Growth response to growth hormone therapy following cranial irradiation |
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Authors: | P E Clayton S M Shalet D A Price |
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Institution: | (1) Department of Child Health, Royal Manchester Children's Hospital, Pendelbury, M27 1HA Manchester, UK;(2) Department of Endocrinology, Christie Hospital, Wilmslow Road, M20 9BX Manchester, UK |
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Abstract: | The growth response to growth hormone (GH) therapy has been studied in 12 children who received irradiation to the cranium alone either for brain gliomas, distant from the hypothalamic-pituitary axis, or as prophylaxis against CNS leukaemia. Seven children have completed GH treatment (mean duration 4 years) and five are presently on GH (mean duration 1.2 years). This response has been compared to that seen in 14 children with isolated idiopathic GH deficiency (IGHD), following GH therapy. Before treatment, the cranially irradiated patients (C-PRGHD) had higher standard deviation scores (SDS) for standing height, sitting height and leg length, and less bone age (BA) retardation, but started treatment at a similar age, and with a similar pre-treatment growth velocity and GH peak to standard provocative tests, compared to IGHD patients. GH produced a significant and similar increase in growth velocity (cm/year and SDS for BA) over the first 2 years' treatment in both groups. However C-PRGHD patients entered puberty and thus completed growth earlier than the IGHD group. As a result, cranially-irradiated children showed no change in height SDS with GH therapy, compared to catch-up growth in IGHD. Nevertheless, GH has enabled C-PRGHD patients to maintain their centile position and to achieve a more acceptable final height.Abbreviations GH
growth hormone
- IGHD
idiopathic growth hormone deficiency
- C-PRGHD
post cranial-irradiation growth hormone deficiency
- SDS
standard deviation score
- BA
bone age
- ALL
acute lymphatic leukaemia
- TSH
thyroid stimulating hormone
- CA
chronological age
- HA
height age |
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Keywords: | Growth hormone Brain tumours ALL Cranial irradiation |
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