Growth hormone retesting during puberty: a cohort study

in European Journal of Endocrinology
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  • 1 Pediatric Division, Department of Pediatrics, University Hospital of Verona, Verona, Italy
  • 2 Pediatric Clinic, Department Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
  • 3 Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
  • 4 Laboratory Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
  • 5 Regional Center for the Diagnosis and Treatment of Children and Adolescents Rare Skeletal Disorders, Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

Correspondence should be addressed to P Cavarzere; Email: paolocavarzere@yahoo.it
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Objectives

To report the frequency and characteristics of growth hormone (GH) deficiency (GHD) in adolescents who had normalized GH secretion at mid-puberty and to identify possible factors predictive for GH sufficiency at puberty.

Design

Clinical analysis of children affected by GHD at five time points: diagnosis; first year of therapy; intermediate stage of puberty; retesting and end of growth phase.

Methods

The study population was 80 children with idiopathic GHD and treated with GH for at least 2 years. Treatment was discontinued at the intermediate stage of puberty. Retesting with an arginine test was performed 12 weeks later. If GH peak at retesting was ≥8 μg/L, the therapy was definitively discontinued, otherwise it was restarted and continued until achievement of near-final height.

Results

GH therapy was discontinued in 44 children (55%), and restarted in 36 (45%). No evidence of differences in definitive height and in the delta height between the genetic target and the definitive height was found between the two groups. The only predictive factor for GHD at mid-puberty was the insulin growth factor-1 (IGF-1) level at 1 year of GH treatment.

Conclusions

GH secretion should be retested at mid-puberty. Retesting at puberty may reduce potential side effects and minimize costs, without impairing growth potential and final height.

Supplementary Materials

    • Table S1 Comparison of clinical data at diagnosis between patients of group A (normal GH secretion) vs group B (persistent GHD)
    • Table S2 Comparison of clinical and auxological data after 1 year of treatment and at puberty between patients of group A (normal GH secretion) vs group B (persistent GHD).
    • Table S3 Comparison of clinical and auxological data after the suspension of GH treatment between patients of group A (normal GH secretion) vs group B (persistent GHD)
    • Figure S1 Bar plots of GHD risk for different intervals of IGF-1 (upper plots) and IGF-1 SDS (lower plots), after 1 year of treatment; intervals defined by IGF-1 quintiles (left plots) and equal-length intervals (right plots).

 

     European Society of Endocrinology

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