Treatment to Near Adult Stature of Patients with Myelomeningocele with Recombinant Human Growth Hormone

Abstract

We evaluated near adult statural outcome of treating growth hormone (GH) deficient children (peak GH values <10 ng/ml) with myelomeningocele (MMC) with 0.3 mg/kg/week of recombinant human GH. Retrospective evaluation of 20 patients (12 males) who were consistently measured using recumbent length and who had achieved more than 90% of their adult stature on GH treatment were included. Pretreatment scoliosis was present in 13 patients (<30 degrees); 16 patients had lumbar level of lesion, while four had sacral level of lesion; 19 of 20 had a ventriculoperitoneal shunt. During GH treatment, two girls were successfully treated with leuprolide acetate for precocious puberty, two patients were concurrently treated for hypothyroidism and were euthyroid. Standard deviation score (SDS) for recumbent length at near adult stature increased in comparison to the general adult population and untreated adults with MMC (-2.6 to -1.4 and +0.6, respectively, p <0.001). Fifteen of 20 patients at near adult stature were above the 3rd percentile of current United States growth charts. These patients were less overweight as body mass index (BMI) was less than untreated shorter adults with MMC (p <0.01 for females, <0.001 for males). Scoliosis did not progress. Near adult stature for GH-treated children with MMC is significantly greater than untreated adults with MMC. Relative obesity is decreased with significant improvement of BMI. This is the first report of statural outcome near completion of growth for GH-treated children with MMC.