ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 S15.4

Consensus on GH Treatment in SGA

Peter Clayton

University of Manchester, Manchester, UK.

In 2006, the International Paediatric Endocrine Societies and the GH Research Society convened a meeting to consider the management of the SGA child through to adulthood. This included consideration of strategies for management of the short SGA child who has failed to show catch-up growth. The following statements relate to the outcomes of this meeting.

Short children born SGA form a heterogeneous group with various aetiologies and treatment should be preceded by an effort to identify the diagnosis. Early evaluation of short children born SGA is recommended, and those under 2 years of age with a current length below −2.5 SD should be referred for evaluation. Factors associated with the response to GH over the first 2–3 years include age and height SDS at start of treatment, mid-parental height and dose. Average height gains after 3 years of GH treatment range from 1.2 to 2.0 S.D. for doses of 35 to 70 μg/kg per day. After the initial catch-up, most of this height gain is maintained up to adult height. The discrepancies between the official indications by the FDA in 2001 (age at start 2 years, no height cut-off stipulated, GH dose 70 μg/kg per d) and the EMEA in 2003 (age at start 4 years, height SDS <−2.5, GH dose 35 μg/kg per d) were recognised. It was proposed that SGA children aged between 2 and 4 years who show no evidence of catch-up with a height <−2.5 S.D. should be eligible for GH treatment. With regard to GH dose, it was proposed that the starting dose should cover the range 35 to 70 μg/kg per day with the higher doses used in those with the most marked growth retardation. In the majority of SGA children treated with GH, pubertal timing will be normal, and inhibition of puberty with GnRH analogue treatment is not routinely recommended. There should be a positive response to GH treatment (height velocity SDs >+0.5 in the first year of treatment). If not, re-evaluation is indicated, including consideration of compliance, GH dose, diagnosis and the decision to discontinue treatment. Treatment emergent adverse events are not more common in SGA than in other conditions treated with GH. It is currently unknown whether GH therapy for the SGA subject through childhood and adolescence is associated with benefits or amplification of risks (such as metabolic consequences) in adult life.

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