Endocrine Abstracts

Background: Although the prognosis inGuillain-Barré syndrome (GBS) is generally good, the protracted and sometimes incomplete recovery is a heavy burden for patients. Animal studies suggest that treatment with growth hormone (GH) could stimulate myelin repair and thus accelerate functional recovery in acute polyneuropathy. We report on the first use of GH in GBS.

Objective: To monitor safety and tolerability as well as to evaluate the effect of off-label GH therapy during recovery from GBS in one patient.

Patient and methods: A 28-year old male with flaccid tetraparesis caused by pure motor GBS was treated with GH (1 mg/day) for 10 weeks. Muscle strength was measured regularly before, during and after the treatment (total time span 330 d). Strength gain was used as the main parameter of efficacy. A polynomial regression was calculated for strength measurements prior to treatment, and a second one for strength measurements during GH treatment. Using these functions, alterations in strength gain were examined. α was set to 0.05. Effect-sizes are given in R² and Glass’ Δ. Pearson cross-correlation was computed for IGF-1 and relative strength gains.

Results: No side effects of GH treatment were observed. Serum IGF-1 increased from 177 ng/ml at baseline (50^th percentile of age- and sex-adjusted reference interval) to a mean value of 342 ng/ml during GH treatment (>97.5^th percentile). Prior to GH administration, body mass (R²=0.85, P<0.01) and relative strength (R²=0.99, P<0.01) were significantly associated with time, representing the natural course of recovery. During GH treatment, the slope of strength gain was increased (R²=0.95, P=0.025). There were three significant alterations of strength gains: both inpatient stays at a neurorehabilitation facility and the GH application (Glass’ Δ_Rehab1=-1.50, P<0.01, Glass’ Δ_Rehab2=0.57, P<0.04, Glass’ Δ_GH=1.08, P<0.01). Alterations of strength gain correlated with IGF-1 serum levels (R²=0.36, P=0.09). Body mass gain was not increased during GH treatment.

Conclusion: In this single case, GH treatment seemingly led to an acceleration of strength recovery in GBS. Controlled studies should be discussed in order to establish GH as a therapeutic approach in GBS recovery.