Stimulation of collagen synthesis and linear growth by growth hormone in glucocorticoid-treated children.
Impaired linear growth and skeletal maturation associated with chronic glucocorticoid therapy may result from (1) inhibited insulin-like growth factor 1 (IGF-1) activity; (2) impaired type 1 collagen synthesis; or (3) suppressed growth hormone (GH) secretory response to growth hormone-releasing hormone. Each mechanism could potentially be improved by exogenous GH treatment. Seven slowly growing glucocorticoid-treated children received recombinant DNA human GH (0.3 mg/kg/per week) for 6 to 21 (mean 13.1 +/- 4.9) months. Height, weight, IGF-1 activity, glycosylated hemoglobin level, and C-terminal type 1 procollagen level were measured every 3 months and growth velocity was calculated. Skeletal maturation and 2-hour postprandial serum glucose and insulin levels were assessed every 6 months. All patients showed increased growth velocity during treatment with GH. Mean growth velocity increased from 3.43 +/- 0.65 cm/y to 6.72 +/- 0.84 cm/y with GH therapy (P less than .005). Growth velocity standard deviation scores corrected for bone age (P less than .005), IGF-1 levels (P less than .05), and C-terminal type 1 procollagen levels (P less than .005) also increased with GH therapy. C-terminal type 1 procollagen levels correlated well with growth velocity (r = .652) while IGF-1 levels did not (r = .17). Glycosylated hemoglobin levels remained unchanged, but 2-hour postprandial glucose levels rose during GH treatment. Slowly growing glucocorticoid-treated children receiving GH therapy increased growth velocity for 6 to 21 months. Initially diminished C-terminal type 1 procollagen levels rose with GH therapy, a change which corresponded with growth acceleration.(ABSTRACT TRUNCATED AT 250 WORDS)
Allen
D B
DB
Department of Pediatrics, University of Wisconsin-Madison School of Medicine.
Goldberg
B D
BD
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006130:Growth Disorders / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy*; D013006:Growth Hormone / Q000031:analogs & derivatives* / Q000097:blood* / Q000627:therapeutic use; D019382:Human Growth Hormone; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000097:blood*; D011347:Procollagen / Q000097:blood*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use
D001786:Blood Glucose; D005938:Glucocorticoids; D006442:Glycated Hemoglobin; D013006:Growth Hormone; D019382:Human Growth Hormone; D010446:Peptide Fragments; D011347:Procollagen; D011994:Recombinant Proteins; C042813:procollagen type I carboxy terminal peptide