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Submitted on July 26, 2005
Accepted on January 30, 2006
Department of Pediatrics, Division of Endocrinology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands, Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands, Juliana Children's Hospital, The Hague, The Netherlands, Rijnstate Hospital, Arnhem, The Netherlands, University Medical Center, St Radboud, Nijmegen, The Netherlands, Beatrix Children's Hospital, Groningen, The Netherlands, Canisius-Wilhelmina Hospital, Nijmegen The Netherlands, Free University Medical Center, Amsterdam, The Netherlands, Catharina Hospital, Eindhoven, The Netherlands, University Medical Center, Leiden, The Netherlands
* To whom correspondence should be addressed. E-mail: m.vandijk.1{at}erasmusmc.nl.
Context. Epidemiological studies have indicated that high serum levels of GH and IGF-I are associated with long term risks.
Objective. To evaluate the changes in serum levels of GH during overnight profiles, IGF-I and IGFBP-3 in short SGA children during GH treatment with two doses.
Patients. Thirty-six prepubertal short SGA children.
Intervention. Subjects received 1 (group A) or 2 mg (group B) GH /m2·day
Main Outcome Measures. At baseline and after 6 months of GH treatment, overnight GH profiles were performed and serum IGF-I and IGFBP-3 levels were measured.
Results. After 6 months, group B had significantly higher GH levels during the profile (mean, maximum and AUC0) than group A (p< 0.009). In group B maximum GH levels increased from in 43.9 to 161 mU/L (P < 0.0002) and in group A from 57.2 to 104 mU/L (P = 0.002). During the profile (i.e. 12 h per day), children of group B had mean GH levels of 64.4 vs. 34.8 mU/L in group A (p=0.001). The IGF-I and IGF-I/IGFBP-3 ratio SDS increased significantly in both groups, but were higher in group B than A (1.5 vs. 0.2 (p= 0.002) and 1.4 vs. 0.3 (P = 0.007), respectively). In group B, 74% of the children had IGF-I levels in the highest quintile during GH treatment compared with 19% in group A.
Conclusion: Our study shows that high-dose GH treatment in short SGA children results in high serum GH and IGF-I levels in most children. We recommend monitoring IGF-I levels during GH therapy to ensure these remain within the normal range.
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