Therapeutic Effect Of Recombinant Human Growth Hormone On Puberty And Adolescent Idiopathic Short Stature

Objective (1) To observe the therapeutic effects and security of replacement therapy with recombinant human growth hormone (rhGH) on children with idiopathic short stature (ISS).(2) To explore the effect of rhGH therapy and influential factors on ISS patients, who were grouped to prepuberty and puberty ones. Method50ISS children were treated with rhGH in the clinic of Jinshan Hospital Fudan University during July2010-December2011. They were divided into two groups:25cases in prepuberty group (Tanner I) and25cases in puberty group (Tanner II-IV) according to whether entering adolescence. They were treated with rhGH(0.15IU/kg·d) and the course of treatment was at least twelve months. Observation points: before treatment and after3m,6m,9m,12m. Measurements:height、weight、 growth velocity (GV)、height-standard deviation score (HtSDS)、predicted adult height(PAH)、bone age and serum insulin-like growth factor-1. Results (1) The growth efficacy of rhGH therapy in chidlren with ISS:In prepuberty group:the GV increased to (9.85±1.25) cm/y after12months rhGH therapy from (4.19±0.37) cm/y before therapy; the HtSDSCA increased to-1.32±0.25from-2.28±0.25. In puberty group:the GV increased to (7.96±2.08) cm/y after12months rhGH therapy from (3.38±0.87)cm/y before therapy;the HtSDSCA increased to-1.92±0.40from-2.35±0.30; the PAH increased to157.27±10.22cm from153.85±8.89cm. There were significant differences between before and after treatment in both groups (P<0.01).(2) After12months rhGH therapy,△GV and△HtSDSCA in prepuberty group were5.66±1.21cm/y and0.96±0.30respectively, while in puberty group were4.58±1.56cm/y and0.42±0.28respectively. There were significant differences between the two groups (P<0.01).(3) The growth was highest during0-3month treatment and△HtSDSCA was0.25±0.13.△HtSDSCA of3-6m、6-9m and9-12m were0.18±0.11、0.14±0.12and0.12±0.11, respectively. There was significant differences between0-3m and others (P<0.05).(4) After12months of rhGH therapy in the groups, AHtSDSCA、△GV were negatively related with the age and bone age at the beginning of treatment (P<0.01).△HtSDSCA、△GV were positively related with bone age delay and the basis of height and target height difference begin treatment (P<O.01).△ HtSDSCA in the first year was significantly related with AHtSDSCA of0-3m (r=0.82, P<0.01).(5) The levels of serum IGF-1elevated in both groups signigicantly0-3m after treatment and slowed down afterwards. There was no significant difference between each treatment period (P>0.05). In prepuberty group, there was a positive correlation between the levels of serum IGF-1after3months of therapy and the AGV after12months of therapy (r=0.58, P<0.05).(6) In the two groups, BMI was no significant change after the treatment and bone age was no significant progress. There was no significant side efect. Conclusion (1) The rhGH has growth promotion effect, but it does not induce evident adverse reaction.(2) RhGH therapy in prepuberty group was more effective than in puberty group. Thus, rhGH therapy should be started at an earlier age, at least before the puberty.(3) The efficacy after12months of rhGH therapy in the two groups was negatively related with the age and bone age at the beginning of treatment. It positively related with bone age delay and the basis of height and target height difference begin treatment. The therapeutic effect in the first3months may be a good predictor of one year therapeutic efficacy.(4) To ISS children in prepuberty with rhGH therapy, the levels of serum IGF-1may be the good indicators of assessing and predicting GH efficacy. To ISS children in puberty with rhGH therapy, the levels of serum IGF-1can not be the indicators of assessing and predicting GH efficacy.