Adult Height after Growth Hormone Treatment at Pubertal Onset in Short Adolescents Born Small for Gestational Age: Results from a Belgian Registry-Based Study.

M Thomas,S Van Der Straaten,P Lysy,N Reynaert,M Roelants,R Rooman,J De Schepper,G Massa,D Beckers,M.-C Lebrethon,C Brachet,H Dotremont

doi:10.1155/2018/6421243

Abstract

Objectives Information on the efficacy of GH treatment in short SGA children starting their treatment in adolescence is limited. Therefore, adult height (AH), total height gain, and pubertal height gain were evaluated in short SGA children who started GH treatment at pubertal onset. Patient and Methods Growth data of 47 short SGA adolescents (22 boys) who started GH treatment at pubertal onset (PUB group) were compared with results from 27 short SGA patients (11 boys) who started GH therapy at least 1 year before pubertal onset (PrePUB group). Results The PUB group achieved a mean (±SD) total height gain of 0.8 ± 0.7 SDS and an AH of −2.5 ± 0.7 SDS after 4.1 ± 1.1 years of GH treatment with a dosage of 41.8 ± 8.4 μg/kg/day. These results were comparable with those in the PrePUB group, which was treated for a longer duration (5.8 ± 2.1 years), resulting in a total height gain of 1.1 ± 0.7 SDS and an AH of −2.1 ± 1.0 SDS. Multiple regression analysis showed a significantly lower height gain in pubertal patients, females, and patients weighing less at start of GH treatment. An AH above −2 SDS and above the parent-specific lower limit of height was, respectively, reached in 28% and 70% of PUB and 44% and 67% of PrePUB patients (NS). AH SDS was positively correlated with the height SDS at start of GH. Conclusions Short SGA adolescents starting GH therapy at an early pubertal stage have a modest and variable height gain. A normal AH can be expected in one third of the patients, especially in those with a smaller height deficit at onset of GH treatment.

Highlights

In Europe, growth hormone (GH) treatment is, since 2003, an approved growth-promoting therapy for children born small for gestational age (SGA) who do not show postnatal spontaneous catch-up growth
Inclusion criteria were as follows: (1) diagnosis of SGA (Birth weight and/or length < −2 SDS), (2) treatment with recombinant human GH, given continuously on a daily basis during at least 3 years when treatment started before puberty and at least 2 years when started near the onset of puberty, (3) breast stage
A total height gain > 0.5 SDS was observed in 85% (23/27) of patients in the PrePUB group and in 64% (30/47) of patients in the PUB group (p = 0 06) (Figures 2(a) and 2(b))

Summary

Introduction

In Europe, growth hormone (GH) treatment is, since 2003, an approved growth-promoting therapy for children born small for gestational age (SGA) who do not show postnatal spontaneous catch-up growth. Adult height (AH) in short SGA children treated with GH is mainly dependent on the duration of treatment: the best response is obtained when treatment is International Journal of Endocrinology started several years before the onset of puberty [1, 2]. Diagnosis and referral for treatment of SGA children without catch-up growth before puberty has been advocated [3]. Median age at start of GH treatment in short SGA children in Belgium is 7.7 years (data on file, Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED)). Despite efforts to promote early referral of short SGA children during the last decennium in most European countries, a variable percentage of short SGA children still consults for growth-promoting therapy around the onset of puberty (up to 17% in Belgium). Increasing the dose of GH and/ or additional treatment with GnRH agonists remain controversial issues in the management of short SGA adolescents, presenting with a major height deficit, and are not commonly performed in Belgium [4, 5]

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