Long-term GH Therapy Does Not Advance Skeletal Maturation in Children and Adolescents

Overview

Journal J Endocr Soc

Specialty Endocrinology

Date 2021 Apr 16

PMID 33860132

Citations 1

Authors

Benjamin Udoka Nwosu

Gabrielle Jasmin

Sadichchha Parajuli

Alan D Rogol

Ellen Christine Wallace

Austin F Lee

Affiliations

Soon will be listed here.

Abstract

Context: There is no consensus on the effect of recombinant human GH (rhGH) therapy on skeletal maturation in children despite the current practice of annual monitoring of skeletal maturation with bone age in children on rhGH therapy.

Aims: To investigate the effects of long-term rhGH therapy on skeletal age in children and explore the accuracy of bone age-predicted adult height (BAPAH) at different ages based on 13 years of longitudinal data.

Methods: A retrospective longitudinal study of 71 subjects aged 2 to 16 years, mean 9.9 ± 3.8 years, treated with rhGH for nonsyndromic short stature for a duration of 2 to 14 years, mean, 5.5 ± 2.6 years. Subjects with syndromic short stature and systemic illnesses such as renal failure were excluded.

Results: Bone age minus chronological age (BA-CA) did not differ significantly between baseline and the end of rhGH therapy (-1.05 ± 1.42 vs -0.69 ± 1.63, = 0.09). Piecewise regression, however, showed a quantifiable catch-up phenomenon in BA of 1.5 months per year of rhGH therapy in the first 6.5 years ( = 0.017) that plateaued thereafter ( = 0.88). BAPAH overestimated near-adult height in younger subjects but became more accurate in older subjects ( < 0.0001). IGF-I levels correlated significantly with increases in child's height and BA-CA.

Conclusion: Long-term rhGH therapy demonstrated an initial catch-up phenomenon in skeletal maturation in the first 6.5 years that plateaued thereafter with no overall significant advancement in bone age. These findings are reassuring and support strategic, but not the insurance company mandated reflexive annual monitoring of skeletal maturation with bone age in children receiving rhGH therapy.

Citing Articles

Clinical and laboratory characteristics but not response to treatment can distinguish children with definite growth hormone deficiency from short stature unresponsive to stimulation tests.

Lanzetta M, Dalla Bona E, Tamaro G, Vidonis V, Vittori G, Faleschini E Front Endocrinol (Lausanne). 2024; 15:1288497.

PMID: 38495788 PMC: 10940512. DOI: 10.3389/fendo.2024.1288497.

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