacotherapy in a variety of disorders with short stature. However, even today, the reported adult heights achieved often remain below the normal range. In addition, the treatment is expensive and may be associated with long-term risks. Thus, a discussion of the factors relevant for achieving an optimal individual outcome in terms of growth, costs, and risks is required. In the present review, the heterogenous approaches of treatment with GH are discussed, considering the parameters available for an evaluation of the short- and long-term outcomes at different stages of treatment. This discourse introduces the potential of the newly emerging prediction algorithms in comparison to other more conventional approaches for the planning and evaluation of the response to GH. In rare disorders such as those with short stature, treatment decisions cannot easily be deduced from personal experience. An interactive approach utilizing the derived experience from large cohorts for the evaluation of the individual patient and the required decision-making may facilitate the use of GH. Such an approach should also lead to avoiding unnecessary long-term treatment in unresponsive individuals.

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          Most cited references 83

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          Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards.

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            Minireview: IGF, Insulin, and Cancer.

            In recent years, the influence of the IGF system and insulin on cancer growth has been widely studied. Observational human studies have reported increased cancer mortality in those with obesity and type 2 diabetes, which may be attributable to hyperinsulinemia, elevated IGF-I, or potentially both factors. Conversely, those with low insulin, IGF-I and IGF-II levels appear to be relatively protected from cancer development. Initial attention focused on the role of IGF-I in tumor development. The results of these investigations allowed for the development of therapies targeting the IGF-I receptor signaling pathway. However, after in vitro and in vivo studies demonstrating that insulin may also play a significant and independent role in tumorigenesis, insulin is now receiving more attention in this regard. Some studies suggest that targeting insulin receptor signaling may be an important alternative or adjunct to targeting IGF-I receptor signaling. In this minireview, we discuss some of the recent in vitro, animal, and clinical studies that have elaborated our understanding of the influence of IGF and insulin on tumorigenesis. These studies have shed more light on the interaction between insulin and IGF signaling in cancer cells. They have made possible the development of novel targeted therapies and highlighted some of the potential future directions for research and therapeutics.
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              Consensus statement on the standardization and evaluation of growth hormone and insulin-like growth factor assays.

              Growth hormone (GH) and insulin-like growth factor I (IGF-I) measurements are widely used in the diagnosis of disorders of GH secretion, evaluation of children with short stature from multiple causes, management of disorders that lead to nutritional insufficiency or catabolism, and monitoring both GH and IGF-I replacement therapy. Therefore, there is an ongoing need for accurate and precise measurements of these 2 peptide hormones. Representatives of the Growth Hormone Research Society, the IGF Society, and the IFCC convened an international workshop to review assay standardization, requirements for improving assay comparability, variables that affect assay interpretation, technical factors affecting assay performance, assay validation criteria, and the development and use of normative data. Special attention was given to preanalytical conditions, the use of international commutable reference standards, antibody specificity, matrix requirements, QC analysis, and interference by binding proteins. Recommendations for each of these variables were made for measurements of each peptide. Additionally, specific criteria for IGF-I were recommended for age ranges of normative data, consideration of Tanner staging, and consideration of the effect of body mass index. The consensus statement concludes that major improvements are necessary in the areas of assay performance and comparability. This group recommends that a commutable standard for each assay be implemented for worldwide use and that its recommendations be applied to accomplish the task of providing reliable and clinically useful results.

                Author and article information

                Horm Res Paediatr
                Hormone Research in Paediatrics
                S. Karger AG
                March 2013
                26 February 2013
                : 79
                : 2
                : 51-67
                aPaediatric Endocrinology Section, Children's Hospital, University of Tuebingen, Tuebingen, Germany; bPfizer Inc., Pfizer Endocrine Care, KIGS/KIMS/ACROSTUDY Medical Outcomes, Sollentuna, Sweden; cDivision of Paediatric Endocrinology, Diabetology and Metabolism, Inselspital, University Children's Hospital, Bern, Switzerland; dChildren's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, Calif., USA; eTanaka Growth Clinic, Tokyo, Japan; fLiggins Institute, University of Auckland, Grafton, Auckland, New Zealand; gCentre de Référence du syndrome de Prader-Willi, Department of Endocrinology, Children´s Hospital, Toulouse, France; hUniversity Department of Paediatrics, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
                Author notes
                *Prof. emer. Michael B. Ranke, FRCP (Edin), Paediatric Endocrinology and Diabetology, University Children's Hospital, Hoppe-Seyler-Strasse 1, DE-72076 Tuebingen (Germany), E-Mail Michael.Ranke@med.uni-tuebingen.de
                347121 Horm Res Paediatr 2013;79:51-67
                © 2013 S. Karger AG, Basel

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                Page count
                Figures: 3, Tables: 8, Pages: 17
                Mini Review


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