scholarly journals Is a Combination of a GnRH Agonist and Recombinant Growth Hormone an Effective Treatment to Increase the Final Adult Height of Girls with Precocious or Early Puberty?

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Wei Song ◽  
Fei Zhao ◽  
Shuang Liang ◽  
Guimei Li ◽  
Jiang Xue
Keyword(s):  
Growth Hormone ◽  
Standard Deviation ◽  
Adult Height ◽  
Combined Therapy ◽  
Standard Deviation Score ◽  
Height Standard Deviation Score ◽  
Early Puberty ◽  
Deviation Score ◽  
Final Adult Height ◽  
Rhgh Treatment

The aim of treatment for idiopathic central precocious puberty (ICPP) is to increase final adult stature, for which gonadotropin-releasing hormone agonist (GnRHa) is the gold standard. Early puberty is frequently similar to ICPP, with pubertal onset only slightly advanced. Short stature may result from early pubertal onset. Some studies have suggested that recombinant human growth hormone (rhGH) should be combined with a GnRHa to improve adult height, while others have not. Here, the aim was to compare the efficacy of combined GnRHa and rhGH treatment with GnRHa or rhGH treatment alone, or no therapy, for the improvement of the final height of girls with ICPP or early puberty. Electronic databases of randomized and quasi-randomized controlled trials, in which the efficacy of GnRHa preparations was compared with that of rhGH for the treatment of children with precocious or early puberty, were searched and a meta-analysis conducted. Five studies of early puberty and four studies of ICPP were identified. There were no statistically significant differences between final adult height standard deviation score and initial height standard deviation score in the treatment of early puberty (GnRHa and rhGH versus rhGH alone or no treatment). The overall analysis of the data failed to indicate any benefit of combined therapy, while individual reports suggested that in specific instances combined therapy may be beneficial in preserving or reclaiming growth potential and improving adult height.

Adult Height in Growth Hormone Deficiency: Historical Perspective and Examples From the National Cooperative Growth Study

PEDIATRICS ◽  
1999 ◽  
Vol 104 (Supplement_5) ◽  
pp. 1000-1004 ◽  
Author(s):  
J. Paul Frindik ◽  
Joyce Baptista
Keyword(s):  
Growth Hormone ◽  
Standard Deviation ◽  
Adult Height ◽  
Historical Data ◽  
Pubertal Development ◽  
Standard Deviation Score ◽  
Growth Study ◽  
Deviation Score ◽  
Number Of Patients ◽  
National Cooperative

There are few historical data on final or adult heights after the completion of long-term growth hormone (GH) therapy in children with GH deficiency (GHD). Adult height has been defined as that achieved at chronologic ages ranging from 18 to 30 years, at bone ages ≥13 years (girls) and ≥15 years (boys), at growth velocities ≤1 to 2 cm per 6 to 12 months, at the “cessation of growth,” at “1 year after the completion of pubertal development,” and that at which patients are either “satisfied with their height” or have attained an “accept adult stature.” Without GH treatment, children with GHD have a mean adult height standard deviation score of −4.7 (range, −6.1 to −3.9). After treatment, the standard deviation score range from −4.7 to −1.2 (pituitary GH [pitGH] 2–4 times a week) and from −1.4 to −0.5 (recombinant human [rhGH] GH 3 times a week to daily) in women and from −3.6 to −1.1 (pitGH) and from −1.3 to −0.7 (rhGH) in men. Because there is no uniformly applied definition of adult height, comparisons are difficult, but historical data suggest that posttreatment heights are greater with rhGH than with pitGH. Using the National Cooperative Growth Study database, we found that the criteria used to define adult height affected the apparent outcome. When chronologic age ≥20 years for men and ≥18 years for women was the only criterion, 27% of patients grew ≥5 cm after having reached this age. Adding the requirement of advanced puberty before adult height could be considered to have been attained reduced the proportion of those who later grew ≥5 cm to <10%, but also decreased the number of patients available for analysis. A combination of criteria for adult height (chronologic and bone age ≥16 years for boys and ≥14 years for girls plus advanced puberty plus growth rate of <2 cm per year) left only 1% of patients with later growth of ≥5 cm.

scholarly journals Effect of Growth Hormone Therapy in Patients with Noonan Syndrome: A Retrospective Study

2020 ◽  
Vol 18 (4) ◽  
Author(s):  
Louise Jayne Apperley ◽  
Renuka Ramakrishnan ◽  
Poonam Dharmaraj ◽  
Urmi Das ◽  
Mohammed Didi ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Standard Deviation ◽  
Hormone Therapy ◽  
Noonan Syndrome ◽  
Growth Hormone Treatment ◽  
Growth Hormone Therapy ◽  
Standard Deviation Score ◽  
Hormone Treatment ◽  
Height Standard Deviation Score ◽  
Deviation Score

Background: Noonan syndrome is an autosomal dominant condition with an incidence of 1:1000 to 1:2500. The disorder is associated with distinct dysmorphic features, cardiac anomalies, developmental delay and delayed puberty. Short stature is a recognised feature of Noonan syndrome. Objectives: The aim of this study is to assess the effect of growth hormone treatment in patients with Noonan syndrome. Methods: Retrospective data was collected from patients with Noonan syndrome treated with growth hormone. The results were analysed with variables expressed as mean values and standard deviation scores. Results: Twelve Noonan syndrome patients (M: F = 10:2) treated with growth hormone were identified. The mean age of starting growth hormone was 8 years, with baseline height standard deviation score of -2.96 (range: -1.64 to -5.54). The height standard deviation score significantly improved to -2.50 (P = 0.0035) and then -2.22 (P = 0.0025), following one and two years of treatment, respectively. The average height velocity for the patients prior to starting treatment was 5.16cm/year (range: 2.4 - 8.2 cm/year), which significantly improved to 7.76cm/year (ranging from 4.1 to 12.8 cm/year) after one year of growth hormone treatment (P = 0.020) and to 6.51cm/year at the end of two years. Conclusions: Our study has shown that growth hormone treatment significantly improves the height standard deviation score of patients with Noonan syndrome over a two-year course of growth hormone therapy without any side effects. Further research is required to analyse the long-term effect of growth hormone therapy in patients with Noonan syndrome, including the impact on final adult height.

The Frequency of Bleeding and Height of Adolescent Haemophiliacs

1979 ◽  
Vol 41 (02) ◽  
pp. 286-290 ◽  
Author(s):  
J L Bem ◽  
M J Painter ◽  
A Aronstam ◽  
J H Patrick ◽  
R E Newcombe
Keyword(s):  
Standard Deviation ◽  
Standard Deviation Score ◽  
Height Standard Deviation Score ◽  
Deviation Score

SummaryThe relation between the height of adolescent haemophiliacs and their bleeding frequency has been studied. 45 haemophiliacs aged 10-19 years were divided into 3 groups: small, medium and tall, using a Height Standard Deviation Score. The average bleeding frequency per 100 days in the group of small haemophiliacs was 8.71 ± SD 4.47, in the medium height group 10.18 ± SD 6.71, while the tall individuals bled in average 15.97 ± SD 3.15 every 100 days. There was no relationship between age and bleeding frequency.

Final height of patients with idiopathic growth hormone deficiency after long-term growth hormone treatment

1989 ◽  
Vol 120 (4) ◽  
pp. 409-415 ◽  
Author(s):  
Itsuro Hibi ◽  
Toshiaki Tanaka ◽  
_ _
Keyword(s):  
Growth Hormone ◽  
Standard Deviation ◽  
Growth Hormone Deficiency ◽  
Final Height ◽  
Standard Deviation Score ◽  
Hormone Deficiency ◽  
Chronological Age ◽  
Deviation Score ◽  
Idiopathic Growth Hormone Deficiency ◽  
Group A

Abstract. One hundred and 8 patients with idiopathic growth hormone deficiency with spontaneous pubertal maturation (group A), were followed until they reached their final height after hGH treatment lasting between 2 and 11.1 (average 5.5) years. Their standard deviation scores of final height averaged 3.3 sd below the population mean, which was significantly lower than 1.1 standard deviation below the mean in 29 GH deficient patients without spontaneous puberty (group B) who were treated with hGH and sex hormones. The presence of gonadal function was found to be unbeneficial for final height. The final height of the patients in both groups was not related to either 1) age at the start of hGH treatment, 2) age at the onset of puberty, or 3) the duration of hGH treatment. It was, however, significantly related to the standard deviation score of height at the start of hGH treatment in both groups and to that of height at the onset of puberty in group A. The findings demonstrated that earlier introduction of hGH treatment resulted in earlier onset of puberty in group A, because the chronological age at the onset of puberty was positively correlated to the chronological age at the start of hGH treatment. It was also confirmed that the later puberty began, the taller the final height in GH deficient patients who had the same degree of standard deviation score of height for chronological age before puberty.

scholarly journals Idiopathic short stature

2013 ◽  
Vol 141 (3-4) ◽  
pp. 256-261 ◽  
Author(s):  
Jovan Vlaski ◽  
Dragan Katanic ◽  
Jadranka Jovanovic-Privrodski ◽  
Ivana Kavecan ◽  
Ivana Vorgucin ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Standard Deviation ◽  
Short Stature ◽  
Standard Deviation Score ◽  
The Body ◽  
Idiopathic Short Stature ◽  
Hormone Deficiency ◽  
Growth Monitoring ◽  
Social Suffering ◽  
Deviation Score

Growth is a complex process and the basic characteristic of child- hood growth monitoring provides insight into the physiological and pathological events in the body. Statistically, the short stature means departure from the values of height for age and sex (in a particular environment), which is below -2 standard deviation score, or less than -2 standard deviation, i.e. below the third percentile. Advances in molecular genetics have contributed to the improvement of diagnostics in endocrinology. Analysis of patients? genotypes should not be performed before taking a classical history, detailed clinical examination and appropriate tests. In patients with idiopathic short stature specific causes are excluded, such as growth hormone deficiency, Turner syndrome, short stature due to low birth weight, intrauterine growth retardation, small for gestational age, dysmorphology syndromes and chronic childhood diseases. The exclusion of abovementioned conditions leaves a large number of children with short stature whose etiology includes patients with genetic short stature or familial short stature and those who are low in relation to genetic potential, and who could also have some unrecognized endocrine defect. Idiopathic short stature represents a short stature of unknown cause of heterogeneous etiology, and is characterized by a normal response of growth hormone during stimulation tests (>10 ng/ml or 20 mJ/l), without other disorders, of normal body mass and length at birth. In idiopathic short stature standard deviation score rates <-2.25 (-2 to -3) or <1.2 percentile. These are also criteria for the initiation of growth hormone therapy. In children with short stature there is also the presence of psychological and social suffering. Goals of treatment with growth hormone involve achieving normal height and normal growth rate during childhood.

GROWTH-PROMOTING THERAPIES MAY BE USEFUL IN SHORT STATURE PATIENTS WITH NONSPECIFIC SKELETAL ABNORMALITIES CAUSED BY ACAN HETEROZYGOUS MUTATIONS: SIX CHINESE CASES AND LITERATURE REVIEW

2020 ◽  
Vol 26 (11) ◽  
pp. 1255-1268
Author(s):  
Hanting Liang ◽  
Hui Miao ◽  
Hui Pan ◽  
Hongbo Yang ◽  
Fengying Gong ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Standard Deviation ◽  
Literature Review ◽  
Growth Hormone Deficiency ◽  
Short Stature ◽  
Standard Deviation Score ◽  
Hormone Deficiency ◽  
Novel Mutations ◽  
Deviation Score ◽  
Growth Promoting

Objective: There are numerous reasons for short stature, including mutations in osteochondral development genes. ACAN, one such osteochondral development gene in which heterozygous mutations can cause short stature, has attracted attention from researchers in recent years. Therefore, we analyzed six cases of short stature with heterozygous ACAN mutations and performed a literature review. Methods: Clinical information and blood samples from 6 probands and their family members were collected after consent forms were signed. Gene mutations in the probands were detected by whole-exome sequencing. Then, we searched the literature, performed statistical analyses, and summarized the characteristics of all reported cases. Results: We identified six novel mutations in ACAN: c.1411C>T, c.1817C>A, c.1762C>T, c.2266G>C, c.7469G>A, and c.1733-1G>A. In the literature, more than 200 affected individuals have been diagnosed genetically with a similar condition (height standard deviation score [SDS] −3.14 ± 1.15). Among affected individuals receiving growth-promoting treatment, their height before and after treatment was SDS −2.92 ± 1.07 versus SDS −2.14 ± 1.23 ( P<.001). As of July 1, 2019, a total of 57 heterozygous ACAN mutations causing nonsyndromic short stature had been reported, including the six novel mutations found in our study. Approximately half of these mutations can lead to protein truncation. Conclusion: This study used clinical and genetic means to examine the relationship between the ACAN gene and short stature. To some extent, clear diagnosis is difficult, since most of these affected individuals’ characteristics are not prominent. Growth-promoting therapies may be beneficial for increasing the height of affected patients. Abbreviations: AI = aromatase inhibitor; ECM = extracellular matrix; GnRHa = gonadotropin-releasing hormone analogue; IQR = interquartile range; MIM = Mendelian Inheritance in Man; PGHD = partial growth hormone deficiency; rhGH = recombinant human growth hormone; SDS = standard deviation score; SGA = small for gestational age; SGHD = severe growth hormone deficiency

scholarly journals Growth Screening and Urban Deprivation

1995 ◽  
Vol 2 (3) ◽  
pp. 140-144 ◽  
Author(s):  
E White ◽  
A Wilson ◽  
S A Greene ◽  
W Berry ◽  
C McCowan ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Short Stature ◽  
Social Deprivation ◽  
Standard Deviation Score ◽  
Primary School Children ◽  
British Society ◽  
Health Clinic ◽  
Height Standard Deviation Score ◽  
Deviation Score ◽  
Urban Deprivation

Objectives — To assess the effect of urban deprivation on childhood growth in a modern British society by analysing data from a regional growth survey, the Tayside growth study. Setting — The Tayside Region in Scotland, which has three districts with distinct socioeconomic status: Dundee (D, urban city), Angus (A, rural), and Perth (P, rural and county town). Subjects and methods — Height and weight of 23 046 children (>90% of the regional childhood population) were measured as part of a child health surveillance programme, by community health care workers at 3, 5, 7, 9, 11, and 14 years. Height standard deviation score (calculated against Tanner) and body mass index (BMI-weight (kg)/height (m)2) were calculated for each child by a central computer program; mean height standard deviation score and BMI standard deviation score were calculated for each measuring centre (school, health clinic). A deprivation score for each centre was calculated from the prevalence of single parent families; families with more than three children; unemployment rate; the number of social class V individuals; the percentage of council houses. Results — Mean height standard deviation score for Tayside was 0·11. An intra-regional difference was demonstrated: mean height standard deviation score (SD) D = 0·04 (1·0); A = 0·14 (1·1); P = 0·21 (1·1); P<0·002. There was a positive association between short stature and increasing social deprivation seen throughout Tayside (P<0·05), with a strong association in Dundee primary school children (r = 0·6; P<0·001). Analysis by district showed that the association was significant only above the age of 8 (P<0·004). There was no relation between BMI and social deprivation. Conclusions — In an industrialised developed society, urban deprivation appears to influence height mostly in late childhood, and this association should be taken into consideration in the clinical management of short stature. Height seems to be a better physical indicator of urban deprivation, and hence an index of childhood health, than BMI.

Growth response to growth hormone (GH) treatment in children with GH deficiency (GHD) and those with idiopathic short stature (ISS) based on their pretreatment insulin-like growth factor 1 (IGFI) levels and at diagnosis and IGFI increment on treatment

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ashraf Soliman ◽  
Alan D. Rogol ◽  
Sohair Elsiddig ◽  
Ahmed Khalil ◽  
Nada Alaaraj ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Standard Deviation ◽  
Growth Factor ◽  
Short Stature ◽  
Linear Growth ◽  
Standard Deviation Score ◽  
Idiopathic Short Stature ◽  
Insulin Like Growth Factor ◽  
Gh Therapy ◽  
Deviation Score

Abstract Objectives Some idiopathic short stature (ISS) patients may have varying degrees of insulin-like growth factor 1 (IGFI) deficiency. Others with growth hormone deficiency (GHD) (peak GH < 7 ng/dL after provocation) have normal IGFI levels. Do children with ISS or those with GHD with variable pretreatment IGFI standard deviation score (IGFISDS) have different IGFI and growth responses to recombinant human growth hormone (rhGH) therapy? Methods We studied the effect of GH therapy (0.035–0.06 mg/kg/day) on linear growth and weight gain per day (WGPD) in children with ISS (n=13) and those with GHD (n=10) who have low pretreatment IGFISDS (IGF SDS < −1.5) and compared them with age-matched prepubertal children with ISS (n=10) and GHD (n=17) who had normal pretreatment IGFISDS. An untreated group of children with ISS (n=12) served as a control group. Results At presentation, the height standard deviation score (HtSDS) of children with ISS who had low pretreatment IGFISDS was significantly lower compared to the normal IGFI group. The age, body mass index (BMI), BMISDS, peak GH response to clonidine provocation and bone age did not differ between the two study groups. After 1 year of treatment with rhGH (0.035–0.06 mg/kg/day) IGFISDS increased significantly in both groups (p<0.05). Both had significantly increased HtSDS (catch-up growth). The increase in the HtSDS and WGPD were significantly greater in the lower pretreatment IGFISDS group. The IGFSDS, BMISDS, HtSDS and difference between HtSDS and mid-parental HtSDS were significantly greater in the rhGH treated groups vs. the not treated group. In the GHD groups (normal and low IGFISDS), after 1 year of GH therapy (0.03–0.05 mg/kg/day), the HtSDS increased significantly in both, (p<0.01). The WGPD and increment in BMI were significantly greater in children who had low pretreatment IGFISDS. There was a significant increase in the IGFSDS in the two treated groups (p<0.05), however, the WGPD was greater in the pretreatment low IGFISDS. Conclusions IGFI deficiency represents a low anabolic state. Correction of IGFI level (through rhGH and/or improved nutrition) in short children (ISS and GHD) was associated with increased linear growth and WGPD denoting significant effect on bone growth and muscle protein accretion.

Normal growth in the short normal prepubertal child: the Wessex Growth Study

1998 ◽  
Vol 5 (3) ◽  
pp. 127-130 ◽  
Author(s):  
L D Voss ◽  
J Mulligan
Keyword(s):  
Standard Deviation ◽  
Standard Deviation Score ◽  
Normal Growth ◽  
Normal Velocity ◽  
Height Standard Deviation Score ◽  
Normal Children ◽  
Velocity Change ◽  
Prepubertal Children ◽  
Deviation Score ◽  
Rate Of Growth

Objective The study aimed at defining the normal rate of growth for short, prepubertal children, and comparing their pattern of growth with those of average stature. Setting Community based. Design Observation of an unselected population of 109 very short, normal prepubertal children (<3rd height centile) and 107 controls matched for age and sex (10th to 90th centile). Main outcome measuresHeight, velocity, change in height standard deviation score, from 6 to 9 years of age. Results The absolute mean rate of growth was significantly different between groups—short normal 5.3 cm/year, controls 5.9 cm/year—corresponding to velocities on the 25th and 50th centiles, respectively. The relative growth rates, however, as shown by the changes in height standard deviation score (short normal 0.10 (SD 0.22), controls 0.10 (SD 0.24) did not differ, and each group remained close to its original 3rd and 50th centiles. Two short children showed “catch up” growth after adoption, but, otherwise, the divergence from their original height centile was the same for short normal and control children. No social or biological factors were found to predict growth rate in the short normal children, and only target height in controls. “Normal” velocity is conditional on height. Short normal children do grow more slowly than children of average stature, but they do not necessarily grow more poorly. From 6 to 9 years of age they are no more likely to fall off their height centiles than children of average stature. The value of height monitoring at this age is questioned.

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