Endocrine Abstracts

Introduction: Many problems hinder the diagnostic and therapeutic approach of growth hormone deficiency (GHD) in developing countries. The lack of early diagnosis and adequate treatment have adverse consequences, especially the small final height with the resulting psychological impact. Our study examined 40 cases of GHD who received treatment by recombinant human Growth Hormone (rhGH).

Patients and methods: This is a retrospective longitudinal study of 40 cases of GHD collected in the pediatric department of Mahdia between 1994 and 2014.

Results: The mean chronologiacal age (CA) at the start of treatment was 9.91±0.55 years with an average processing times of 10.37±1.99 months. The mean duration of treatment for all patients was 3.3±0.3 years. At the time of this study, 60% of patients (group A) still received rhGH, 17.5% of patients (group B) defaulted from follow-up and 22.5% of patients (group C) completed their course of rhGH after an average treatment duration of 3.95±0.91 years. Among these patients (group C), four had a 15 year bone age, two had reached their mid-parental height (MPH), one patient had a growth height less than 2 cm/year, and one patient received treatment for only 12 months because of medical insurance problems. The final height (after treatment completion for group C and at the last check up for group B and A) was between −2 S.D. and the mean height in 54.2% of patients in group A, in 57.2% of patients in group B and in 66.7% of patients in group C. This corresponds to a height outcome of 0.95 S.D. ±0.14 in group A, 0.71 S.D. ±0.42 in group B and 1.33 S.D. ±0.23 in group C. Thirty-three point three percent of patients in group C were able to reach their MPH. There were a strong correlation between the height outcome and the mean duration of treatment, the CA at the start of treatment and the height at the start of treatment. This implies earli diagnosis, early treatment and a regular follow-up.

Conclusion: The initial approach to rhGH substitution focused on growth only and ended once adult height was reached. But monitoring children with GHD has revealed the need to define the factors that predict the persistence of this deficit in adulthood and the need to continue the treatment.