Abstract
In the state of insulin deficiency, the growth hormone—insulin-like growth factor-I (GH–IGF-I) axis is altered due to hepatic GH resistance, which leads to GH hypersecretion and low circulating IGF-I concentration. On the other hand, both growth hormone deficiency (GHD) and GH excess have significant influence on carbohydrate metabolism. These complex interactions are challenging in diagnosing GHD in subjects with type 1 diabetes mellitus (T1DM) and in treating subjects with T1DM with GH. So far, there is only limited clinical experience in GH treatment in patients with T1DM, but recently first reports on metabolic safety and efficacy of GH treatment in subjects with T1DM have been published.
Highlights
The combination of the two diagnoses “growth hormone deficiency” (GHD) and “type 1 diabetes mellitus” (T1DM) is quite rare, given a prevalence of GHD ranging between 1:3500 and 1:8700 and an incidence of T1DM
Uncertainty relating to diagnostic criteria (insulin-like growth factor-I (IGF-I) normal values and growth hormone cut-off in a diabetic child) and fear of worsening metabolic diabetes control might be obstacles in treating diabetic children with growth hormone
In only 13 centers in total 17 patients were treated with growth hormone under various indications (GHD, short stature without catch-up growth in children born small for gestational age, and Turner Syndrome); in nine patients, GH treatment had already been started before diabetes onset, and in eight patients, after diagnosis of T1DM [3]
Summary
The combination of the two diagnoses “growth hormone deficiency” (GHD) and “type 1 diabetes mellitus” (T1DM) is quite rare, given a prevalence of GHD ranging between 1:3500 and 1:8700 and an incidence of T1DM
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