Abstract
In a retrospective, population based cohort study, we examined whether constitutional delay was associated with the growth response to growth hormone (GH) in children with short stature and normal GH responses. 70 patients were treated with 21 GH iu/m2/week from 1975 to 2013 throughout New Zealand. Demographic and auxological data were prospectively collected and standard deviation scores (SDS) were calculated for height (HtSDS), yearly growth velocity (GV-SDS), body mass index (BMI-SDS) and predicted adult height (PAH-SDS) at time of the last available bone age. In the first year, GH was associated with marked increase in HtSDS (+0.46 (0.19, 0.76), p < 0.001) and GV-SDS (from −1.9 (−3.6, −0.7) to +2.7 (0.45, 4.2), p < 0.001). The increase in HtSDS but not in GV-SDS was greatest with younger patients and greater bone age delay, with no effect of sex, BMI-SDS or baseline HtSDS. PAH-SDS increased with treatment (+0.94 (0.18, 1.5)); increased PAH-SDS was associated with less bone age delay and greater initial increase in HtSDS. This study shows that greater bone age delay was associated with greater initial improvement in height but less improvement in predicted adult heights, suggesting that children with very delayed bone ages may show accelerated maturation during GH treatment.
Highlights
Population based cohort study, we examined whether constitutional delay was associated with the growth response to growth hormone (GH) in children with short stature and normal GH responses. 70 patients were treated with 21 GH iu/m2/week from 1975 to 2013 throughout New Zealand
In this study we examined the hypothesis that constitutional delay of growth is positively related with response to GH treatment and evaluated the relationship between age at the start of treatment, ethnicity, and sex on growth rate and increase in height in an unselected national cohort of New Zealand children and adolescents with short stature
This study has demonstrated that while delayed bone age in an unselected group of children with short stature and growth hormone sufficiency was associated with a modestly greater initial growth response to GH treatment, greater delay was associated with a smaller increase in predicted final height after a median of 3 years of treatment
Summary
Population based cohort study, we examined whether constitutional delay was associated with the growth response to growth hormone (GH) in children with short stature and normal GH responses. 70 patients were treated with 21 GH iu/m2/week from 1975 to 2013 throughout New Zealand. There is evidence from controlled trials that recombinant human growth hormone (GH) can increase short term growth rates and that this increases final height by a mean of approximately 5.5 cm[1,3,4,5] Not surprisingly in this heterogeneous group, the response to GH is highly variable and some patients show little or no apparent gain in height. In this study we examined the hypothesis that constitutional delay of growth is positively related with response to GH treatment and evaluated the relationship between age at the start of treatment, ethnicity, and sex on growth rate and increase in height in an unselected national cohort of New Zealand children and adolescents with short stature. We evaluated the effect of bone age delay and GH treatment on change in predicted adult height
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