Abstract
Objectives:
Continuation of growth hormone (GH) treatment in adolescents with severe childhood onset idiopathic GH deficiency (IGHD) during the transition period, irrespective of achievement of final height, is still debatable. We aimed to prospectively investigate the metabolic profile, bone mineral density (BMD) and body composition of patients with IGHD in whom GH treatments were terminated after they had reached their final height, six months after the cessation of therapy.
Methods:
Twelve patients, six of whom had peak GH levels <5 ng/mL [permanent GH deficiency (GHD), group 1], and six who had peak GH levels >5 ng/mL (transient GHD, group 2) after insulin stimulation test were evaluated for anthropometric and laboratory parameters including fasting blood glucose (FBG), fasting insulin, lipid profile, BMD, body composition measurements and 24-hour ambulatory blood pressure monitoring before (baseline) and at six months after discontinuation of GH.
Results:
No differences were found in clinical, laboratory, BMD and body composition measures between groups 1 and 2 at baseline. All IGHD patients had significant increments of body weight (BW), body mass index (BMI), BMD, total body fat (TBF), TBF%, truncal fat (TF) and TF% after GH cessation. Six months later BW, BMI, BMD and TF% was increased significantly while FBG and lipids showed no change in group 1. In group 2, TBF% and TF% were increased, FBG, total cholesterol and high-density lipoprotein decreased after six months. Changes in these parameters in group 2 were not statistically different from group1.
Conclusion:
TF% increase in both groups after cessation of therapy. We did not observe a clinical condition requiring GH treatment in any of the study subjects during the follow-up period.
Keywords: Growth hormone deficiency, transition, childhood
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References
Attanasio AF, Howell S, Bates PC, Frewer P, Chipman J, Blum WF, Shalet SM. Body composition, IGF-I and IGFBP-3 concentrations as outcome measures in severely GH-deficient (GHD) patients after childhood GH treatment: a comparison with adult onset GHD patients. J Clin Endocrinol Metab 2002;87:3368-3372.
Chamberlain SH, Levy RA. Transition care of patients with growth hormone deficiency from pediatric endocrinologists to adult endocrinologists. Endocr Pract 2012;18:256-268.
Johannsson G, Albertsson-Wikland K, Bengtsson BA. Discontinuation of growth hormone (GH) treatment: metabolic effects in GH-deficient and GH-sufficient adolescent patients compared with control subjects. Swedish Study Group for Growth Hormone Treatment in Children. J Clin Endocrinol Metab 1999;84:4516-4524.
Shalet SM, Shavrikova E, Cromer M, Child CJ, Keller E, Zapletalová J, Moshang T, Blum WF, Chipman JJ, Quigley CA, Attanasio AF. Effect of growth hormone (GH) treatment on bone in postpubertal GH-deficient patients: a 2-year randomized, controlled, dose-ranging study. J Clin Endocrinol Metab 2003;88:4124-4129.
Attanasio AF, Shavrikova E, Blum WF, Cromer M, Child CJ, Paskova M, Lebl J, Chipman JJ, Shalet SM; Hypopituitary Developmental Outcome Study Group. Continued growth hormone (GH) treatment after final height is necessary to complete somatic development in childhood-onset GH-deficient patients. J Clin Endocrinol Metab 2004;89:4857-4862.
Mauras N, Pescovitz OH, Allada V, Messig M, Wajnrajch MP, Lippe B; Transition Study Group. Limited efficacy of growth hormone (GH) during transition of GH-deficient patients from adolescence to adulthood: a phase III multicenter, double-blind, randomized two-year trial. J Clin Endocrinol Metab 2005;90:3946-3955. Epub 2005 Apr 26
Cohen P, Rogol AD, Deal CL, Saenger P, Reiter EO, Ross JL, Chernausek SD, Savage MO, Wit JM; 2007 ISS Consensus Workshop participants. Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology Workshop. J Clin Endocrinol Metab 2008;93:4210-4217. Epub 2008 Sep 9
Goksen D, Darcan S, Coker M, Kose T. Bone mineral density of healthy Turkish children and adolescents. J Clin Densitom 2006;9:84-90. Epub 2006 Mar 27
Thomas M, Massa G, Maes M, Beckers D, Craen M, François I, Heinrichs C, Bourguignon JP; Belgian Study Group for Paediatric Endocrinology (BSGPE). Growth hormone (GH) secretion in patients with childhood-onset GH deficiency: retesting after one year of therapy and at final height. Horm Res 2003;59:7-15.
Malaspina JP, Bussiere H, Le G. The total cholesterol/HDL cholesterol ratio: a suitable atherogenesis index. Atherosclerosis 1981;40:373-375.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-419.
Fors H, Bjarnason R, Wirent L, Albertsson-Wikland K, Bosaeust L, Bengtsson BA, Johannsson G. Currently used growth-promoting treatment of children results in normal bone mass and density. A prospective trial of discontinuing growth hormone treatment in adolescents. Clin Endocrinol (Oxf) 2001;55:617-624.
Carroll PV, Drake WM, Maher KT, Metcalfe K, Shaw NJ, Dunger DB, Cheetham TD, Camacho-Hübner C, Savage MO, Monson JP. Comparison of continuation or cessation of growth hormone (GH) therapy on body composition and metabolic status in adolescents with severe GH deficiency at completion of linear growth. J Clin Endocrinol Metab 2004;89:3890-3895.
Kaufman JM, Taelman P, Vermeulen A, Vandeweghe M. Bone mineral status in growth hormone-deficient males with isolated and multiple pituitary deficiencies of childhood onset. J Clin Endocrinol Metab 1992;74:118-123.
Baroncelli GI, Bertelloni S, Sodini F, Saggese G. Longitudinal changes of lumbar bone mineral density (BMD) in patients with GH deficiency after discontinuation of treatment at final height; timing and peak values for lumbar BMD. Clin Endocrinol (Oxf) 2004;60:175-184.
Ogle GD, Moore B, Lu PW, Craighead A, Briody JN, Cowell CT. Changes in body composition and bone density after discontinuation of growth hormone therapy in adolescence: an interim report. Acta Paediatr Suppl 1994;399:3-7.
Vahl N, Juul A, Jorgensen JO, Orskov H, Skakkebaek NE, Christiansen JS. Continuation of growth hormone (GH) replacement in GH-deficient patients during transition from childhood to adulthood: a two-year placebo-controlled study. J Clin Endocrinol Metab 2000;85:1874-1881.
Monson JP. Indications for GH replacement in adolescents and young adults. J Endocrinol Invest 2005;28(Suppl 5):52-55.
