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The Mathematical Model for Total Pubertal Growth in Idiopathic Growth Hormone (GH) Deficiency Suggests a Moderate Role of GH Dose

Pediatric Endocrinology Section, University Children’s Hospital (M.B.R., D.D.M.), Tubingen D-72076 Germany; Pfizer (A.L., B.B., P.W.), Stockholm, Sweden; Pediatric Growth Research Center, University of Gothenburg (K.A.-W.), Gothenburg, Sweden; Institute of Endocrinology and Diabetes, The Children’s Hospital (C.T.C.), Westmead, Australia; Department of Child Health, Royal Manchester Children’s Hospital (D.A.P.), Manchester, United Kingdom; and Tufts University of Medicine (E.O.R.), Springfield, Massachusetts 01199

Address all correspondence and requests for reprints to: Dr. Michael B. Ranke, Pediatric Endocrinology Section, University Children’s Hospital, Eberhard Karls University Hoppe-Seyler, Strasse 1, Hoppe Seyler Strasse 1, Tubingen D-72076, Germany. E-mail: michael.ranke{at}med.uni-tuebingen.de.

The role of GH treatment during total pubertal growth (TPG) is still unclear. We developed a prediction model for TPG (centimeters) through a multiple regression analysis of various prepubertal parameters in 303 adolescents with idiopathic GH deficiency from the KIGS database. Prepubertal catch-up growth and near-adult height were achieved, and GH dose was kept constant at approximately 30 µg/kg·d. The model was validated on a cohort of 36 patients from one center. Four TPG predictors explained 70% of the variability with an error SD of 4.2 cm: gender (TPG in males was >11.3 cm vs. that in females), age at onset of puberty (negative), height SD score minus midparental height SD score at puberty onset (negative), and mean GH dose during puberty (positive). Our analysis suggests that TPG in idiopathic GH deficiency is only moderately dependent on GH dose. The use of a higher GH dosage at the onset of puberty should thus depend on the individual’s height development. The TPG model aids in the planning of individually optimized and cost-effective GH treatment.

Abbreviations: GHD, GH deficient, GH deficiency; MPH, midparental height; TPG, total pubertal growth.

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