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Growth Hormone (GH) Dosing during Catch-Up Growth Guided by Individual Responsiveness Decreases Growth Response Variability in Prepubertal Children with GH Deficiency or Idiopathic Short Stature

Artikel i vetenskaplig tidskrift
Författare Berit Kriström
A. S. Aronson
Jovanna Dahlgren
J. Gustafsson
M. Halldin
S. A. Ivarsson
N. O. Nilsson
J. Svensson
T. Tuvemo
Kerstin Albertsson-Wikland
Publicerad i Journal of Clinical Endocrinology and Metabolism
Volym 94
Nummer/häfte 2
Sidor 483-90
ISSN 1945-7197
Publiceringsår 2009
Publicerad vid Institutionen för kliniska vetenskaper
Sidor 483-90
Språk en
Länkar dx.doi.org/10.1210/jc.2008-1503
Ämneskategorier Medicin och Hälsovetenskap

Sammanfattning

Context: Weight-based GH dosing results in a wide variation in growth response in children with GH deficiency (GHD) or idiopathic short stature (ISS). Objective: The hypothesis tested was whether individualized GH doses, based on variation in GH responsiveness estimated by a prediction model, reduced variability in growth response around a set height target compared with a standardized weight-based dose. Setting: A total of 153 short prepubertal children diagnosed with isolated GHD or ISS (n = 43) and at least 1 sd score (SDS) below midparental height SDS (MPH(SDS)) were included in this 2-yr multicenter study. Intervention: The children were randomized to either a standard (43 mug/kg . d) or individualized (17-100 mug/kg . d) GH dose. Main Outcome Measure: We measured the deviation of height(SDS) from individual MPH(SDS) (diffMPH(SDS)). The primary endpoint was the difference in the range of diffMPH(SDS) between the two groups. Results: The diffMPH(SDS) range was reduced by 32% in the individualized-dose group relative to the standard-dose group (P < 0.003), whereas the mean diffMPH(SDS) was equal: -0.42 +/- 0.46 and -0.48 +/- 0.67, respectively. Gain in height(SDS) 0-2 yr was equal for the GH-deficient and ISS groups: 1.31 +/- 0.47 and 1.36 +/- 0.47, respectively, when ISS was classified on the basis of maximum GH peak on the arginine-insulin tolerance test or 24-h profile. Conclusion: Individualized GH doses during catch-up growth significantly reduce the proportion of unexpectedly good and poor responders around a predefined individual growth target and result in equal growth responses in children with GHD and ISS.

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