BSPED2013 Poster Presentations (1) (89 abstracts)
How late is too late to treat with Growth Hormone? A case study
Elaine O’Mullane 1 , Susan O’Connell 3 , Edna Roche 2 & Hilary Hoey 2
1The National Children’s Hospital, Tallaght Hospital, Dublin 24, Ireland; 2University of Dublin, Trinity College, Dublin 2, Ireland; 3Cork University Hospital, Cork, Ireland.
Introduction: 13.1-year-old boy referred for growth hormone (GH) treatment with extreme short stature.
Background: Born premature at 28 weeks gestation, fraternal twin, birth weight: 1.06 kg (−0.58 SDS). Neonatal course complicated by respiratory distress syndrome, grade 2 Intraventricular haemorrhage, grade 2 Retinopathy and failure to thrive. Although not born small for gestational age, he was small at term (1.67 kg (−4.18 SDS)).
Initial assessment at 13.1 years: Height: 125.2 cm (−3.86 SDS), Weight: 21.8 kg (−4.56 SDS), Tanner stage G1 P1 A1 TV 2mls. Parental Adjusted Height: −3.75 SDS. Height velocity for 0.9 years pre-GH treatment: 4 cm/year.
Management: GH treatment with Norditropin Simplex initiated at 14yrs (Height: 128.9 cm (−4.41 SDS)). GH doses ranged from 0.03−0.067mg/kg/day, titrated according to IGF levels. Pubertal development noted at 15.1 years.
| Insulin tolerance test | Peak GH – 29.3 mU/l |
| Cortisol | 480 nmol/l (245–725) |
| 24 h GH profile | 4 peaks >20 mU/l |
| IGF-1 | 13.9 nmol/l (23–90) |
| IGF-BP3 | 1.6 mg/l (2.1–5.3) |
| Bone age | 11 years |
| Skeletal survey | No evidence of dysplasia |
| Dual-energy X-ray absorptiometry (DXA) | L1–L4 ‘Z’ score: −3.2 Total body ‘Z’ score: −3.1 Total body (%fat): 9.0 Android fat (%): 7.1, Gynoid fat (%): 19.2 |
| Height | 159.3 cm (SDS: −2.51) |
| Tanner stage | G5 P5 TV 25/25mls |
| Height velocity | 2.5 cm/year |
| Parental adjusted height SDS | −1.62 SDS |
| IGF-1 | 56.8 nmol/l (nmol/l) |
| IGF-BP3 | 6.77 mg/l (mg/l) |
| Bone age | 17 years |
| DXA | L1–L4 ‘Z’ score: −2.4 Total body ‘Z’ score: −3.0 Total body (%fat): 6.7 Android fat (%): 9.5 Gynoid fat (%): 11.4 |
Conclusions: GH therapy has improved this patient’s height with notable change in his android/gynoid fat distribution. Little is known about fat mass distribution in SGA children and adolescents during puberty. Gynoid fat mass has been positively associated with several cardiovascular risk factors and warrants further investigation.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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