Growth Hormone Deficiency Short Stature Research Articles

A prospective study of etiology and clinical characteristics of children with short stature and response to treatment

OBJECTIVE: To study the etiological and clinical profile of children presenting with short stature and to assess growth velocity in children after 6 months of treatment.METHODS: This prospective observational study was conducted between January 2017 to May 2018. One hundred consecutive children attending the outpatient department for short stature were thoroughly evaluated clinically and investigations were done as deemed necessary. The cases were followed up for 6 months to assess the growth velocity.RESULTS: Female to male ratio was 1.56. Nutritional short stature (NSS) and normal variant short stature were the most prevalent, with the equal frequency of 19% each, followed by endocrine and other causes. The significant number of children had Vitamin D deficiency/insufficiency (92%). mid-parental height (MPH) was below-1 standard deviation score (SDS) from the national standard in all the children studied.CONCLUSION: In the present study, normal variants of short stature and NSS were the most common causes of short stature, followed by endocrine disorders. Vitamin D status was low in the majority of the children (92%), with possible contribution to short stature in all groups irrespective of primary diagnosis and needs further exploration. Growth hormone (GH) therapy in select non GH deficiency short stature can be promising. We also noted that maternal, paternal heights, and consequently, MPH was below the national standard in 100% of children. This may implicate ethnic variations and maybe a call for local growth charts. It needs further studies to look for factors responsible for lower MPH in our cohort.

Baseline IGFBP - 3 as the Key Element to Predict Growth Response to Growth Hormone and IGF - 1 Therapy in Subjects with Non - GH Deficient Short Stature and IGF - 1 Deficiency.

BackgroundShort stature in children represents a heterogeneous group with different etiologies. Primary Insulin like growth factor 1 (IGF - 1) deficiency in short stature can present with normal or elevated growth hormone (GH) production. Currently there is no model that can reliably predict response to recombinant (r)GH therapy and/or rIGF - 1 therapy in children with non - GH deficient short stature.HypothesisBaseline Insulin like growth factor binding protein 3 (IGFBP - 3) along with ∆ IGF - 1 in the first 3 months of GH therapy level can be a marker of growth response to the rGH and/or rIGF - 1 therapy in children with non - growth hormone deficiency short stature.ObjectivesTo study the relationship between baseline IGFBP - 3 and IGF - 1 levels and the response to rGH and rIGF - 1 therapy in children with short stature, normal GH secretion and low IGF - 1 SDS.Methods43 children, age 9.07 ± 2.75 years with height -2.72 ± 0.7 SD and baseline IGF - 1 of -2.76 ± 0.58 SD, who passed the growth hormone releasing hormone (GHRH) stimulation test were included in a retrospective chart review. They were treated with rGH therapy with a mean dose of 0.46 ± 0.1 mg/kg/week. Growth velocity (GV), IGF - 1 and IGFBP - 3 levels were done at 3 and 6 months of therapy. Subjects with poor response to rGH after 6 months of therapy were switched to rIGF - 1 therapy at 0.24 mg/kg/day for the next 6 months. Subjects were divided according to their growth rate into responders to rGH (N = 23); non - responders to rGH, responders to rIGF - 1 (N = 14) and non - responders to rGH and rIGF-1 (N = 6).ResultsThere was no correlation between GV and peak GH level at GHRH test. Growth velocity positively correlated with ΔIGF - 1 SD among subjects treated with rGH therapy. Height SD positively correlated with IGFBP - 3 SD. Baseline IGFBP - 3 also inversely correlated with GH peak during GHRH test.ConclusionsIn subjects with short stature and low IGF - 1 level, baseline IGFBP - 3 levels can predict the growth response to rGH and/or rIGF - 1 therapy.

Growth hormone deficiency short stature in a third world adult endocrine clinic: Usefulness of clonidine test in its diagnosis

Short stature (SS) can be treatable; yet the diagnostic value of a simple test in correctly identifying the two common etiologies in developing countries, viz., growth hormone deficiency (GHD) and normal variant short stature (NVSS), has not been reported in a typical third world population. The aim of the study was to evaluate the reliability of clonidine test in differentiating short stature caused by GHD from NVSS. Data of subjects evaluated for growth hormone deficiency SS at a Saudi Arabian university hospital were retrospectively reviewed. Clonidine and insulin tolerance tests (ITT) were conducted on 60 subjects aged 12 years and above with SS, while peak stimulated growth hormone cut off value of < 10 microg/l was used to diagnose GHD. Sensitivity and specificity for clonidine test and ITT were computed, while receiver operator characteristic (ROC) curves were constructed from the results in order to assess the diagnostic usefulness of the two tests. Mann-Whitney test was used to determine level of significance. Clonidine test showed superior sensitivity and specificity, viz., 81% and 82%, as against 65% and 59% for ITT respectively. Overall, the efficiency of clonidine test in correctly differentiating short stature caused by GHD from NVSS was higher, viz., 90%, compared to ITT's 77%. Clonidine test proved to be an excellent test for initial assessment of GHD and may be used as a screening test for short stature in third world countries.

Helicobacter pylori infection in patients with idiopathic short stature.

Some investigators have recently described an association between Helicobacter pylori infection and children with short stature. In the present study, we aimed to evaluate children with short stature with different etiologies. This study evaluated short patients aged from 1 to 16 years. These patients were divided into a growth hormone deficient short stature group (n = 27) and an idiopathic short stature group (n = 14). A control group included children with normal growth and no abdominal pain (n = 47). Anti-H. pylori antibodies were measured in each group (total of 88). The antibody positivity rates for each group were as follows: growth hormone deficient short stature group, 7.4%; idiopathic short stature group, 28.6%; and control group, 6.4%. The H. pylori antibody positivity rate in the idiopathic short stature group was significantly higher than in the control group. Our findings suggest an association between H. pylori infection and idiopathic short stature.

1 Normal growth and techniques of growth assessment

The shape of the human growth curve is described and illustrated. Growth studies may be longitudinal, cross-sectional, mixed longitudinal or linked-longitudinal; each has advantages and disadvantages, and each requires appropriate statistical methods for handling the data. Standards for height and height velocity for use in a clinical setting wherein follow-up over several years is presumed are described and illustrated. Such standards have to take into account tempo of growth at ages over nine years. Cross-sectionally derived standards do not do this and are not suitable for clinical use. The techniques of measurement of height, sitting height and skinfolds are described and illustrated. Growth and development during puberty is described; there are changes in body composition as well as in body size and shape. Standards for pubertal stages of breasts, pubic hair and genitalia are given and emphasis is laid on the great variation in both the timing and the duration of these pubertal changes. Measurement of developmental age is discussed. The Greulich-Pyle and Tanner-Whitehouse methods for skeletal age are described. These methods can be used for predicting adult height which is useful both in diagnosis and in following the effects of treatment. In diagnosis the predicted adult height is compared to the range of expected heights in the children of the particular pair of parents concerned (the so-called 'target' range of heights) to see if smallness is simply due to delay. Change in Tanner-Whitehouse predicted height occurs on successful treatment of, for example, growth hormone deficient short stature, and is thus a guide to the success of treatment. Standards are also given for height of children from age two to nine inclusive, with allowance for height of their parents.