Post on 30-Dec-2015
Treatment of short statureM. Hashemipour MD
Pediatric EndocrinologistIsfahan University of Medical
Sciences
1
The height of an individual
Height of an individualDepends on Genetics Nutritional status Hormonal milieu various environmental factors
The indications for of GH treatment
Turner syndrome idiopathic short stature intrauterine growth retardation Prader-Willi syndrome Down syndrome Chondrodysplasia Chronic renal failure Height Deficit at Puberty
The indications for of GH Treatment
GH improves growth and clinical status in children with cystic fibrosis
Bone Mass Development and Bone Metabolism in Juvenile Idiopathic Arthritis: Treatment with Growth Hormone for 4 Years
The indications for of GH Treatment
The indications for of GH Treatment X-linked hypophosphatemic rickets. AIDS wasting or cachexia Short-bowel syndrome
The growth response
Maximal in the first year of treatment 200% of the pre-treatment velocity After several years, averages 150% of the
baseline
DURATION OF THERAPY
GH therapy should be continued at least until growth ceases
Many young adults who had GHD in childhood have normal GH
In contrast, children with multiple pituitary hormone deficiencies (usually organic) rarely recover the ability to secrete growth hormone as an adult.
Adverse reactions
hypertension hair loss exacerbation of psoriasis seizures Otitis media Glucosuria Rhinitis Flu-like syndrome
slipped capital epiphysis of femur Pseudo tumor cerebri Leukemia INS resistance Recurrence risk of CNS tumors Hypothyroidism Transient gynecomastia Scoliosis
Adverse reactions
Adverse reactions
carpal tunnel syndrome increase in the growth and pigmentation of
nevi, local lipoatrophy or lipodystrophy Swelling of hands and feet type 2 diabetes mellitus Acute pancreatitis Retinal changes
Adverse reactions
Mild transient edema Fever, malaise, dizziness hyperlipidemia vomiting, nausea, abdominal pain pain in hip, knee, and back, scoliosis,
myalgia Musculoskeletal pain, swelling, stiffness,
arthralgia
Idiopathic Short Stature
defined by height more than 2.25 standard deviations below the mean for age and sex
Height velocity<25th Diagnostic evaluation excludes causes of
short stature
Idiopathic Short Stature
Growth hormone therapy is approved by FDA Whether is due to correction of abnormality in
GH secretion or to the effect of pharmacologic doses of GH is not known
Multiple years of this therapy may add a few centimeters to adult height but it is difficult to predict which children will respond.
1.11 IU/kg weekly divided into daily doses
ISS& GH Therapy ISS& GH Therapy
FDA in 2003FDA in 2003 Height <2.25 SD mean valueHeight <2.25 SD mean value Epiphyses are not closed Epiphyses are not closed Delayed BADelayed BA Impaired or attenuated pubertal growth spurt Impaired or attenuated pubertal growth spurt Expected adult height is less thanExpected adult height is less than 160 cm for boys 160 cm for boys 150 cm for girls150 cm for girls