Auxological Data Research Articles

The association between growth response to growth hormone and baseline body composition of children with growth hormone deficiency

ObjectiveWe wanted to examine the relationship between initial growth response to recombinant human Growth Hormone (rhGH) treatment and body composition in children with growth hormone deficiency (GHD). Design and methodsForty-two patients (21 boys and 21 girls) aged between 5.7–15.5years (mean age: 10.8±2.6years) with isolated GHD. The auxological and laboratory data (GH and IGF-I levels) and results of bioelectrical impedance analyses were evaluated. Children with GHD were followed up for 12months and categorized according to growth response to rhGH into good and poor responders (change in height of >0.7 SDS or <0.7 SDS over one year respectively). Mean doses of rhGH per kg of fat free mass (FFM) were calculated. ResultsForty-eight percent of patients showed a good growth response to rhGH therapy. At study entry, mean age, height SDS, weight SDS, serum IGF-1 SDS, IGFBP-3 SDS, growth velocity prior to rhGH therapy, GH after clonidine and l-dopa were similar in the two groups. At baseline, BMI SDS and waist–hip ratio were significantly higher in good responders (p=0.02 and p=0.006, respectively). Good responders had lower percentages of FFM (73.4±8.9 vs. 83.1±5.9) and total body water (TBW) (56.5±5.3 vs. 63.1±4.4), compared to poor responders (p<0.05). There were significant correlations between changes in height SDS over one year and baseline body composition in children with GHD on rhGH treatment (r=−0.617 for percentage of FFM, r=−0.629 for percentage of TBW, p<0.001). A correlation between BMI SDS, waist–hip ratio, mean rhGH dose per FFM and growth response was observed only in prepubertal subjects. ConclusionBaseline body composition data in children with GHD can be used to predict the growth response to rhGH treatment. A management strategy that involves titrating rhGH dose according to FFM as a means of optimizing the growth response to intervention requires further study.

Carotid intima-media thickness; normal values from 4 years

The study of the common carotid artery using ultrasound, ever has greater significance for the prevention, treatment and evaluation of the risk of developing cardiovascular disease. Increased intima-media thickness is associated with the presence of other cardiovascular, cerebrovascular disease and the development of atherosclerosis in both adults and pediatric populations. A cross-sectional study in 202 healthy children aged between 4 and 15 years. It has been analyzed auxological data, systolic and diastolic blood pressure and carotid intima-media thickness. There are 100 men and 102 women, with no differences among them about sex; it is shown graphical representations of the values of carotid intima-media thickness in the total sample and by gender. There is a positive correlation between carotid intima-media thickness with age (r = 0.229, p < 0.05), weight (r = 0.228, p < 0.05), height (r = 0.265, p > 0.01) and BMI (r = 0.212, p < 0.05). Identification of modifiable risk factors should be our priority in clinical practice. Thus, in any health program it should be focused on reducing cardiovascular risk in children and adolescents by promoting a lifestyle of healthy eating and regularly physical exercise. Ultrasound measurement of carotid intima-media thickness is an added factor for an early identification of cardiovascular disease and its evolution in both adult and pediatric population.

GH dynamics in oral glucose tolerance test in children and adolescents with tall stature

Conclusions Assessment of GH dynamics in OGTT in children and adolescents with tall stature in various stages of pubertal development for documenting a possible autonomous GH secretion. Our study included 44 subjects, 18 girls and 26 boys, aged between 6.5 years and 17.3 years diagnosed with constitutional tall stature. • The inclusion criterion was height ≥+2 DS. • The exclusion criteria were: diabetes, thyroid dysfunction, Cushing's syndrome, hypothalamicpituitary pathology, renal failure, medication that alters glucose/ GH dynamics such as estrogen and thyroid hormones. • The following parameters were assesed: historical and auxological data, clinical examination, laboratory evaluations: karyotype, thyroid function, androgens, IGF1 (CLIA method with detection limit 3-1500ng/ml), IGFBP3, prolactin, evaluation of other pituitary hormone deficiency, bone age, cardiac ultrasound, eye examination, CT/MRI of the hypothalamic-pituitary region. OGTT was performed with 1.75 g/kg of glucose po. Glucose and GH (CLIA method with detection limit 0,1-80 ng/ml) were tested at 0, 30, 60, 90 and 120 minutes. • Brain imaging was performed in 20 cases. • Statistical analysis was performed using PASW software version 18, 2010 using Pearson correlation, T test, and Mann-Whitney test and the level of significance used was p 1ng/ml. • For girls GH nadir was higher than for boys. • The lowest value of GH both for girls and boys was at 90 minutes. • 2 patients with IGF1>+2DS for chronological age had normal levels of IGFBP3. • In 6 patients with GH suppression >1ng/ml, the levels of IGF1 and IGFBP3 were normal. • CT/MRI of the hypothalamic-pituitary region revealed an inhomogeneous pituitary gland. P 805

Hormonal and auxological data of the patients with persistent and transient GH deficiency, diagnosed according to different criteria after completion of growth-promoting therapy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Decreased placental expression of pre-adipocyte factor-1 in children born small-for-gestational-age: Association to early postnatal weight gain

BackgroundPreadipocyte factor-1 (Pref-1) is a key regulator of adipocyte differentiation acting as an inhibitor of adipogenesis; Pref-1 is highly expressed in embryonic tissues and placenta supporting a role in embryonic and fetal growth. The potential impact of placental Pref-1 expression in human pre- and postnatal development is unclear. Objective and hypothesesTo assess the contribution of placental Pref-1 to fetal and postnatal growth. Population and methodsPlacentas (N = 99) were collected at term delivery from singleton infants, who were born either appropriate (AGA; n = 59) or small-for-gestational-age (SGA; n = 40). Auxological data of all subjects were obtained at birth. In a subset of subjects (n = 31) we also obtained weight data at 4 mo and at 1 yr, together with body composition assessment (by DXA) at the age of 1 yr. Placental expression of Pref-1 was quantified by real-time PCR; the housekeeping gene GAPDH was used for comparisons. ResultsPref-1 was significantly downregulated in the placentas from SGA babies as compared to AGA controls (P = 0.005). In SGA infants placental Pref-1 expression associated positively to body weight at 4 and 12 mo (r = 0.44, P = 0.05; r = 0.66, P = 0.001 respectively); at age 12 mo, placental Pref-1 expression was inversely related to total fat mass and positively correlated with total lean mass (r = −0.59, P = 0.01; and r = −0.59, P = 0.01,respectively). ConclusionPlacental Pref-1 expression in SGA fetuses was decreased and associated with postnatal body weight, suggesting a role of Pref-1 in the regulation of postnatal development.

Growth patterns in pubertal HIV-infected adolescents and their correlation with cytokines, IGF-1, IGFBP-1, and IGFBP-3.

This study aims to describe the final adult height (FAH) and pubertal growth patterns in human immunodeficiency virus (HIV)-infected adolescents and to compare these to an age-matched population of seroreverting HIV-exposed, uninfected (HEU) adolescents. It further aims to evaluate the interplay of proinflammatory cytokines with insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3), and IGFBP-1 during the pubertal growth spurt. HIV-infected (n=34) and HEU (n=12) adolescents who had achieved FAH were evaluated. Auxologic data, viral load, CD4+ T-lymphocyte (CD4) count, and the use of highly active antiretroviral therapy were obtained via a retrospective chart review. Serum interleukin (IL)-1α, IL-6, tumor necrosis factor (TNF)-α, IGFBP-1, IGFBP-3, and IGF-1 were assessed. The mean FAH standard deviation score for the HIV-infected group was -0.78 (±1.1) compared to 0.05 (±0.78) for the HEU (p=0.034). There was a positive correlation between CD4 count and FAH (p=0.019). The mean age and magnitude of peak growth velocity (GV) was within normal limits. IL-1α, IL-6, TNF-α, IGFBP-3, and IGF-1 were not significantly correlated with HIV RNA or height. IGFBP-1 was detectable in 100% of poorly controlled HIV-infected patients and 25% of the HEU cohort (p=0.0003). The FAH of HIV-infected patients was significantly shorter than that of HEU patients, and it positively correlated with CD4 count. Our cohort demonstrated normal timing and magnitude of peak GV during puberty.

ENDOCRINE DISORDERS IN CHILDHOOD AND ADOLESCENCE: Natural history of subclinical hypothyroidism in children and adolescents and potential effects of replacement therapy: a review

Subclinical hypothyroidism (SH) is quite common in children and adolescents. The natural history of this condition and the potential effects of replacement therapy need to be known to properly manage SH. The aim of this review is to analyze: i) the spontaneous evolution of SH, in terms of the rate of reversion to euthyroidism, the persistence of SH, or the progression to over hypothyroidism; and ii) the effects of replacement therapy, with respect to auxological data, thyroid volume, and neuropsychological functions. We systematically searched PubMed, Cochrane, and EMBASE (1990-2012) and identified 39 potentially relevant articles of which only 15 articles were suitable to be included. SH in children is a remitting process with a low risk of evolution toward overt hypothyroidism. Most of the subjects reverted to euthyroidism or remained SH, with a rate of evolution toward overt hypothyroidism ranging between 0 and 28.8%, being 50% in only one study (nine articles). The initial presence of goiter and elevated thyroglobulin antibodies, the presence of celiac disease, and a progressive increase in thyroperoxidase antibodies and TSH value predict a progression toward overt hypothyroidism. Replacement therapy is not justified in children with SH but with TSH 5-10 mIU/l, no goiter, and negative antithyroid antibodies. An increased growth velocity was observed in children treated with levothyroxine (l-T(4); two articles). l-T(4) reduced thyroid volume in 25-100% of children with SH and autoimmune thyroiditis (two studies). No effects on neuropsychological functions (one study) and posttreatment evolution of SH (one study) were reported.

Psyllium Supplementation in Adolescents Improves Fat Distribution &amp; Lipid Profile: A Randomized, Participant-Blinded, Placebo-Controlled, Crossover Trial

AimsWe aimed to assess the effects of psyllium supplementation on insulin sensitivity and other parameters of the metabolic syndrome in an at risk adolescent population.MethodsThis study encompassed a participant-blinded, randomized, placebo-controlled, crossover trial. Subjects were 47 healthy adolescent males aged 15–16 years, recruited from secondary schools in lower socio-economic areas with high rates of obesity. Participants received 6 g/day of psyllium or placebo for 6 weeks, with a two-week washout before crossing over. Fasting lipid profiles, ambulatory blood pressure, auxological data, body composition, activity levels, and three-day food records were collected at baseline and after each 6-week intervention. Insulin sensitivity was measured by the Matsuda method using glucose and insulin values from an oral glucose tolerance test.Results45 subjects completed the study, and compliance was very high: 87% of participants took >80% of prescribed capsules. At baseline, 44% of subjects were overweight or obese. 28% had decreased insulin sensitivity, but none had impaired glucose tolerance. Fibre supplementation led to a 4% reduction in android fat to gynoid fat ratio (p = 0.019), as well as a 0.12 mmol/l (6%) reduction in LDL cholesterol (p = 0.042). No associated adverse events were recorded.ConclusionsDietary supplementation with 6 g/day of psyllium over 6 weeks improves fat distribution and lipid profile (parameters of the metabolic syndrome) in an at risk population of adolescent males.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12609000888268

Comparison of response to 2-years’ growth hormone treatment in children with isolated growth hormone deficiency, born small for gestational age, idiopathic short stature, or multiple pituitary hormone deficiency: combined results from two large observational studies

BackgroundFew studies have compared the response to growth hormone (GH) treatment between indications such as isolated growth hormone deficiency (IGHD), born small for gestational age (SGA), idiopathic short stature (ISS), and multiple pituitary hormone deficiency (MPHD). The aim of this analysis of data, collected from two large ongoing observational outcome studies, was to evaluate growth and insulin-like growth factor-I (IGF-I) response data for children of short stature with IGHD, MPHD, SGA, or ISS following two years of treatment with the recombinant GH product Norditropin® (Novo Nordisk A/S, Bagsværd, Denmark).MethodsAnalysis of auxologic data from two ongoing prospective observational studies, NordiNet® International Outcomes Study (NordiNet® IOS) and NovoNet®/American Norditropin® Studies: Web-enabled Research (ANSWER) Program®.Results4,582 children aged <18 years were included: IGHD, n = 3,298; SGA, n = 678; ISS, n = 334; and MPHD, n = 272. After two years’ GH treatment, change in height standard deviation score (SDS) was +1.03 in SGA and +0.84 in ISS vs. +0.97 in IGHD (p = 0.047; p < 0.001 vs. IGHD, respectively). Height gain was comparable between IGHD and MPHD. In pre-pubertal children vs. total population, height SDS change after two years was: IGHD, +1.24 vs. +0.97; SGA, +1.17 vs. +1.03; ISS, +1.04 vs. +0.84; and MPHD, +1.16 vs. +0.99 (all p < 0.001).ConclusionsAfter two years’ GH treatment, change in height SDS was greater in SGA and less in ISS, compared with IGHD; the discrepancy in responses may be due to the disease nature or confounders (i.e. age). Height SDS increase was greatest in pre-pubertal children, supporting early treatment initiation to optimize growth outcomes.

Body weight predicts spinal canal depth in general paediatric population

Aims Samples of cerebrospinal fluid (CSF) are required for the management of many disease states. One of the commonest errors in performing lumbar punctures (LPs) is inaccurate insertion of the spinal needle (too shallow or too deep), with blood contamination often complicating subsequent laboratory interpretation. We previously demonstrated a good correlation between ultrasound measures of spinal canal depth (SCD) and body weight in neonates, producing a nomogram (1) which has been tested in clinical practice (2). Here, we present preliminary data from ultrasound and auxological assessment in an older general paediatric population. Other studies have been limited by small cohort size, measurements being taken in the supine position during CT, or data gathered post-LP procedure, based on recall of depth of needle insertion. Methods Single-centre study of patients aged 0–18 years presenting at a tertiary paediatric centre. Patients were recruited from cardiology outpatients, PICU and paediatric inpatient wards. Individuals with pre-existing spinal abnormalities were excluded. Ultrasound measures of the spinal canal were performed in the left lateral position to obtain anterior and posterior SCDs; from these measures the mid-SCD (MSCD) was calculated. Patient age and auxological parameters including patient weight, height and body surface area (BSA) were recorded. Results 125 children were recruited and had complete data recorded (figure 1). The median age of the study population was 7.0 years (range 0.3-16.0). All auxological data are presented as means (standard deviation; range). Weight was 30.6 kgs (16.1; 7.8-88.9) and height 128 cms (29.1; 67.9-179.6), resulting in a mean BSA of 1.03 m 2 (0.39; 0.35-1.88). We identified a linear correlation between MSCD (mm) and age (R2 0.68), weight (R2 0.79), height (R2 0.74) and BSA (R2 0.79). The approximated formula for predicting MSCD from body weight (W Kg) in this cohort is MSCD (mm) = 0.4W + 20 (figure 1). Conclusion Our preliminary data demonstrates good correlation between both patient weight and BSA and MSCD in an unselected older general paediatric population. The most practical MSCD correlation is likely to be that based on weight, as height is infrequently routinely measured in clinical practice. This needs testing in clinical practice.

Growth Response to Growth Hormone (GH) Therapy in Children with and without GH Deficiency

The diagnosis of growth hormone deficiency (GHD) needs consideration of both clinical and biological aspects such as auxological data, GH provocative tests and active metabolites of GH including IGF-I and IGFBP-3. In children with GHD, recombinant human GH (rhGH) replacement therapy has been used worldwide with minimal serious side effects. This study aimed to report the results of an investigations for GHD, to describe the growth responses to rhGH in deficient children compared to those without GH deficiency, to evaluate the relationship between clinical and biochemical responses, and to describe the experience of diagnosis and treatment with rhGH at Hamad General Hospital, the main hospital in Qatar where most short children are referred for further investigation. The clinical records of 116 short children were reviewed retrospectively. Forty-six failed the clonidine test and 42 of these also failed the glucagon test and were confirmed with GHD. These and 16 children without GDH were treated with rhGH (25 gg/kg/ day) and were evaluated in terms of growth response, HtSDS, changes of IGF-I concentration and the relationship between these parameters. Treatment with GH of short children with GHD does produce a satisfactory growth response but the HtSDS gain was significantly higher in those with GHD compared to children without GHD. Measurement of IGF-I was found not to be a useful diagnostic test in GHD.

Adrenarche and Puberty in Children with Classic Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

There have been only a few studies on adrenarche in girls with classic congenital adrenal hyperplasia (CAH) showing that dehydroepiandrosterone sulfate (DHEAS) levels did not rise at the physiological age of adrenarche. Objective: Longitudinal analysis of serum DHEAS levels and Tanner stages in CAH children. Design: We studied 98 CAH patients (52 females), aged between 1 month and 18.0 years. All patients had genetically proven classic CAH and received steroid substitution therapy. Results: Serum DHEAS levels did not differ between CAH children and healthy children from the age of 1 year until 5–6 years. Beginning at the age of 7–8 years, there was a continuous but blunted increase in DHEAS levels in CAH boys and girls compared to healthy children. There was no correlation of DHEAS levels with the genotype, glucocorticoid dosage, auxological data, or quality of metabolic control. Pubarche (PH2) as well as gonadarche (G2) and thelarche (B2) occurred significantly earlier in CAH boys and girls than in the reference group, but timing of menarche was normal. Conclusions: Pubarche and adrenarche are dissociated in classic CAH: earlier pubarche, gonadarche and thelarche, respectively, in both sexes contrast with the absence of typical adrenarche.

Neonatal follow-up of 995 consecutively born children after embryo biopsy for PGD

Outcome data on children born after assisted reproduction treatments are important for both patients and health-care providers. The objective of this study was to determine whether embryo biopsy as performed in PGD has an impact on the health of infants up to 2 months of age. A prospective comparative follow-up study of children born after PGD and children born after ICSI by collecting written reports and performing a physical examination at 2 months was performed. Auxological data at birth and physical findings up to 2 months of age were compared for 995 children consecutively live born after embryo biopsy (1994-2009) and for a control group of 1507 children born after ICSI with embryo transfer on Day 5. No differences regarding mean term, prematurity (term <32 w and <37 w), mean birthweight, very low birthweight (<1500 g), perinatal death, major malformations and neonatal hospitalizations in singletons and multiples born following PGD versus ICSI were observed. Compared with ICSI, fewer multiples born following PGD presented a low birthweight (<2500 g) (P = 0.005). Embryo biopsy for PGD does not introduce extra risk to the overall medical condition of newborn children. Multiples born following embryo biopsy appear to be at lower risk for low birthweight compared with multiples born following ICSI.

Poor oral hygiene and gingivitis are associated with obesity and overweight status in paediatric subjects

The association between obesity and periodontitis has been extensively investigated in adults but not in young people. Our aim is to evaluate whether overweight/obese paediatric patients have a greater chance of being affected by gingivitis than those of normal weight. Ninety-eight subjects ranging between 10 and 17 years of age were classified as obese/overweight or normal weight on the basis of body mass index. Auxological data, blood pressure, insulin resistance, psychological profile, oral hygiene habits, plaque and gingival indices were collected. Anthropometric measurements and blood pressure were significantly higher in overweight/obese subjects than in the normal-weight subjects (p<0001). The overweight/obese subjects showed a worse attitude towards oral hygiene. Two-way anova revealed a significant effect of obesity status (p<0001) on the gingival index. Logistic and linear regression analyses identified gingivitis as dependent on insulin resistance and bad oral hygiene rather than on the overweight/obese status simply defined. Negative psychological features related to physical and academic self-concept were also risk factors for gingivitis probably because they were related to a generic poor self-awareness. The gingivitis observed in overweight and obese young subjects is probably due to a combination of metabolic and inflammatory profiles and neglected attitude towards oral hygiene.

SCAMP: standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care

BackgroundInfants born <29 weeks gestation are at high risk of neurocognitive disability. Early postnatal growth failure, particularly head growth, is an important and potentially reversible risk factor for impaired neurodevelopmental outcome. Inadequate nutrition is a major factor in this postnatal growth failure, optimal protein and calorie (macronutrient) intakes are rarely achieved, especially in the first week. Infants <29 weeks are dependent on parenteral nutrition for the bulk of their nutrient needs for the first 2-3 weeks of life to allow gut adaptation to milk digestion. The prescription, formulation and administration of neonatal parenteral nutrition is critical to achieving optimal protein and calorie intake but has received little scientific evaluation. Current neonatal parenteral nutrition regimens often rely on individualised prescription to manage the labile, unpredictable biochemical and metabolic control characteristic of the early neonatal period. Individualised prescription frequently fails to translate into optimal macronutrient delivery. We have previously shown that a standardised, concentrated neonatal parenteral nutrition regimen can optimise macronutrient intake.MethodsWe propose a single centre, randomised controlled exploratory trial of two standardised, concentrated neonatal parenteral nutrition regimens comparing a standard macronutrient content (maximum protein 2.8 g/kg/day; lipid 2.8 g/kg/day, dextrose 10%) with a higher macronutrient content (maximum protein 3.8 g/kg/day; lipid 3.8 g/kg/day, dextrose 12%) over the first 28 days of life. 150 infants 24-28 completed weeks gestation and birthweight <1200 g will be recruited. The primary outcome will be head growth velocity in the first 28 days of life. Secondary outcomes will include a) auxological data between birth and 36 weeks corrected gestational age b) actual macronutrient intake in first 28 days c) biomarkers of biochemical and metabolic tolerance d) infection biomarkers and other intravascular line complications e) incidence of major complications of prematurity including mortality f) neurodevelopmental outcome at 2 years corrected gestational ageTrial registrationCurrent controlled trials: ISRCTN76597892; EudraCT Number: 2008-008899-14

Multiple pituitary hormone deficiency caused by pit-I mutation and the challenges of management in a developing country.

In most developing countries, childhood endocrine disorders are not as common as infections but they do occur. Multiple pituitary hormone deficiency (MPHD) is a known cause of familial short stature. This is very rarely diagnosed in Nigerian children. We describe the challenges of diagnosis and management of childhood endocrine conditions in a developing economy using a ten year old Nigerian girl with MPHD as an illustration. Patient had auxological data suggestive of short stature. In order to make a definitive diagnosis, pituitary function tests were carried out in the United Kingdom. Biochemical tests revealed growth hormone (GH) deficiency, Thyroid Stimulating Hormone (TSH) deficiency, decreased prolactin (PRL) level, normal cortisol and gonadotrophins. Her DNA analysis identified PIT-1 mutation in exon-6. She was placed on recombinant GH and thyroxine with evidence of catch up in height. There were challenges to management such as, inadequate facility for diagnosis, huge cost of treatment and little awareness about childhood endocrine conditions amongst health workers in a developing economy.

Prospective Study Confirms Oxandrolone-Associated Improvement in Height in Growth Hormone-Treated Adolescent Girls with Turner Syndrome

Background/Aims: Untreated girls with Turner syndrome (TS) have growth failure, and adult height is, on average, 20 cm less than predicted height. Treatment with growth hormone (GH) is now standard of care. The objective of this study was to investigate the benefit of adding oxandrolone (Ox) to GH in a long-term, randomized, placebo (Pl)-controlled prospective trial to near adult height in TS. Methods: Prospective, randomized, Pl-controlled study: 76 girls with TS (ages 10–14.9 years) were randomized to receive Ox (0.06 mg/kg/day) or Pl in combination with GH (0.35 mg/kg/week, daily) over 2 years. Auxologic data, breast and pubic hair Tanner stages, and hormone and lipid levels were measured. Subjects who chose to continue were followed in a 2-year double-blind extension, also received estrogen therapy (years 3, 4), and had dual-energy X-ray absorptiometry evaluation of bone density (years 3, 4). Results: At year 4, the change in absolute height and height SDS was greater in the GH/Ox versus GH/Pl group [26.2 ± 6.7 vs. 22.2 ± 5.1 cm, analysis of covariance (ANCOVA) p < 0.001; 1.8 ± 0.9 vs. 1.2 ± 0.7 standard deviation scores, ANCOVA p < 0.001]. Bone mineral density (BMD) of the wrist (0.51 ± 0.17 vs. 0.54 ± 0.05 g/cm²) and spine (0.91 ± 0.34 vs. 0.96 ± 0.13 g/cm²) in the GH/Ox versus GH/Pl groups was similar after 4 years. Breast development was slower in the GH/Ox versus GH/Pl group [year 4: Tanner stage 2.9 ±1.3 (Ox) vs. 4.1 ± 1.3 (Pl), p = 0.003], and menarche was approximately 1 year later. Conclusions: The addition of Ox to GH at mean age 12.0 ± 1.7 year augmented height gain after 4 years of treatment, slowed breast development and did not affect BMD in girls with TS. Whether initiation of Ox prior to initiation of pubertal development would optimize height gain without impeding breast development will require further study.

Should Blood Gas Analysis Be Part of the Diagnostic Workup of Short Children? Auxological Data and Blood Gas Analysis in Children with Renal Tubular Acidosis

Background: Renal tubular acidosis (RTA) is a rare cause of growth failure, therefore it is uncertain whether routine screening with blood gas analysis of short infants and children is cost-effective. Objective: To investigate the clinical, growth and laboratory parameters in children with RTA to estimate the possible value of laboratory screening for this disorder in infants and children referred for short stature according to a recent guideline. Method: Retrospective chart analysis of 30 children diagnosed between 1978 and 2005 in The Netherlands and 3 centers in Belgium. Results: The current guideline for short stature detected 33% of children with RTA. Assuming a pre-test probability of RTA of 0.6 per 100,000 births, the likelihood ratio of poor growth was 58 and 17 below and above 3 years, respectively. Sensitivity was 17/30 and 12/24 for a –2.0 SDS cutoff for weight and body mass index, respectively. In infants and toddlers diagnosed before 3 years of age, the mean weight loss was 1.5 SD, and 0.8 SDS in older children. In short children >3 years RTA was extremely rare, always associated with clinical symptoms, and rarely detected by blood gas analysis. Conclusion: According to our data a decreasing weight SDS for age is a sufficient indication to perform blood gas analysis in children <3 years of age, particularly in the presence of additional clinical features, whereas it can be omitted in short children >3 years of age.

Final Height in Patients Perinatally Infected with the Human Immunodeficiency Virus

Introduction: Data concerning final height are completely lacking in human immunodeficiency virus (HIV)-infected children. Design: Retrospective evaluation of auxological data up to final height in a cohort of patients with perinatal HIV infection. Patients and Methods: In 95 Caucasian patients (57 females and 38 males, median age 17.5 years) the following data were evaluated as standard deviation (SD) score: prepubertal height (PrH), height velocity (HV), final height (FH), target height (TH), FH minus PrH, predicted adult height (PAH), FH minus PAH, and FH minus TH. Results: Patients showed a significantly reduced PrH and FH compared to their TH (p < 0.001), even if no difference was evidenced between PrH and FH. Age at puberty onset displayed a negative significant correlation with PrH (p = 0.002) and CD4+ cell percentage (p < 0.01). Finally, HV displayed a significant correlation with viremia (p = 0.001), but not with CD4+ cell percentage. Conclusions: HIV perinatally infected patients show a FH significantly reduced and not in accordance with TH. Our data seem to suggest that the losses in stature accumulated throughout the total period of childhood and adolescence may contribute to their reduced FH.

GenenCalc V 2: A Practical Growth Assessment and Documentation Tool

GenenCalc version 2 is a tool for the pediatric endocrine and nephrology health care professional (HCP) that may be used for two purposes: assessment, calculation, and documentation of auxologic data for all patients and calculation and documentation of doses for rh growth hormone (rhGH).