BSPED2009 Oral Communications Oral Communications 2 (2 abstracts)
Recombinant human GH improves linear growth in children with inflammatory bowel disease: results of a randomised controlled trial
S C Wong 1 , P Kumar 2 , D H Casson 3 , A M Dalzell 3 , J C Blair 2 , M Didi 3 , K Hassan 4 , P McGrogan 4 & S F Ahmed 1
1Bone and Endocrine Research Group, Royal Hospital for Sick Children Yorkhill, Glasgow, UK; 2Department of Endocrinology, Royal Liverpool Children’s Hospital Alder Hey, Liverpool, UK; 3Department of Gastroenterology, Royal Liverpool Children’s Hospital Alder Hey, Liverpool, UK; 4Department of Gastroenterology, Royal Hospital for Sick Children Yorkhill, Glasgow, UK.
Background: Despite optimal management, children with inflammatory bowel disease (IBD) may suffer from growth retardation. The role of rhGH in these children is unclear.
Design: Randomised controlled trial of rhGH (0.067 mg/kg per day) for 6 months.
Subjects: Twenty-two children with IBD and HtSDS<−2 or HtSDS<−1 and HVSDS<−1. Eleven were in the control group (C) and eleven in the treatment group (Rx).
Methods: HtSDS, HV, HVSDS were compared between in Rx and C at baseline (T0) and 6 months (T6). HVSDS was adjusted for Tanner stage (TS) for girls ≥11 years and boys ≥12 years. Glucose homeostasis was assessed by fasting glucose, insulin and HbAlc. All data are expressed as median (10th, 90th).
Results: CA at T0 was 14.7 years (9.3, 16.2) and 13.7 (9.1, 15.5); median CA-BA at T0 was 1.7 years (−0.3, 3.6) and 1.7 years (−0.7, 4.1) for Rx and C. Pubertal progress was noted in 5/11 and 3/11 of Rx and C. HtSDS at T0 was in Rx and C: −2.8 (−4.1, −1.5) and −1.8 (−2.7, −1.3), (P=0.001). Change in HtSDS at T6 in Rx and C was significantly different: 0.3 (0.1, 0.8) and −0.1 (−0.3, 0.3), P<0.0001. HV at T0 was similar in Rx and C: 5.0 cm/year (0.8, 8.8) and 3.8 cm/year (1.6, 6.5) and so was HVSDS: −3.1 (−6.0, 4.4) and −2.4 (−6.2, 1.8). HV at T6 in Rx and C was 10.8 cm/year (6.1, 14.3) and 3.5 cm/year (2.0, 9.3), P<0.0001. HVSDS at T6 in Rx and C was 3.2 (−0.4, 16.4) and −2.0 (−6.3, 4.9), P=0.0001. CRP, ESR, Alb, Hb and cumulative prednisolone dose were similar between the Rx and C at T0 and T6. ΔBA/ΔCA was similar in the two groups at T6. At T6, in Rx and C, fasting insulin, was 7.0 mU/l (2.1, 15.7) and 3.8 mU/l (2.1, 6.6), P=0.04 and HOMA index was 1.5 (0.3, 3.7) and 0.3 (0.2, 0.8), P=0.05. Fasting glucose and HbAlc, were similar in both groups at T6.
Conclusion: rhGH in children with IBD and growth retardation can increase HV by over 100% without excessive skeletal maturation. It may be associated with a reduction in insulin sensitivity but there is no overt abnormality of glucose tolerance.
Volume 23
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