Effect of long-term growth hormone therapy on bone age and pubertal maturation in boys with and without classic growth hormone deficiency

• Published in: The Journal of pediatrics Vol. 125; no. 2; pp. 189 - 195
• Main Authors: Zadik, Z., Chalew, S., Zung, A., Landau, H., Leiberman, E., Koren, R., Voet, H., Hochberg, Z., Kowarski, A.A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-1994; Mosby-Year Book, Inc
• Subjects: Age Determination by Skeleton; Body Height - drug effects; Child; Growth - drug effects; Growth Disorders - drug therapy; Growth Hormone - pharmacology; Growth Hormone - secretion; Growth Hormone - therapeutic use; Humans; Male; Puberty - drug effects; Regression Analysis
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(18)31671-8

We evaluated the effect of growth hormone (GH) therapy on bone age, pubertal maturation and predicted adult height in two groups of boys treated for 4 years: 40 growth hormone-deficient boys who had growth hormone response to provocative stimulation <10 μg/L (GHD group) and 43 boys whose stimulated growth hormone ≥10 μg/L (group with neurosecretory dysfunction (NSD)). All patients had a subnormal integrated concentration of growth hormone ≤3.2 μg/L, height < -2 SD, growth velocity <4.5 cm/yr, and bone age ≤ -2 SD for chronologic age. Patients were treated with recombinant growth hormone, 0.1 mg/kg per dose given three times a week. The pretreatment height SD of the GHD group (-3.6 ± 1.0) was less than that of the NSD group (-2.7 ± 0.7; p <0.001). After 4 years of therapy, both groups had catch-up growth (GHD group to -2.0 ± 1.3 height SD (n = 35), and NSD group to -1.4 ± 0.7 height SD (n = 32)); the rate of height SD gain was better in patients with GHD (p <0.01). The response to growth hormone was inversely related to pretreatment chronologic age (p <0.001). The Tanner-Whitehouse II predicted adult height improved for both groups: +9.3 ± 7.7 cm in the GHD group, giving an adult height SD of -0.9 ± 1.0, and +5.4 ± 5.5 cm in patients with NSD, for an adult height SD if -0.8 ± 0.7. Testosterone levels became higher in the NSD group after 2 years and remained higher at year 4. We conclude that patients respond favorably to growth hormone therapy and in a manner similar to patients with GHD. Initiation of therapy at a younger age gives a greater improvement in gained height and predicted adult height. (J Pediatr 1994;125:189-95)