Growth Hormone Treatment Research Articles

8015 Growth Hormone Axis Dysfunction in PMM2-CDG: Exploring the Role of Dynamic Tests for the Management of Short Stature in Two Pediatric Cases

Abstract Disclosure: G. Del Medico: None. E. Procopio: None. L. Ferri: None. A. Barbato: None. A. Morrone: None. S. Stagi: None. PMM2-CDG is the most prevalent congenital disorder of glycosylation (CDG) and is caused by defective phosphomannomutase2 (PMM2) activity. According to the 2019 guidelines, approximately half of PMM2-CDG patients exhibit short stature and low serum levels of insulin-like growth factor-1 (IGF-1), IGF binding protein 3 (IGFBP3), and acid-labile subunit (ALS). Despite this, there is no expert consensus on the endocrinological management of this condition. We investigated the growth hormone (GH) axis in two 12-year-old female patients with PMM2-CDG. The first patient was compound heterozygote for the most common PMM2 gene variants in Italy, p.(Leu32Arg) and p.(Arg141His). She presented with short stature (< 2 Standard Deviation Score, SDS) and low serum levels of IGF-1 and IGF-BP3 (< 2.5° for age and sex). Bone age was significantly delayed. Tanner stage was prepubertal. Somatotropic response to GH stimulation testing (Levodopa) was normal. After the IGF-1 generation test with recombinant GH, serum IGF-1 increased by 115%. The second patient was compound heterozygote for the known PMM2 pathogenetic variant p.(Ala108Val) and the novel p.(Thr171Asnfs*11) variant (only case described in literature). She presented short stature (< 2 SDS) with near-to-normal IGF-1 and IGF-BP3 serum levels (2.5° for age and sex). Bone age was slightly delayed. Tanner stage was prepubertal. She also exhibited severe obesity, hypertriglyceridemia, and hepatic steatosis. Her somatotropic response to two GH stimulation tests (Levodopa and Arginine) was deficient, probably because of her significant overweight. IGF-1 serum levels didn’t increase after the IGF-1 generation test. Hypoglycosylation in PMM2-CDG impairs the IGF1 system on multiple levels. It destabilizes the ternary complex formed by IGF-1 and glycoproteins IGFBP3 and ALS, therefore reducing the half-life of circulating IGF-1. Hypoglycosylation also reduces IGF1 production by impairing its precursor proIGF-1Ea and its cellular secretion. As a result, PMM2-CDG patients have GH insensitivity, with normal GH production but low levels of IGF-1. However, there is a lack of information in the literature on the use of dynamic tests and hormonal therapies (GH and rhIGF-1) in CDG. The IGF-1 generation test in our patients showed partial GH sensitivity in the first patient and GH insensitivity in the second patient. These observations suggest variability. Some PMM2-CDG patients may benefit from an extended trial with GH therapy, while for GH-insensitive patients a trial with recombinant IGF-1 might be considered. This is one of the first reports that explores the potential role of dynamic tests in PMM2-CDG. As the biochemical effects of hypoglycosylation on the GH-IGF1 pathway are becoming clearer more clinical research is needed to reach a consensus on the management and treatment of short stature in these patients. Presentation: 6/3/2024

8486 Age at diagnosis in Prader Willi Syndrome (PWS)

Abstract Disclosure: R. Sritharan: None. J. Lodge: None. S. Tadros: None. L. Menzies: None. E.F. Gevers: None. PWS is a complex neurodevelopmental disorder characterised by neonatal hypotonia,failure to thrive, hypothalamic and endocrine dysfunction, behavioural and learning difficulties and hyperphagia. It is caused by absence of expression of paternally imprinted genes on chromosome 15q11-q13. PWS is confirmed by genetic methylation analysis of this region. Most patients with PWS are referred for genetic investigations in the first months of life due to severe hypotonia and/or failure to thrive. However, it is known that some patients are still only diagnosed in adulthood, with resulting missed opportunities for prompt early treatments for PWS, such as growth hormone therapy. Little information is available on age of diagnosis of PWS, and whether opportunities to request genetic investigation are missed in childhood. We therefore aimed to study age at diagnosis of PWS in the UK. To do so, we assessed data as reported to the UK patient association PWSA-UK from 1968-2023, and additionally audited PWS genetic testing by the North Thames Genomics Laboratory Hub from 2019-22. Of 1145 people registered at PWSA as having PWS, 945 had an age of diagnosis recorded. Of these, 254 (28%) were diagnosed over 1 year of age. From March 2021 to Sept 2023, 13 were diagnosed over 1 year of age with a mean age at diagnosis of 9.27 yr (95% CI 4.15 to 14.4) and with 8 patients below 5 years of age. We assessed PWS diagnoses made in blocks of 4 years from 1968, and the number of PWS diagnoses in people over age 1 year in those time blocks. The number of diagnoses in people over 1 year of age appeared to decrease since 1996 to 7 but from 2015 this has been fluctuating. North Thames Genomics Laboratory Hub provides testing for around 10 million people in and around London. Over a 3-year period between 2019-2022, there were 59 requests for PWS testing. 28 of these were positive (a 47% diagnostic yield). 20/28 (71%) of patients were diagnosed under 1 month of age, 7% were diagnosed at 1-24 months of age, 3.5% at 2-5 yrs and 18% at >5 yrs of age (one at age 9, two at age 18, one at age 29 and one at 33 yrs of age). Most tests were performed in children under1 month of age (91% yield), followed by those over 5 yrs of age (30% yield). For 10 individuals, microarray was requested, however methylation studies would have been more appropriate. All patients diagnosed over 5 years of age had hypotonia and were described as hyperphagic and having intellectual disability, and 75% were obese. Patients diagnosed after age 8were described as having neonatal hypotonia and may have been eligible for genetic testing soon after birth. These data suggest that a considerable percentage of patients are diagnosed with PWS after the first year of life in the UK. Further root analysis, interventions, and education is required to reduce age at diagnosis in patients with PWS to allow for optimal management starting in the first few months of life. Presentation: 6/1/2024

6818 Adherence Risk Management in Patients on Recombinant Human Growth Hormone Therapy, With Traffic Light Alerting Systems Tailored for Both Weekday and Weekend Adherence

Abstract Disclosure: S. Loche: Advisory Board Member; Self; SL has received advisory board fees from Merck KGaA, Darmstadt, Germany. Consulting Fee; Self; SL has received consultancy fees from Merck KGaA, Darmstadt, Germany. Speaker; Self; SL has received lecture fees from Merck KGaA, Darmstadt, Germany. P. van Dommelen: Consulting Fee; Self; PvD has a consultancy agreement with Merck KGaA, Darmstadt, Germany. V. Tornincasa: Employee; Self; VT is an employee of Ares Trading SA, an affiliate of Merck KGaA. L. Arnaud: Employee; Self; LA is an employee of Ares Trading SA, an affiliate of Merck KGaA. E. Koledova: Employee; Self; EK is an employee of Merck KGaA,Darmstadt, Germany. Stock Owner; Self; EK is an employee of Merck KGaA,Darmstadt, Germany. Background: The integration of data-driven strategies, such as clustering analysis with an alerting system, empowers healthcare professionals with actionable insights. In this study, we focused on clustering adherence patterns during the weekdays and weekends in the first 12 weeks of treatment. Our aim is to develop a data-driven clinical decision support system based on "traffic light" visualizations addressing adherence challenges during both weekdays and weekends in patients receiving Recombinant Human Growth Hormone Therapy. Data and Methods: Adherence data between March-November 2023 were extracted from the newly launched third generation of easypod™ device (EP3) and GrowZen Connect Next ecosystem. EP3 is the only connected device that delivers r-hGH and monitors real-time adherence to therapy. EP3 was perceived by health care professionals as more intuitive, comfortable, user-friendly, simpler, and easier to use than previous EP2. Patients with age 2-18 years at treatment start, a 7-day regimen and complete adherence data available between 1-12 weeks of treatment were selected. Patients’ adherence to therapy was represented using mean and standard deviation (SD) of adherence (%) and the interquartile range (IQR) of the timing of injections throughout the day in minutes aggregated by weekday (Monday-Thursday) and weekend day (Friday-Sunday). Cluster analysis was used to categorize adherence patterns using a Gaussian mixture model. Following a traffic lights-inspired visualization approach, the algorithm was set to create three clusters: high (green), medium (yellow), and low adherence (red). The area under the receiver operating characteristic curve (AUC-ROC) was used to find optimum thresholds for independent traffic lights. Results: Data for 232 patients (124 boys and 108 girls, median (Q25-Q75) age at treatment start was 10.5 (7.6-12.3)) were available. The most appropriate traffic light used the SD of adherence during the weekend, with an AUC-ROC value of 0.87. For the weekday, adherence-based traffic lights using optimum thresholds were >98% (SD<10.2), 88-98% (SD:10.2-22.8) and <88% (SD>22.8) for high, medium, and low adherence, respectively. For IQR of the timing of injections throughout the weekday, optimum thresholds were <38, 38-70 and >70 (min). For the weekend, optimum thresholds were >96% (SD<7.7), 86-96% (SD:7.7-21.5) and <86% (SD>21.5). For IQR of the timing of injections throughout the weekend, optimum thresholds were <56, 56-84 and >84 (min). Conclusions: Our research indicates that implementing a practical data-driven alert system, utilizing our proposed traffic-light coding, would empower healthcare practitioners to monitor patients' adherence to growth hormone therapy comprehensively. By understanding patient behavior during the weekdays and weekend, healthcare practitioners can tailor interventions for improved treatment outcomes. Presentation: 6/3/2024

6369 Weiss-Kruszka Syndrome and Growth Hormone Deficiency, Adrenal Insufficiency, and Morbid Obesity

Abstract Disclosure: T. Falcon-Rodriguez: None. N. Solano: None. A. Diaz: None. Background: Weiss-Kruszka syndrome (WKSA) is a rare autosomal dominant genetic disorder caused by heterozygous loss-of-function variants in the ZNF462 gene. Individuals affected by this condition exhibit distinctive craniofacial features, ptosis, dysgenesis of the corpus callosum, hearing loss, intellectual disability, and hypotonia. There is one other case report that described a boy with empty sella syndrome with growth hormone deficiency and delayed puberty. Case Presentation: We present the case of a 15-year-old boy who initially came under the care of endocrinology at age 9 due to severe obesity and short stature. Past medical history included ADHD (for which he was on stimulants since age 5), microcephaly, VUR, asthma, and developmental delay. He grew along the 2nd percentile for height from the ages of 6 and 13, after which his growth velocity notably decelerated. His initial bone age at 9 years old was advanced by 3 years. His BMI had exceeded the 99th percentile since age 3. His family history was relevant for maternal type 1 diabetes mellitus, paternal height of 165 cm, and maternal height of 160 cm. Upon physical examination, notable findings included short stature, severe obesity, a low anterior hairline, arched eyebrows, upslanted palpebral fissures, low-set ears, a tubular and short nasal bridge, and an exaggerated cupid's bow. At age 9, the patient was diagnosed with growth hormone (GH) deficiency following a clonidine and glucagon stimulation test, with a GH peak of 1.9 ng/mL (normal >7 ng/mL). Additionally, he was diagnosed with adrenal insufficiency (cortisol peak of 5 ug/dL, after 250 mcg of cosyntropin). A brain/sella MRI revealed a hypoplastic pituitary gland. Subsequently, hydrocortisone replacement was initiated at a dose of 6 mg/m2/day, and GH treatment at a weekly dose of 0.3 mg/kg. Despite treatment with growth hormone and IGF-1 levels on the upper side of the normal range, his growth velocity did not improve significantly. He reached his peak adult height of 150 cm at age 15. His BMI had consistently been at the 99th percentile. According to his mother, he did not have issues with satiety, and his portion sizes were considered normal. He did not consume fast foods or sugary drinks, and his level of physical activity was suboptimal. Whole Exome Sequencing identified a heterozygous de novo pathogenic variant in the ZNF462 gene, specificallyc.2664 C>A, p.(C888*) (NM_021224.4), consistent with the diagnosis of Weiss-Kruszka syndrome (OMIM # 618619). Conclusion: We present, to our knowledge, the first report of morbid obesity and central adrenal insufficiency in a child with WSKA. GH deficiency had been previously reported in 1 patient with WSKA. The finding of a hypoplastic pituitary gland supports the diagnosis of GH deficiency and central adrenal insufficiency. Presentation: 6/3/2024

6996 Optimal Growth Hormone Response Despite Low Insulin-Like Growth Factor-1: Clinical Picture of an A67T IGF-1 Variant

Abstract Disclosure: E.M. Bomberg: Research Investigator; Self; Novo Nordisk. Z. Wu: Employee; Self; Quest Diagnostics. I. Motorykin: Employee; Self; Quest Diagnostics. J. Torkelson: None. N. Schmitz: None. A. Drilling: None. M.J. McPhaul: Employee; Self; Quest Diagnostics. B.S. Miller: Advisory Board Member; Self; Abbvie, Ascendis Pharma, Biomarin, Bristol-Myers Squibb, Eton Pharmaceuticals, EMD Serono, Endo Pharmaceuticals, GenSci, Novo Nordisk, Pfizer, Inc., Provention Bio, Sanofi, Tolmar. Consulting Fee; Self; Abbvie, Ascendis Pharma, Biomarin, Bristol-Myers Squibb, Eton Pharmaceuticals, EMD Serono, Endo Pharmaceuticals, GenSci, Provention Bio, Sanofi, Tolmar. Grant Recipient; Self; Alexion Pharmaceuticals, Inc., Abbvie, Aeterna Zentaris, Amicus, Foresee Pharmaceuticals, Lumos Pharma, Lysogene, Novo Nordisk, OPKO Health, Pfizer, Inc., Prevail Therapeutics, Sangamo Therapeutics. Research Investigator; Self; Alexion Pharmaceuticals, Inc., Abbvie, Aeterna Zentaris, Amicus, Foresee Pharmaceuticals, Lumos Pharma, Lysogene, Novo Nordisk, OPKO Health, Pfizer, Inc., Prevail Therapeutics, Sangamo Therapeutics. Speaker; Self; Biomarin, Novo Nordisk, Pfizer, Inc., Tolmar. Introduction: Insulin-like growth factor-1 (IGF-1) measurements are used for growth hormone (GH) deficiency screening and helpful in monitoring GH treatment effectiveness. However, IGF-1 variants have been reported with mass spectrometry (MS)-based assays, potentially limiting interpretation of reported results. Clinical Case: A 14-year-old male presented for short stature. Evaluation was non-revealing aside from low serum IGF-1 measured via liquid chromatography (LC)-MS assay (58 ng/mL; -3.8 standard deviation score [SDS]), and IGF-Binding Protein 3 (3.7 ug/mL; -1.7 SDS). Height was 148.2 cm (1st percentile, -2.08 SDS; mid-parental height 172.7 cm [31st percentile, -0.48 SDS]), pubertal exam Tanner stage 2, and bone age 2.5 years delayed. A GH stimulation test showed a peak GH of 8.1 ug/L; brain MRI was normal. GH was started at 0.29 mg/kg/wk. One month later, IGF-1 remained low (89 ng/mL; -3.2 SDS) and GH was increased to 0.36 mg/kg/wk, and over time to 0.52 mg/kg/wk due to persistently low IGF-1 (-2.9 to -2.3 SDS), despite reports of good compliance and significant catch-up growth (height increased to 19th percentile, -0.84 SDS). He reported no significant side effects during GH treatment. At 17.5 years old, he returned to clinic reporting self-discontinuing GH 1 month prior. Height was at the 27th percentile (171.5 cm, -0.59 SDS), he was fully pubertal, IGF-1 128 ng/mL (-3.1 SDS), and bone age 1.5 years delayed. Further review of IGF-1 linked reports accompanying lab values directly entered into the electronic health record (EHR; starting 2021) described the presence of a rare heterozygous IGF-1 functional variant with unknown clinical significance based on MS data. Concentration of the variant was expected to be identical to that reported for the wild type IGF-1 protein, potentially explaining the lower than expected values. Analysis of the raw LC-MS data (variant peak at m/z 1098.09, isotopic peak index [IP6], relative retention time [rRT]=0.00 min) was consistent with either an A67T or A70T IGF-1 variant. To resolve this ambiguity, the specimen was reanalyzed with an LC-tandem MS/MS fragmentation method, which identified distinguishing peaks at m/z 503.28 (y5 ion) and 305.18 (y3 ion) characteristic of A67T, a known benign variant. Conclusions: Benign IGF-1 variants should be considered in cases of unexplained low IGF-1 levels, including when these remain low despite increasing GH doses, good adherence, and optimal growth velocity. Presence of IGF-1 variants should not affect GH stimulation results (e.g., GH levels), however, may lower reported IGF-1 levels used to determine need for diagnostic testing and followed when monitoring GH response. Careful review of IGF-1 lab reports and full abstraction of these into the EHR should be performed. Knowing a variant is benign could help providers set lower wild-type IGF-1 targets when monitoring GH response to avoid unnecessarily high GH doses. Presentation: 6/3/2024

6367 Growth gone Awry: A Rare Case of Acromegaly in a 16-Year-Old Female with Panhypopituitarism Secondary to Craniopharyngioma on Low Doses of Growth Hormone with Low IGF-1 levels

Abstract Disclosure: L.M. Ayala Castro: None. J. Ye Tay: None. A. Diaz: None. This report highlights a rare case of a 16-year-old female with panhypopituitarism due to craniopharyngioma, where GH replacement therapy triggered acromegaly features despite having low IGF-1 levels. Background: Craniopharyngiomas are the most common tumors causing acquired pituitary deficiencies in children. Various mechanisms contribute to acromegaly, and hypersensitivity to hormonal treatment in this benign tumor emerges as a plausible avenue for investigation. Case Presentation: A 16-year-old female diagnosed with craniopharyngioma at age 5 developed secondary panhypopituitarism. Baseline hormonal profiles indicated markedly reduced levels of IGF-1 and insulin growth factor–binding protein 3 (IGF-BP3). Despite the established condition, GH treatment was initiated at age 8 for potential growth and development benefits. Before commencing GH therapy, a bone age assessment revealed normal skeletal development. However, GH replacement therapy led to an unexpectedly robust response, resulting in physical changes consistent with acromegaly. Paradoxically, laboratory evaluations showed low IGF-1 levels. Imaging studies, including pituitary MRI, ruled out new abnormalities or tumors. As the patient approached peak adult height at 16, having been on adult GH therapy since age 13, a decision was made to discontinue GH replacement therapy and address acromegaly symptoms. Frequent follow-up visits were planned to assess growth velocity, monitor hormonal levels, and evaluate potential adverse effects. Discussion: This case demonstrates an unusual sensitivity to exogenous GH, resulting in an exaggerated response contrary to expected IGF-1 elevation. Atypical IGF-1 levels may suggest alterations in liver physiology, GH receptor signaling pathways (e.g., Laron Syndrome), or downstream defects in IGF-1 synthesis. Further research is crucial to elucidate the underlying mechanisms. Conclusion: Only 3 cases of acromegaly as a side effect of GH replacement therapy have been reported in the literature. We report a further case that underscores the complexity of managing hormonal imbalances, especially in unique patient populations with panhypopituitarism secondary to craniopharyngioma. The unexpected response to GH treatment emphasizes the need for individualized approaches and vigilant monitoring.

12423 Pre-treatment Blood Transcriptome Accurately Predicts Growth Response To Daily And Weekly GH Treatment In Children Born Small For Gestational Age

Abstract Disclosure: T. Garner: Grant Recipient; Self; Novo Nordisk. P. Murray: Grant Recipient; Self; Novo Nordisk. M. Hojby: Employee; Self; Novo Nordisk. Stock Owner; Self; Novo Nordisk. R. Ard: Employee; Self; Novo Nordisk. Stock Owner; Self; Novo Nordisk. P.E. Clayton: Grant Recipient; Self; Novo Nordisk. A. Stevens: Grant Recipient; Self; Novo Nordisk. Background: Predicting GH therapy response from gene expression has the potential to improve clinical management of short stature. Treatment in children born small for gestational age (SGA) requires daily GH injections. Although no long-acting GHs (LAGHs) are currently approved for SGA, results from REAL5 (randomised, multinational, open-label, controlled, phase 2 trial; NCT03878446) indicate that the LAGH somapacitan has an efficacy, safety, and tolerability profile similar to daily GH (1). Here, we investigate growth response prediction based on the baseline blood transcriptome with and without clinical variables in daily GH- or somapacitan-treated children in REAL5. Methods: REAL5 tested three somapacitan doses (0.16, 0.20, & 0.24 mg/kg/week; n=12, n=13, & n=12, respectively) versus two daily GH doses (0.035 & 0.067 mg/kg/day; n=12 & n=13, respectively). GH response was explored using four metrics calculated over 52-weeks: height velocity (HV; cm/year), HV standard deviation score (SDS), change in height SDS, and change in IGF-I SDS. Due to small sample sizes, dose groups were combined. Participants were split into tertiles to define fastest/slowest responders to each treatment which were compared to remaining tertiles. Differentially expressed genes (DEGs) were defined to distinguish one tertile from the remaining two. Random forest (RF) models were generated using the top 100 DEGs as well as in combination with a set of clinical variables. Area under the curve (AUC) describes RF prediction accuracy: for somapacitan sufficient samples were available for both training and validation while for daily growth hormone samples were only sufficient for training generating out of bag (OOB) AUCs, accompanied by error rates (ER). Accuracies were calculated for both fast & slow responders across all response metrics in each treatment. Results: We demonstrate excellent predictive ability of the transcriptome to identify SGA children who respond slowest in HV following treatment with either daily GH or somapacitan (OOB AUC (ER)= 1.0 (5.0%) & 0.99 (6.9%), respectively; validation AUC=0.812 for somapacitan), while prediction of other response measures was highly variable, particularly in validation (AUCs=0.56-1.0). The clinical variables combined with the transcriptomic data resulted in reduced accuracies and increased error rates (OOBs AUC(ER)=0.93(25%) [daily] & 0.90(19%) [somapacitan]). Conclusions: In the first use of transcriptomics for growth response prediction in children born SGA we show good performance for those treated with both daily and weekly GH. However, when the transcriptome is combined with clinical data performance is reduced, indicating the importance of gene expression signatures for GH-response prediction. These findings may be promising for personalizing dose in GH-treated SGA patients. (1) Juul et al. EJE 2023:188,19-30. Presentation: 6/3/2024

6471 Adult Height in Male Survivors of Childhood Cancer Treated with Aromatase Inhibitors and Growth Hormone

Abstract Disclosure: N.I. Pollock: None. M. Song: None. A. Wolf: None. Y. Li: None. C. Hawkes: None. N. Motamedi: None. M.R. Denburg: None. S. Mostoufi-Moab: None. Title: Adult Height in Male Survivors of Childhood Cancer Treated with Aromatase Inhibitors and Growth Hormone Objectives: Aromatase inhibitor (AI) therapy in combination with growth hormone (GH), or as monotherapy, may have a role in improving height outcomes in male pediatric patients with GH deficiency (GHD). The effectiveness of AI therapy in the childhood cancer survivors is not known. In this retrospective study, we assess adult height (AH) in childhood cancer survivors treated with AI combined with GH therapy compared to those treated with GH alone. Methods: This was a single center retrospective cohort study of male survivors of childhood cancer treated with GH for diagnosis of GHD between 2007 and 2023. We compared AH outcomes in males treated with GH alone or in combination with off-label use of AI. Demographic and clinical characteristics, including anthropometric measurements, endocrinopathies, and cancer history, were obtained from the medical record. AH was noted as height documented at fusion of growth plates or following 18 years of age. Differences in demographic, clinical, and treatment characteristics were assessed using univariate tests of association. Multivariable regression with stepwise selection was used to examine risk factors associated with AH. All statistical analyses were performed using Stata 18.0. Results: Ninety-two patients were included; 70 were treated with GH monotherapy and 22 with combination AI/GH. Median age at AI initiation was 13.6 years (IQR 12.3-14.3) versus 11.2 years (IQR 8.6-12.9) for GH (unpaired t-test p-value <0.01; 95% CI -4.01, -1.91). A greater proportion of patients in the AI/GH group had been treated with stem cell transplantation, abdominal radiation, total body irradiation, and cis-retinoic acid (Fisher’s exact p-value <0.01). There was no statistically significant difference in AH or AH Z-score between treatment groups, with the median AH Z-score in the AI/GH group -1.95 (IQR -3.11, -0.75) versus -1.39 (IQR -2.65, 0.11) in the GH group. In multivariable linear regression, history of radiation to the spine (β= -5.9, 95% CI -11.2, -0.6), height Z-score (β= 0.3, 95% CI 0.11, 0.46), BMI Z-score (β= 3.2, 95% CI 0.95, 5.5), and advanced bone age at GH or AI treatment initiation (β= -10.1, 95% CI -17.3, -2.9) were significantly associated with AH. Conclusions: Adjunctive treatment with AI and GH was not associated with increased AH outcomes in male survivors of childhood cancer compared to GH monotherapy. Future work is needed to determine optimal adjunctive medical therapy to maximize FAH impacted by cancer therapy for this patient population. Presentation: 6/3/2024

6778 Visual Presentations for Adherence Risk Management In Patients Receiving Recombinant Human Growth Hormone Therapy

Abstract Disclosure: P. van Dommelen: Consulting Fee; Self; PvD has a consultancy agreement with Merck KGaA, Darmstadt, Germany. F. Michelis: Employee; Self; FL is an employee of Ares Trading SA, an affiliate of Merck KGaA. L. Arnaud: Employee; Self; LA is an employee of Ares Trading SA, an affiliate of Merck KGaA. S. Loche: Advisory Board Member; Self; SL has received advisory board fees from Merck KGaA, Darmstadt, Germany. Consulting Fee; Self; SL has received consultancy fees from Merck KGaA, Darmstadt, Germany. Speaker; Self; SL has received lecture fees from Merck KGaA, Darmstadt, Germany. E. Koledova: Employee; Self; EK is an employee of Merck KGaA,Darmstadt, Germany. Stock Owner; Self; EK holds shares in Merck KGaA, Darmstadt, Germany. Background: A data-driven clinical decision support system based on visual presentations for adherence risk management can support patients receiving recombinant human growth hormone (r-hGH) treatment. Our focus is on examining adherence patterns during the first 6 weeks of treatment, with a particular emphasis on the days of the week, the variability in injection timings and the summer holiday. Our aim is to assess whether these early patterns can serve as indicators for predicting adherence in the subsequent 7-12 weeks of treatment. Data and Methods: Adherence data between March-November 2023 were extracted from the newly launched third generation of easypod™ device (EP3) and GrowZen Connect Next ecosystem. EP3 is the only connected device that delivers r-hGH and monitors real-time adherence to therapy. EP3 was perceived by health care professionals as more intuitive, comfortable, user-friendly, simpler, and easier to use than previous EP2. Patients with age 2-18 years at treatment start, a 7-day regimen and complete adherence data available between 1-12 weeks of treatment were selected. Data about sex, age at start treatment, as well as adherence, classified as high (≥95%) versus low/medium <95%), standard deviation (SD) of adherence (%), log (to adjust for skewness) of the interquartile range (IQR) of the timing of injection throughout the day, median timing of the injection after midnight, and ≥50% versus <50% of the injections fall in the summer period (July-August) aggregated by day over the first 6 weeks of treatment were included in a generalized linear mixed model with adherence between 7-12 weeks as outcome. Results: In total, data for 232 patients (124 boys and 108 girls, median (Q25-Q75) age at treatment start was 10.5 (7.6-12.3)) were available. The model showed no difference in effect of adherence rates during Monday-Thursday. We, therefore, aggregated the data by weekday (Monday-Thursday) versus weekend day (Friday-Sunday, Friday was included due to the common practice of administering injections during the evening). Adherence, SD of adherence, IQR of timing of injections, and injections falling in summer were significant (p<0.05) predictors of adherence during a weekday and weekend between 7-12 weeks. Areas under the curves were both 0.96 during the weekday and weekend. Conclusions: Our research shows that adherence and timing of injections, as well as taking into account the summer holidays, can predict future adherence accurately. Visual presentations showing aggregated adherence rates and variation of timing of injections by days of the week, as well as highlighting the summer periods may improve adherence risk management and timely support. Presentation: 6/3/2024

8509 Molecular and Reproductive Assessment in Ames strain under or not Hormonal Replacement

Abstract Disclosure: B.V. Azevedo: None. N. Trigueiro: None. J.M. Marques: None. V. Yariwake: None. L. Tamashiro: None. R. Cruz: None. M.M. Veras: None. L. Carvalho: None. Introduction: The Ames lineage, a mouse model with a mutation in the Prop1 gene, exhibits GH, TSH, and PRL deficiencies along with low levels of gonadotropins. This has prompted an investigation into aging and reproductive restoration after hormone replacement reported in the literature. Aims: The present study aims to analyze the pathophysiologic mechanisms in the reproductive system and fertility restoration. Methods: This is a prospective study approved by the ethical committee for animal use at the University of Sao Paulo Medical School. An isogenic Ames lineage was categorized into four groups: 1) Ames wild-type mice, 2) untreated Ames dwarf mice with sexual maturity, 3) untreated Ames dwarf mice without sexual maturity, and 4) Ames dwarf mice under hormonal treatment. Male Ames dwarf mice received treatment with levothyroxine and human recombinant GH, starting at 30 days postnatal (dp) for 40 days, followed by weekly applications until 90 dp. At the time of euthanasia, a set of analyses were conducted on animals from each group to characterize sexual maturation, fertility, and tissue collection for reproductive parameter analyses, such as seminiferous tubule morphology by histology, testicular weight, gonadosomatic index, and spermogram analysis. Additionally, pituitary RNAseq was performed using the poly-A tail capture method with the Illumina stranded mRNA prep kit and sequenced on the NextSeq 2000. Results: Treated dwarf mice exhibited fertility restoration, an increase in testicular volume with an improvement of testicular function, and complete spermatogenesis. Untreated Ames dwarf mice were infertile, but those that reached sexual maturity without hormonal replacement showed improvements in reproductive parameters, such as enhanced testicular development, maturation of some seminiferous tubules, increased testicular weight, and improvement in the spermogram compared to immature Ames dwarf mice. Transcriptome analyses revealed distinct patterns of all Ames dwarf mice groups and the wild-type. It was observed a decrease in Fshb expression in the group without sexual maturation compared to the wild-type group. Additionally, Prl and Slc6a12 were upregulated in the spontaneously sexually mature Ames dwarf compared to the non-restored Ames dwarf mice. Conclusion: GH and levothyroxine treatment in the Ames lineage are effective in restoring fertility and improving reproductive parameters in male Ames dwarf mice. However, sexually mature Ames dwarf mice without treatment presented improvements in reproductive and molecular parameters despite remaining infertile. These findings provide valuable insights into the complex interaction among hormonal replacement, modulating mechanisms, and sexual maturity. Presentation: 6/2/2024

8509 Molecular and Reproductive Assessment in Ames strain under or not Hormonal Replacement

Abstract Disclosure: B.V. Azevedo: None. N. Trigueiro: None. J.M. Marques: None. V. Yariwake: None. L. Tamashiro: None. R. Cruz: None. M.M. Veras: None. L. Carvalho: None. Introduction: The Ames lineage, a mouse model with a mutation in the Prop1 gene, exhibits GH, TSH, and PRL deficiencies along with low levels of gonadotropins. This has prompted an investigation into aging and reproductive restoration after hormone replacement reported in the literature. Aims: The present study aims to analyze the pathophysiologic mechanisms in the reproductive system and fertility restoration. Methods: This is a prospective study approved by the ethical committee for animal use at the University of Sao Paulo Medical School. An isogenic Ames lineage was categorized into four groups: 1) Ames wild-type mice, 2) untreated Ames dwarf mice with sexual maturity, 3) untreated Ames dwarf mice without sexual maturity, and 4) Ames dwarf mice under hormonal treatment. Male Ames dwarf mice received treatment with levothyroxine and human recombinant GH, starting at 30 days postnatal (dp) for 40 days, followed by weekly applications until 90 dp. At the time of euthanasia, a set of analyses were conducted on animals from each group to characterize sexual maturation, fertility, and tissue collection for reproductive parameter analyses, such as seminiferous tubule morphology by histology, testicular weight, gonadosomatic index, and spermogram analysis. Additionally, pituitary RNAseq was performed using the poly-A tail capture method with the Illumina stranded mRNA prep kit and sequenced on the NextSeq 2000. Results: Treated dwarf mice exhibited fertility restoration, an increase in testicular volume with an improvement of testicular function, and complete spermatogenesis. Untreated Ames dwarf mice were infertile, but those that reached sexual maturity without hormonal replacement showed improvements in reproductive parameters, such as enhanced testicular development, maturation of some seminiferous tubules, increased testicular weight, and improvement in the spermogram compared to immature Ames dwarf mice. Transcriptome analyses revealed distinct patterns of all Ames dwarf mice groups and the wild-type. It was observed a decrease in Fshb expression in the group without sexual maturation compared to the wild-type group. Additionally, Prl and Slc6a12 were upregulated in the spontaneously sexually mature Ames dwarf compared to the non-restored Ames dwarf mice. Conclusion: GH and levothyroxine treatment in the Ames lineage are effective in restoring fertility and improving reproductive parameters in male Ames dwarf mice. However, sexually mature Ames dwarf mice without treatment presented improvements in reproductive and molecular parameters despite remaining infertile. These findings provide valuable insights into the complex interaction among hormonal replacement, modulating mechanisms, and sexual maturity. Presentation: 6/2/2024

7194 The Use Of GloBE-Reg As A Global Platform For Performing Safety & Efficacy Studies Of rhGH Therapy - First Year Results

Abstract Disclosure: M. Alimussina: None. J. Bryce: None. M. Chen: None. S. Koley: None. A. Al-Agha: None. N. Amin: None. N. Atapattu: None. J. Chen: None. Y. Deyanova: None. A. Fu: None. C. Gong: None. V. Iotova: None. D. Janus: None. A. Jorge: Consulting Fee; Self; Novo Nordisk. Grant Recipient; Self; BioMarin. R. Markosyan: None. S. Seneviratne: None. M.G. Shaikh: None. S. Shenoy: None. S. Shepherd: None. L. Tack: None. M. Wasniewska: None. S. Chen: Research Investigator; Self; Pfizer, Inc. S.F. Ahmed: Grant Recipient; Self; GenSci, Novo Nordisk, Pfizer, Inc.. Speaker; Self; Ipsen. Introduction: The Global Registry For Novel Therapies In Rare Bone & Endocrine Conditions (GloBE-Reg, https://globe-reg.net/) project was launched in 2022 with the aim of supporting studies that focus on effectiveness and long-term safety of specific therapies. The project’s initial focus has been on recombinant human growth hormone therapy (rhGH). Although safety information on rhGH therapy has now been collected for several years, there are still existing gaps in our knowledge, especially with the introduction of new indications and novel forms of rhGH. Methods: The GloBE-Reg registry has three layers of datasets, with the first dataset consisting of internationally agreed core data elements that can apply to any rare condition, another set of data elements that allows the selection of a specific therapy and diagnosis, a third set of additional data elements that is made up of the therapy and diagnosis-specific minimum dataset (MDS) and an option to have a more extended dataset. The minimum dataset collects information on the diagnosis, therapy, clinician reported outcomes, patient reported outcomes and adverse events. The platform and the registry received ethics/IRB approval in the UK and is now extending internationally. The fields within the MDS are developed following guidance from short-life expert working groups (EWG). Results: Since its launch in November 2022, 51 centres from 29 countries have registered their interest to use the platform and of these, 14 centres from 11 countries in 3 continents have already included 444 (M:F, 282:162) patients with a median age of 11 yr (range <1, 29). Of these, 317 (71%) were on daily rhGH, 126 (28%) were on long-acting rhGH, one was on daily rhGH as an adult and in one, rhGH therapy had been discussed but not started. Nine different brands of rhGH were being used across these centres for 9 groups of indications, whereas long-acting rhGH was being used for only 4 indications. In addition, there were 11 (3%) cases receiving rhGH for other conditions associated with short stature or growth retardation. The largest indication group was GHD (65%) followed by SGA (10%), TS (7%), PWS (7%), ISS (5%) and others. Of the 444 cases, 67 (15%) had also been entered in other disease registries and 18 (27%) of these 67 had been entered by one centre into the GloBE-Reg through its bulk upload facility. A Childhood GHD MDS is now fully operational and MDS for other conditions are under development. Conclusion: Since its launch, GloBE-Reg has shown that a relatively low-cost platform operated through an academic institution can have sufficient stakeholder acceptability and versatility for collecting information that can support the development of long-term safety and effectiveness studies. The preliminary data that have been collected on rhGH show the long-term utility of the platform for collecting global brand and diagnosis-specific data. Presentation: 6/2/2024

7234 Creation Of The Minimum Dataset Required For Monitoring The Safety And Efficacy of Growth Hormone Therapy in Children with Noonan Syndrome - A GloBE-Reg Initiative

Abstract Disclosure: S. Chen: Research Investigator; Self; Pfizer, Inc.. J. Bryce: None. M. Chen: None. G. Binder: Advisory Board Member; Self; Ascendis, Ferring Pharmaceuticals, Ipsen, Novo Nordisk, Pfizer, Inc., Sandoz. Grant Recipient; Self; Novo Nordisk. Speaker; Self; Ferring Pharmaceuticals, Ipsen, Lilly USA, LLC, Merck, Novo Nordisk, Pfizer, Inc., Sandoz. C.S. Choong: None. T. Edouard: Advisory Board Member; Self; Biomarin, Novo Nordisk. Speaker; Self; Biomarin, Novo Nordisk. A. Fu: None. R. Horikawa: None. A. Hubbard: None. J. Lebl: Speaker; Self; Pfizer, Inc., Novo Nordisk, Merck. L. Mazzanti: Speaker; Self; Novo Nordisk, Pfizer, Inc., Sandoz. A. Romano: Consulting Fee; Self; Novo Nordisk. Speaker; Self; Novo Nordisk. M. Shaikh: Consulting Fee; Self; Novo Nordisk, Pfizer, Inc.. F. Tamburrino: None. S. Tamponi: None. P. Yger: None. S. Ahmed: Grant Recipient; Self; Novo Nordisk, Pfizer, Inc., GenSci. Speaker; Self; Ipsen. A. Jorge: Grant Recipient; Self; Biomarin. Research Investigator; Self; Novo Nordisk. Speaker; Self; Novo Nordisk, Pfizer, Inc. Introduction: Recombinant human growth hormone (rhGH) is approved internationally for use in Noonan syndrome (NS); initially by the FDA in 2007 and most recently in Europe in 2020. Most studies have shown benefit in linear growth and adult height associated with rhGH therapy, although response to treatment often varies, and longer-term safety data is limited. Moreover, comparisons between studies are compromised by the lack of consistency in data collection. The objective of the current study was to identify the minimum dataset (MDS) that could be monitored and reported globally in a routine clinical setting. Methods: This study was undertaken by the NS Expert Working Group in GloBE-Reg, the Global Registry for Novel Therapies in Rare Bone and Endocrine Conditions (https://globe-reg.net/). Ten international clinical experts in NS from ten different countries and three patient representatives of patient organisations collaborated to develop this recommendation, based on a previously described and published methodology for the grading system to determine if an item fulfils the criteria for the MDS rhGH in childhood onset GH deficiency (GHD) (doi: 10.1159/000533763). Data fields that achieved >70% consensus in terms of importance qualified for the MDS, provided <50% of the group deemed the item difficult to collect. Results: Preparation for the development of the finalised MDS occurred over 4 months, including two teleconference meetings between the group members and a final consensus meeting also held virtually. A total of 256 items were compiled and 9 removed for redundancies, with 247 items subjected to the grading system. Of these, 169 items achieved at least 70% consensus as important data to collect and a total of 169, albeit different items, were deemed easy to collect when monitoring children with NS on rhGH. Combining the criteria of importance and ease of data collection, 124 fulfilled the criteria for the MDS. Six items were designated as core data, 2 were computed fields, 10 items were removed following detailed discussion and 48 items were merged, to produce the final MDS recommendation of 57 items which consisted of 20 items that were only required to be completed once, and the rest at least once annually. Importantly, the exercise also showed that the MDS for monitoring of safety and efficacy of rhGH therapy differs for the different licensed indications for rhGH use, as the need for growth hormone stimulation tests and information on reinitiation after final adult height was not included in the NS MDS in contrast to the MDS for GHD. Conclusion: In summary, this exercise performed through the GloBE-Reg initiative provides a recommendation of the MDS requirement that should be collected as part of routine clinical practice, for the reporting of core outcomes that relate to safety and effectiveness of all forms of rhGH in children with NS. Presentation: 6/3/2024

12256 Sustained Efficacy Of Weekly Somapacitan In Children With GHD: 3-year Results From Phase 3 REAL4 Study

Abstract Disclosure: B.S. Miller: Consulting Fee; Self; Abbvie, Ascendis Pharma, BioMarin, Bristol-Myers Squibb, EMD Serono, Endo Pharmaceuticals, Novo Nordisk, Orchard Therapeutics, Pfizer, Provention Bio, Tolmar. Grant Recipient; Self; Alexion, Abbvie, Aeterna Zentaris, Amgen, Amicus, Lumos Pharma, Lysogene, Novo Nordisk, OPKO Health Pfizer, Prevail Therapeutics, Sangamo Therapeutics. J.C. Blair: Advisory Board Member; Self; Novo Nordisk. Speaker; Self; Novo Nordisk, Ipsen. Other; Self; Novo Nordisk. M. Højby Rasmussen: Employee; Self; Novo Nordisk. Stock Owner; Self; Novo Nordisk. A. Maniatis: Research Investigator; Self; Novo Nordisk, Ascendis, OPKO, Pfizer. J. Mori: Advisory Board Member; Self; Novo Nordisk. Consulting Fee; Self; JCR. Speaker; Self; Novo Nordisk, Pfizer, JCR. V. Böttcher: Advisory Board Member; Self; Merck. Speaker; Self; Novo Nordisk, Merck. Other; Self; Ferring, Lilly, Merck, Novo Nordisk. H. Kim: None. M. Polak: Advisory Board Member; Self; Ipsen, Novo Nordisk, Pfizer. Grant Recipient; Self; Ipsen, Novo Nordisk, Pfizer, Sandoz, Merck, Sanofi. Speaker; Self; Novo Nordisk, Pfizer, Ipsen. R. Horikawa: Advisory Board Member; Self; Novo Nordisk, Pfizer, Ascendis, Lumos Pharma. Grant Recipient; Self; Sandoz. Speaker; Self; Novo Nordisk, Pfizer, JCR. Growth hormone (GH) replacement therapy for children with GH deficiency (GHD) traditionally required daily subcutaneous injections. Somapacitan (Novo Nordisk A/S) is a reversible albumin-binding GH derivative administered once-weekly and the only long-acting GH (LAGH) approved for the treatment of both adults and children with GHD. REAL4 is a randomized, open-label, multi-national, phase 3 trial, consisting of a 52-week main phase and a three-year (week 52 to 208) extension period (NCT03811535). The trial included 200 GH-treatment-naïve, prepubertal children with GHD. Participants received either once-weekly somapacitan (0.16 mg/kg; n=132) or once-daily GH (Norditropin® 0.034 mg/kg; n=68) for 52 weeks. Afterwards, participants receiving daily GH switched to 0.16 mg/kg/week somapacitan (switch group), while those receiving somapacitan continued treatment (soma/soma group). Growth-related endpoints included height velocity (HV), HV standard deviation score (SDS), height SDS, and bone age. The 3-year (156-week) results are presented here. A total of 188 participants (125 in the soma/soma group and 63 in the switch group) completed 3 years of treatment. Improvements in HV, HV SDS, height SDS, and bone age were similar between the groups. In year 3 (week 104 to 156), mean (SD) HV was 7.4 (1.5) cm/year in the soma/soma group and 7.8 (1.4) cm/year in the switch group. The mean (SD) change in height SDS from baseline to week 156 was 2.04 (0.85) in the soma/soma group and 2.38 (1.14) in the switch group, with mean (SD) height SDS at week 156 of -0.95 (0.98) and -1.08 (0.93) in the soma/soma and switch groups, respectively. Mean BMI SDS remained within normal range in both groups at week 156. No safety or tolerability issues were identified. During the extension period (week 52 to 156), a low proportion of the participants reported injection site reactions. No neutralizing antibodies were detected at any of the visits. In conclusion, once-weekly somapacitan showed sustained efficacy and tolerability for three years, as well as for two years following the switching from daily GH treatment in this pivotal phase 3 REAL4 trial. The safety profile of somapacitan was similar to the well-known safety profile of daily GH. Presentation: 6/3/2024

7673 Genetic Analysis and Clinical Characterization of Patients with Congenital Hypopituitarism Due to Gene Defects

Abstract Disclosure: T.M. Sasson: None. I.J. Arnhold: None. B.B. Mendonca: None. L.R. Carvalho: None. Introduction: Congenital hypopituitarism is characterized by the deficiency of one or more hormones secreted by the anterior pituitary gland. The genetics of this pathology is complex, and the molecular diagnosis is established in approximately 13% of cases. Objectives: The aim of the present study is to characterize the phenotype harboring pathogenic variants causing congenital hypopituitarism. Methods: Among 393 subjects with congenital hypopituitarism followed up at a tertiary health center, 57 subjects (14,5%) were selected due to a confirmed molecular diagnosis by exome in 9 subjects or by gene panel or Sanger sequencing in 48 subjects. This was a retrospective study where data from medical records, clinical, laboratory and radiological characteristics were analyzed. Results: The most frequent variants identified by sequencing analyzes were in the following genes: PROP1 (29.8%), GH1 (22.8%), GHRHR (15.7%), followed by GLI2, OTX2, HESX1, POU1F1, TGIF1, GHRS, CDH2, SATB1, SOX3 e LZTR1. Consanguinity was reported in 50% of cases, and there was the presence of familial cases of short stature in 60%. The average age at the start of follow-up was 11.1 years (11 SD), 40% of them were male and 52.3% had physical stigmata typical of GH deficiency. Regarding hormonal deficiencies, 27 (47%) had isolated Growth Hormone Deficiency (DGHI) and the others, multiple deficiencies. MRI study of the pituitary gland showed some alteration in 66%, 54% of whom had adenohypophysis hypoplasia and 31% had an ectopic or non-visualized neurohypophysis. From 29 patients with IGF-1 levels available, 28 were below the reference range for sex and age. The serum GH peak after the stimulus test was on average 1.28 ng/mL (1.4SD), of these, only 4 cases had GH peak between 3.3 and 5.0 ng/mL and 1 patient with low IGF-1 and an ectopic neurohypophysis had GH peak of 6.0 ng/mL in a glucagon test. Regarding growth, the initial height in z-score was -4.8 and the average growth at the end of the first year of treatment was 10.7cm, with the average height after this period of Z-3.35. The average of final delta target height (final height Z-score minus the target height Z-score) of patients who underwent hormonal treatment was -0,53 (good response = delta <-1.5). Conclusion: In subjects with congenital hypopituitarism and an established molecular diagnosis, the most frequently affected genes were PROP1 and GH1, the great majority presented a stimulated GH peak < 3.3 ng/mL (only one patient had GH > 5), low basal serum IGF-1 and good increase in growth speed at the end of the first year of treatment with recovery of final height at the end of GH therapy. Presentation: 6/3/2024

Alternate-day fasting delays pubertal development in normal-weight mice but prevents high-fat diet-induced obesity and precocious puberty

Background/ObjectivesChildhood obesity, particularly in girls, is linked to early puberty onset, heightening risks for adult-onset diseases. Addressing childhood obesity and precocious puberty is vital to mitigate societal burdens. Despite existing costly and invasive medical interventions, introducing lifestyle-based alternatives is essential. Our study investigates alternate-day fasting’s (ADF) impact on pubertal development in normal-weight and high-fat diet (HFD)-induced obese female mice.MethodsFour groups of female mice were utilized, with dams initially fed control chow during and before pregnancy. Post-parturition, two groups continued on control chow, while two switched to an HFD. Offspring diets mirrored maternal exposure. One control and one HFD group were subjected to ADF. Morphometry and hormone analyses at various time points were performed.ResultsOur findings demonstrate that ADF in normal-weight mice led to reduced body length, weight, uterine, and ovarian weights, accompanied by delayed puberty and lower levels of sex hormones and growth hormone (GH). Remarkably, GH treatment effectively prevented ADF-induced growth reduction but did not prevent delayed puberty. Conversely, an HFD increased body length, induced obesity and precocious puberty, and altered sex hormones and leptin levels, which were counteracted by ADF regimen. Our data indicate ADF’s potential in managing childhood obesity and precocious puberty.ConclusionsADF reduced GH and sex hormone levels, contributing to reduced growth and delayed puberty, respectively. Therefore, parents of normal-weight children should be cautious about prolonged overnight fasting. ADF prevented HFD-induced obesity and precocious puberty, offering an alternative to medical approaches; nevertheless, further studies are needed for translation into clinical practice.

Approach to the Patient: Diagnosis and Treatment with Growth Hormone of Turner Syndrome and its Variants.

Turner syndrome (TS) is characterized by a partial or complete absence of the second X chromosome in female. Here, patients with Xp deletion involving SHOX haploinsufficiency caused by unbalanced X-autosome translocations were discussed and considered as TS variants. This work aimed to expand the current knowledge of TS and unbalanced X-autosome translocations and to suggest the definition, clinical characteristics, diagnosis workflow and growth hormone (GH) treatment strategy of TS and its variants. A 9.0-year-old patient of TS variant with tall target height (+2.03SD) but low height velocity (3.6cm/y) and height (-1.33SD) was evaluated as an example. Patients similar to the index patient were systematically searched in MEDLINE and EMBASE and summarized. A diagnosis workflow and scores for risk assessment of GH treatment (RiGHT scores) for TS variants were also proposed in this study. According to the diagnosis workflow, the girl's karyotype was confirmed as 46,X,der(X)t(X;7)(p11.3; p14.1), and was evaluated as low risk using RiGHT scores. After 2-year GH treatment, she had a significantly increased height (-0.94SD). Moreover, a total of 13 patients from 10 studies were summarized, characterized as short stature, growth retardation, craniofacial abnormalities, disorders of intellectual development, and psychomotor delays. Risk assessment of GH treatment using RiGHT scores were also applied in these 13 patients. The patients with Xp deletion caused by unbalanced X-autosome translocations should be considered as TS variants. The diagnosis workflow and RiGHT scores is a useful approach for clinicians in addressing complex cases of TS variants with GH treatment in clinical practice.

Growth hormone attenuates obesity and reshapes gut microbiota in high-fat diet-fed mice

Growth hormone (GH) and gut microbiota are key regulators of metabolism and have been linked to the development and treatment of obesity. Although variations in GH levels are associated with changes in gut microbiota composition, the specific effects of GH on gut microbiota and its role in obesity remain unclear. This study explored the effects of various GH doses (0.25, 0.75 and 1.5 IU/kg) on adipose tissue mass and gut microbiota in high-fat diet-induced obese mice. Notably, high-dose GH (1.5 IU/kg) significantly reduced the adipose tissue mass. This dose also reversed high-fat diet-induced gut microbiota dysbiosis, restoring microbial diversity and increasing the abundance of beneficial genera such as Ruminococcaceae and Muribaculaceae. Additionally, high-dose GH normalized several obesity-related gut microbiota pathways, including starch and sucrose metabolism, galactose metabolism, and secondary bile acid biosynthesis. GH therapy also improved intestinal barrier function, a key determinant of gut microbial homeostasis. These findings underscore the therapeutic potential of GH in obesity management through its effects on gut microbiota, providing new avenues for obesity interventions.

The influence of genotype makeup on the effectiveness of growth hormone therapy in children with Prader-Willi syndrome

BackgroundPrader-Willi syndrome (PWS) is a rare multisystemic hereditary illness. Recombinant human growth hormone (rhGH) therapy is widely recognized as the primary treatment for PWS. This study aimed to examine how different PWS genotypes influence the outcome of rhGH treatment in children with PWS.MethodsA review was conducted on 146 Chinese children with PWS, genetically classified and monitored from 2017 to 2022. Unaltered and modified generalized estimating equations (GEE) were employed to examine the long-term patterns in primary outcomes (growth metrics) and secondary outcomes (glucose metabolism metrics and insulin-like growth factor-1 (IGF-1)) during rhGH therapy. The study also evaluated the prevalence of hypothyroidism, hip dysplasia, and scoliosis before and after rhGH treatment.ResultsChildren with PWS experienced an increase in height/length standard deviation scores (SDS) following rhGH administration. The impact of rhGH therapy on growth measurements was similar in both the deletion and maternal uniparental diploidy (mUPD) cohorts. Nevertheless, the deletion group was more prone to insulin resistance (IR) compared to the mUPD group. No significant variations in growth metrics were noted between the two groups (P > 0.05). At year 2.25, the mUPD group showed a reduction in fasting insulin (FINS) levels of 2.14 uIU/ml (95% CI, -4.26, -0.02; P = 0.048) and a decrease in homeostasis model assessment of insulin resistance (HOMA-IR) of 0.85 (95% CI, -1.52, -0.17; P = 0.014) compared to the deletion group. Furthermore, there was a decrease in the IGF standard deviation scores (SDS) by 2.84 (95% CI, -4.84, -0.84; P = 0.005) in the mUPD group during the second year. The frequency of hip dysplasia was higher in the mUPD group compared to the deletion group (P < 0.05).ConclusionsrhGH treatment effectively increased height/length SDS in children with PWS, with similar effects observed in both deletion and mUPD genotypes. Children with mUPD genetype receiving rhGH treatment may experience enhanced therapeutic effects in managing PWS.

8407 Baseline Clinical Factors Associated with Cessation of Growth Hormone Therapy in Patients with Severe Growth Hormone Deficiency: Real World Evidence

8407 Baseline Clinical Factors Associated with Cessation of Growth Hormone Therapy in Patients with Severe Growth Hormone Deficiency: Real World Evidence