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      Growth Response to Recombinant Human Growth Hormone (GH) in Children with Idiopathic Growth Retardation by Level of Maximum GH Peak during GH Stimulation Tests

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          Due to their lack of reproducibility, it is unlikely that GH stimulation tests can provide reliable diagnostic information to distinguish partial isolated GH deficiency (GHD) from idiopathic short stature (ISS). We hypothesized that the classical distinction between these groups, essentially based on stimulatory GH peaks, is artificial and that, as a consequence, the average response to GH treatment will not be different between them. The hypothesized lack of prognostic validity of stimulatory GH peaks was studied in 435 prepubertal children with nonorganic growth retardation. Children were categorized as ‘severe GHD’, ‘partial GHD’ or ‘ISS’, if the maximum rise in their serum GH during two GH stimulation tests was 0– 10 mU/l, 10–20 mU/l, or >20 mU/l, respectively. Children with ‘partial GHD’ had short-term (1- and 2-year) and long-term (till final adult height) growth responses similar to those of children with ISS, significantly lower than the response seen in children with ‘severe GHD’. In children with stimulatory GH peaks >10 mU/l, including those currently considered partially GH deficient, the maximum GH peak was not a significant determinant of growth response in the short or the long term. In conclusion, ‘partial GHD’ is ill defined and cannot be distinguished from ISS based on the currently applied auxological or GH stimulation test criteria alone. More research is required for better identification of (all) children who will respond to GH treatment, whether or not GH deficient.

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          Most cited references 7

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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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            Diagnostic controversy: the diagnosis of childhood growth hormone deficiency revisited

             R Rosenfeld (1995)
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              Reliability of provocative tests to assess growth hormone secretory status. Study in 472 normally growing children

               E. Ghigo (1996)

                Author and article information

                Horm Res Paediatr
                Hormone Research in Paediatrics
                S. Karger AG
                10 January 2001
                : 53
                : 6
                : 267-273
                aDutch Growth Foundation, Sophia Children’s Hospital, Rotterdam, and bDepartment of Pediatrics, Division of Endocrinology, Sophia Children’s Hospital, Erasmus University, Rotterdam, The Netherlands
                53182 Horm Res 2000;53:267–273
                © 2001 S. Karger AG, Basel

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                Page count
                Tables: 5, References: 30, Pages: 7
                Original Paper


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