title: Reduced levels of growth hormone, insulin-like growth factor-I and binding protein-3 in patients with shunted hydrocephalus.
abstract: OBJECTIVE
  Children with hydrocephalus are characterised by slow linear growth in prepuberty, accelerated physical maturation during puberty, and reduced final height. We aimed to study the possible roles of growth hormone, insulin-like growth factor-I (IGF-I), and IGF binding protein-3 (IGFBP-3) in this growth pattern.
  
  
  METHODS
  One hundred and fourteen patients with shunted hydrocephalus (62 males) aged 5 to 20 years, of whom 17 had spina bifida (six males), and 73 healthy controls (38 males) were studied. Anthropometric measures, body mass index, and body fat mass were assessed and the stage of puberty was determined. Serum growth hormone and plasma IGF-I and IGFBP-3 concentrations were measured.
  
  
  RESULTS
  The patients comprised 44 (26 males) who were prepubertal and 70 (36 males) pubertal or postpubertal, while 32 of the controls (19 males) were prepubertal and 41 (19 males) pubertal or postpubertal. The prepubertal children with hydrocephalus had lower IGF-I (p = 0.002) and IGFBP-3 concentrations (p < 0.001) than the controls, and the pubertal children had four times lower basal growth hormone concentrations (p < 0.001). There was a correlation between height SD score and IGF-I levels in the total patient population (r = 0.23; p = 0.01). Peripheral IGF-I concentrations peaked at pubertal stages 2-3 in the female patients and at stage 4 in the controls. The prepubertal patients on antiepileptic treatment, carbamazepine in most cases (73%), had higher IGF-I (p = 0.01) and IGFBP-3 concentrations (p = 0.03) than those who had never been treated with antiepileptic drugs, but still lower IGFBP-3 levels than the controls (p = 0.01).
  
  
  CONCLUSIONS
  Based on these findings, it can be concluded that reduced growth hormone secretion may contribute to the pattern of slow linear growth and reduced final height observed in these patients.
authors.affiliation: Department of Paediatrics, University of Oulu, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Löppönen
authors.forename: A L
authors.initials: AL
authors.lastname: Saukkonen
authors.forename: W
authors.initials: W
authors.lastname: Serlo
authors.forename: P
authors.initials: P
authors.lastname: Tapanainen
authors.forename: A
authors.initials: A
authors.lastname: Ruokonen
authors.forename: M
authors.initials: M
authors.lastname: Knip
mesh_terms: D000293:Adolescent; D000328:Adult; D001827:Body Height; D016022:Case-Control Studies; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000097:blood*; D013006:Growth Hormone / Q000097:blood*; D006801:Humans; D006849:Hydrocephalus / Q000097:blood* / Q000628:therapy; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D008297:Male; D011627:Puberty / Q000097:blood; D016135:Spinal Dysraphism / Q000097:blood
chemical_list: D018972:Insulin-Like Growth Factor Binding Protein 3; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone