99 TREATMENT OF SHORT NORMAL PREPUBERTAL CHILDREN WITH GRWOTH HORMONE

Abstract

The growth reponse to growth hormone (GH) was studied in 9 short normal prepubertal children (6 boys, 3 girls) with a low height velocity. Their average age was 8.2yr (range 4.7-12.1), height standard deviation score (SDS) for chronological age (CA) was -2.6 (-2.0 to -3.7). All had normal maximum plasma GH responses above 10ng/mL to stimulation with clonidine and/or insulin induced hypoglycemia. Assessment of overnight GH secretion by measurement of GH in 20min intervals for 12h yielded low peak levels of 8.7±3.0(SD)ng/mL and low mean pool values of 1.9±1.0. With informed consent treatment with somatrem (Protropin) 0.11±0.01mg/kg three times weekly s.c. was then begun and continued for one year. No major side effects were noted. After 6 months of GH therapy, height velocity SDS for CA increased significantly (p<0.001) from a pretreatment mean of -1.7 (-0.6 to -3.0) to +3.4 (-1.0 to +5.7), representing a change from 4.7cm/yr (3.5-6.0) to 9.3 (5.7-12.5). Height velocity during GH treatment (SDS for CA and cm/yr) inversely correlated with endogenous nocturnal peak GH concentration (r=-0.76, and r=-0.78; both p<0.05). We conclude that some short normal children with low height velocity and low endogenous GH secretion may profit from GH therapy. A major goal should be the proper identification of these patients and careful long-term follow-up to final height. Supported by Genentech, Inc., South San Francisco, California.