Growth Hormone Treatment for Growth Failure in Pediatric Patients with Crohn's Disease

Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0136, USA.
The Journal of pediatrics (Impact Factor: 3.79). 06/2008; 153(5):651-8, 658.e1-3. DOI: 10.1016/j.jpeds.2008.04.064
Source: PubMed


To investigate the effect of human growth hormone (GH) injections on growth velocity in growth-impaired children with Crohn's disease (CD).
Ten children and adolescents (mean age, 12.6 +/- 4.5 years; 6 males) with CD and poor height growth were treated with open-label recombinant GH, 0.043 mg/kg/day administered via subcutaneous injection, for 1 year. Patients were retrospectively matched with untreated patients (3 comparisons per case) by race, age, sex, and baseline height. Primary endpoint was height velocity; secondary endpoints were disease activity, body composition, and bone density determined by dual-energy x-ray absorptiometry scan.
Mean height velocity increased by 5.33 +/- 3.40 (mean +/- standard deviation) cm/year in the GH-treated patients during the year of GH treatment, compared with 0.96 +/- 3.52 cm/year in the comparison group (P = .03). Height z-score increased by 0.76 +/- 0.38 in the treated group, compared with 0.16 +/- 0.40 in the comparison group (P < .01), and weight z-score increased by 0.81 +/- 0.89 in the treated group, compared with 0.00 +/- 0.57 in the comparison group (P < .01). Bone density revealed an increase of 0.31 +/- 0.33 in the lumbar spine z-score (P = .03 vs baseline).
GH treatment increases height velocity and may enhance bone mineralization in children with CD. A randomized controlled trial in a large cohort of children is needed to evaluate the ultimate impact of GH treatment.

Download full-text


Available from: Benjamin D Gold, Apr 20, 2015
30 Reads
  • Source
    • "In a relatively small study in children with CD, 6-mercaptopurine (6-MP) (whose parent drug is azathioprine) was effective and reduced the need for steroids but had no effect on growth after 18 months compared with conventional prednisone treatment [59]. Growth hormone therapy should be considered in children with severe growth failure when other measures fail, as it has been shown to increase height velocity, improve BMD [60] and induce anabolic effects even in GC-dependent children with CD [61]. If GH is to be used, it is generally more effective when administered in the early rather than in the late puberty [44]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Extraintestinal manifestations from nearly every organ system are common in inflammatory bowel disease (IBD). This review article describes the epidemiology, pathogenesis, diagnosis and management of the main endocrine and metabolic manifestations in IBD, including metabolic bone disease, growth retardation, hypogonadism, pubertal delay, lipid abnormalities and insulin resistance. These clinical problems are commonly interrelated and they share a common basis, influenced by disease-related inflammation and nutritional status. In addition to nutritional support, every effort should be made to achieve and maintain disease remission, thus correcting the underlying chronic inflammation. The criteria for screening and diagnosing osteoporosis are described and treatment options are discussed (lifestyle advice, vitamin D and calcium supplementation, use of bisphosphonates or other specific antiosteoporotic agents, correction of hypogonadism). Chronic glucocorticoid therapy may affect growth as well as predispose to osteoporosis. The diagnosis and management of growth failure, pubertal delay and hypogonadism in IBD are discussed.
    Annals of Gastroenterology 03/2012; 25(1):37-44.
  • Source
    • "None of the reports of ghrelin administration in colitis have included levels of growth hormone or IGF-1, though studies of GHS-1a agonist treatment in cachexia have reported increased levels of IGF-1 [70]. Use of growth hormone as a treatment for IBD has resulted in increased linear growth [46] but not an improvement in disease activity [71], suggesting that this is not a primary mechanism by which ghrelin improves colitis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Inflammatory bowel diseases (IBD)-and in particular Crohn's disease-are immune-mediated processes that result in denuded intestinal mucosa and can produce decreased appetite, weight loss, and systemic inflammation. Current treatments include anti-inflammatory medications, immunomodulators, and feeding interventions. Ghrelin is an endogenous orexigenic hormone that directly stimulates growth hormone release, increases gut motility, and has cardiovascular and anti-inflammatory properties. Although ghrelin levels are elevated in active IBD, administration of ghrelin in most (but not all) animal models of colitis has produced improvements in disease activity and systemic inflammation. The mechanism for these effects is not known but may relate to decreased inflammation, increased motility, increased appetite, and increased colonic blood flow. Human trials have not been performed, however, and more research is clearly needed.
    International Journal of Peptides 08/2011; 2011(1687-9767):189242. DOI:10.1155/2011/189242
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Underweight and specific nutrient deficiencies are frequent in adult patients with inflammatory bowel disease (IBD). In addition, a significant number of children with IBD, especially Crohn's disease (CD) have impaired linear growth. Nutrition has an important role in the management of IBD. In adults with CD, enteral nutrition (EN) is effective in inducing clinical remission of IBD, although it is less efficient than corticosteroids. Exclusive EN is an established primary therapy for pediatric CD. Limited data suggests that EN is as efficient as corticosteroids for induction of remission. Additional advantages of nutritional therapy are control of inflammation, mucosal healing, positive benefits to growth and overall nutritional status with minimal adverse effects. The available evidence suggests that supplementary EN may be effective also for maintenance of remission in CD. More studies are needed to confirm these findings. However, EN supplementation could be considered as an alternative or as an adjunct to maintenance drug therapy in CD. EN does not have a primary therapeutic role in ulcerative colitis. Specific compositions of enteral diets-elemental diets or diets containing specific components-were not shown to have any advantage over standard polymeric diets and their place in the treatment of CD or UC need further evaluation. Recent theories suggest that diet may be implicated in the etiology of IBD, however there are no proven dietary approaches to reduce the risk of developing IBD.
    World Journal of Gastroenterology 07/2009; 15(21):2570-8. · 2.37 Impact Factor
Show more