Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2012) 28 P250

SFEBES2012 Poster Presentations Pituitary (43 abstracts)

Factors affecting growth hormone (GH) replacement during transition in patients with childhood-onset GH deficiency

Ajay Thankamony 1 , Donatella Capalbo 1 , Williams Rachel 1 , James Heywood 1 , Ken Ong 1, , David Dunger 1 & Helen Simpson 3


1Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom; 2Institute of Metabolic Science, MRC Epidemiology Unit, Cambridge, United Kingdom; 3Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Cambridge University Hospitals Foundation Trust, Cambridge, United Kingdom.


Background: GH therapy during the transition period is important for somatic maturation. Identification of factors associated with low IGF-I levels may be useful in optimising GH replacement therapy.

Objectives: To explore the prevalence and determinants of insufficient GH replacement during transition

Methods: Childhood-onset GH deficient (CO-GHD) patients (n=65) who stopped therapy, and were started on adult GH dose during transition (age < 26 yrs) were identified from KIMS (Pfizer International Metabolic Study) database in UK. The IGF-I levels while off therapy (IGF-I-Baseline), first available levels during therapy (IGF-I-Response), and after 6 months of starting GH (IGF-I titrated) were used for analysis. IGF-I standard deviation scores (SDS) were calculated using age and gender-specific normative data.

Results: The mean (± SD) ‘IGF-I-titrated’ SDS (+ 0.22 ± 0.15) was similar to population means (P=0.30). However, insufficient (IGF-I SDS <−2) and suboptimal (IGF-I SDS −2 to 0) levels were observed in 10.5% and 31.6% of patients respectively. Higher GH doses were associated with female gender (P=0.046) (Table) and oestrogen therapy (0.54 ± 0.22 mg vs 0.36 ± 0.11 mg, P=0.022). ‘IGF-I-Response’ SDS was closely associated with ‘IGF-I-Baseline’ SDS (r=0.75, P<0.0001) independent of the GH dose (r=0.34, P=0.006). Lower ‘IGF-I-Baseline’ SDS was related to female gender (−3.53 ± 1.85 vs −2.34 ± 1.67, P=0.010) and oestrogen therapy (−4.12 ± 1.99 vs −2.42 ± 1.43, P=0.025). Younger age was related to lower increments of IGF-I SDS during GH treatment(r=0.27, P=0.041).

Conclusions: Suboptimal IGF-I levels suggests that a proportion CO-GHD patients may be receiving insufficient GH replacement during transition. Lower IGF-I SDS while off therapy, female gender, oestrogen therapy, and younger age adversely affect IGF-I levels during GH therapy. Further studies are required to establish the optimal levels of GH replacement during transition.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: Declaration of Funding: This work was supported by an Independent Investigator Research grant from UK KIGS KIMS board (Pfizer).

Means(SD)/Medians(range)

*P males&females

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