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Individualized GH treatment reduces the variation in insulin levels and in body composition during the maintenance growth phase in prepubertal children

Conference paper
Authors Ralph Decker
Kerstin Albertsson-Wikland
Berit Kriström
Maria Halldin
Jovanna Dahlgren
Published in Horm Res Paediatr
Volume 2011
Issue 76 (suppl)
Pages 84
ISBN 978-3-8055-9835-4
Publication year 2011
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 84
Language en
Keywords Maintenance growth period, growth hormone, individualized treatment, responsiveness, reduced dose
Subject categories Clinical pharmacology, Physiology

Abstract

Background: Few studies have evaluated the metabolic outcomes of growth hormone (GH) treatment in prepubertal short children during different growth phases. We have studied individualized GH treatment in the catch-up growth phase and found a reduction in variation of fasting insulin levels by 34% compared to unchanged standard dose. Thereafter, GH-treated children appear to need lower GH doses to maintain SDscore channel-parallel growth. The individualized approach using prediction models for estimation of GH responsiveness has the advantage of narrowing the range of growth response around mid-parental heights, avoiding too low or high GH doses. Methods: Short prepubertal children with either isolated GHD or ISS participated in a 2-year randomized trial of either individualized GH treatment (range, 17–100 μg/kg/day) or a unchanged (USD) standard dose. After achieving near mid-parental height, children with individualized dosage were randomized to either reduced individualized dose (RID, n=28) (i.e. 50% decreased dose) or unchanged individualized dose (UID, n=37) for 2 more years. The 33 children randomized to the USD (43 μg/kg/day) at start of treatment remained unchanged. Objective and hypotheses: To evaluate if bisection of the reduced individualized GH dose (RID) diminishes the variation in the metabolic parameters measured during maintenance growth compared to reduced individualized GH dose. Hypothesis: Reduction of GH dosage reduces the range of metabolic outcomes without decreasing growth velocity during the maintenance growth phase. Results: : We observed a narrower variation in fasting insulin levels (-50%) and in insulin sensitivity as assessed by homoeostasis model assessment, HOMA (-55.1%), lean soft tissue, LST (-27.8%) and bone mineral content, BMC (-31.3%), in RID compared to UID (p<0.05).

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