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Dose-Dependent Effect of Growth Hormone on Final Height in Children with Short Stature without Growth Hormone Deficiency

Journal article
Authors Kerstin Albertsson-Wikland
A. S. Aronson
J. Gustafsson
L. Hagenäs
S. A. Ivarsson
B. Jonsson
Berit Kriström
C. Marcus
K. O. Nilsson
E. M. Ritzen
T. Tuvemo
Otto Westphal
J. Åman
Published in Journal of Clinical Endocrinology & Metabolism
Volume 93
Issue 11
Pages 4342-50
ISSN 0021-972X
Publication year 2008
Published at Institute of Clinical Sciences
Pages 4342-50
Language en
Links dx.doi.org/10.1210/jc.2008-0707
Subject categories Medical and Health Sciences

Abstract

Context: The effect of GH therapy in short non-GH-deficient children, especially those with idiopathic short stature (ISS), has not been clearly established owing to the lack of controlled trials continuing until final height (FH). Objective: The aim of the study was to investigate the effect on growth to FH of two GH doses given to short children, mainly with ISS, compared with untreated controls. Design and Setting: A randomized, controlled, long-term multicenter trial was conducted in Sweden. Intervention: Two doses of GH (Genotropin) were administered, 33 or 67 mug/kg.d; control subjects were untreated. Subjects: A total of 177 subjects with short stature were enrolled. Of these, 151 were included in the intent to treat (All(ITT)) population, and 108 in the per protocol (All(PP)) population. Analysis of ISS subjects included 126 children in the ITT (ISS(ITT)) population and 68 subjects in the PP (ISS(PP)) population. Main Outcome Measures: We measured FH sd score (SDS), difference in SDS to midparenteral height (diff MPH(SDS)), and gain in height(SDS). Results: After 5.9 +/- 1.1 yr on GH therapy, the FH(SDS) in the All(PP) population treated with GH vs. controls was -1.5 +/- 0.81 (33 mug/kg.d, -1.7 +/- 0.70; and 67 mug/kg.d, -1.4 +/- 0.86; P < 0.032), vs. -2.4 +/- 0.85 (P < 0.001); the diff MPH(SDS) was -0.2 +/- 1.0 vs. -1.0 +/- 0.74 (P < 0.001); and the gain in height(SDS) was 1.3 +/- 0.78 vs. 0.2 +/- 0.69 (P < 0.001). GH therapy was safe and had no impact on time to onset of puberty. A dose-response relationship identified after 1 yr remained to FH for all growth outcome variables in all four populations. Conclusion: GH treatment significantly increased FH in ISS children in a dose-dependent manner, with a mean gain of 1.3 SDS (8 cm) and a broad range of response from no gain to 3 SDS compared to a mean gain of 0.2 SDS in the untreated controls.

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