Predictive clinical factors of stature gain in congenital growth hormone deficiency treated patients

Kacem Akid Faten Haj; Wafa Belabed; Abdel Mouhaymen Missaoui; Wajdi Safi; Mouna Elleuch; Fatma Mnif; Dhoha Ben Salah; Nabila Mejdoub; Mouna Mnif; Mohamed Abid

doi:10.1530/endoabs.90.EP735

Background and aim: The management of Congenital Growth hormone deficiency (CGHD) is based on hormonal substitution with recombinant GH. The stature prognosis may be affected by several clinical, genetic, and therapeutic factors. This study aims to assess the predictive clinical factors of stature gain in CGHD-treated patients.

Patients and Methods: We conducted a retrospective study (1991–2019) at the Endocrinology department of Hedi Chaker University Hospital, Sfax, Tunisia. We involved 87 patients diagnosed with CGHD, whose clinical, biochemical, and imaging peculiarities were collected from medical charts.

Results: The mean age at diagnosis was 14 years, with a male predominance (59%). The most frequent reason for consultation was short stature (75%). The median height was 131 cm. The bone age was behind the chronological age in all cases. The average bone age delay was 48 months. GH substitution was indicated in 60% of cases. The stature gain was significantly associated with the severity of the growth retardation, combined hypopituitarism, pituitary hypoplasia, and pituitary stalk abnormalities as shown in Table 1. The female gender was strongly predictive of reaching the target adult height (Table 2).

Table 1: Predictive clinical factors of stature gain in CGHD-treated patients
Studied factors	Mean stature gain (S.D.)	P-value
CGHD	Isolated	1.1±1	0.009
	Combined	1.8±1.4
CGHD	Total	1.4±1.3	0.773
	Partial	1.3±0.9
Abnormal MRI imaging	1.8±1.4	0.028
Pituitary Hypoplasia	1.9±1.4	0.015
Pituitary stalk interruption	2.1±1.2	0.019
Ectopic posterior pituitary	1.5±1.4	0.792

Table 2: Factors predicting the achievement of target height in CGHD-treated patients
Studied Factors	Target Height	P-value
	Achieved	Non achieved
Gender	M	N=3/9	N=29/39	0.044
	F	N=6/9	N=10/39
Age at diagnosis (years)	12.3±2.2	10±3.8	0.105
Age at treatment initiation (years)	13±2.8	11.3±3.4	0.184
Height at treatment initiation (cm)	132.7±9.4	124±17	0.203
Treatment duration (months)	30±12.3	48.4±29	0.114

Discussion: To optimize stature prognosis in CGHD patients, all studies have tried to find factors that predict good responders to GH treatment. Multivariate analysis in the KIGS study established a strong correlation between parental target height and growth rate in the first year of treatment and stature gain. According to the French registry, younger age at the initiation of treatment, delayed bone age, and severity of DGH were positive predictive factors for stature gain, which is in line with our results.

Endocrine Abstracts

EP735