Treatment of short statureM. Hashemipour MD

Pediatric EndocrinologistIsfahan University of Medical

Sciences

1

Treatment of short stature

Treatment of short stature

Short stature

Height velocity can be a sensitive indicator of disease

The height of an individual

Height of an individualDepends on Genetics Nutritional status Hormonal milieu various environmental factors

The indications for of GH treatment

Turner syndrome idiopathic short stature intrauterine growth retardation Prader-Willi syndrome Down syndrome Chondrodysplasia Chronic renal failure Height Deficit at Puberty

The indications for of GH Treatment

GH improves growth and clinical status in children with cystic fibrosis

 Bone Mass Development and Bone Metabolism in Juvenile Idiopathic Arthritis: Treatment with Growth Hormone for 4 Years

The indications for of GH Treatment

The indications for of GH Treatment X-linked hypophosphatemic rickets. AIDS wasting or cachexia Short-bowel syndrome

Goals of the Treatment

Achieve normal height during childhood

Attain normal adult height

The growth response

Maximal in the first year of treatment 200% of the pre-treatment velocity After several years, averages 150% of the

baseline

DURATION OF THERAPY

GH therapy should be continued at least until growth ceases

Many young adults who had GHD in childhood have normal GH

In contrast, children with multiple pituitary hormone deficiencies (usually organic) rarely recover the ability to secrete growth hormone as an adult.

Adverse reactions

hypertension hair loss exacerbation of psoriasis seizures Otitis media Glucosuria Rhinitis Flu-like syndrome

slipped capital epiphysis of femur Pseudo tumor cerebri Leukemia INS resistance Recurrence risk of CNS tumors Hypothyroidism Transient gynecomastia Scoliosis

Adverse reactions

Adverse reactions

carpal tunnel syndrome increase in the growth and pigmentation of

nevi, local lipoatrophy or lipodystrophy Swelling of hands and feet type 2 diabetes mellitus Acute pancreatitis Retinal changes

Adverse reactions

Mild transient edema Fever, malaise, dizziness hyperlipidemia vomiting, nausea, abdominal pain pain in hip, knee, and back, scoliosis,

myalgia Musculoskeletal pain, swelling, stiffness,

arthralgia

Idiopathic Short Stature

defined by height more than 2.25 standard deviations below the mean for age and sex

Height velocity<25th Diagnostic evaluation excludes causes of

short stature

Idiopathic Short Stature

Growth hormone therapy is approved by FDA Whether is due to correction of abnormality in

GH secretion or to the effect of pharmacologic doses of GH is not known

Multiple years of this therapy may add a few centimeters to adult height but it is difficult to predict which children will respond.

1.11 IU/kg weekly divided into daily doses

ISS& GH Therapy ISS& GH Therapy 

FDA in 2003FDA in 2003 Height <2.25 SD mean valueHeight <2.25 SD mean value Epiphyses are not closed Epiphyses are not closed Delayed BADelayed BA Impaired or attenuated pubertal growth spurt Impaired or attenuated pubertal growth spurt Expected adult height is less thanExpected adult height is less than 160 cm for boys 160 cm for boys 150 cm for girls150 cm for girls

2020