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.

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    • "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]. "
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