Growth hormone treatment in children with rheumatic disease, corticosteroid induced growth retardation, and osteopenia.
BACKGROUND
In children with severe rheumatic disease (RD), treatment with corticosteroids (CS) is frequently needed and growth retardation and osteopenia may develop. A beneficial effect of human growth hormone (hGH) has been reported but mostly in trials without a control group.


OBJECTIVE
To study the effect of hGH on growth, bone mineral density (BMD), and body composition, taking the disease activity and CS use into account.


METHODS
Randomised controlled trial on 17 prepubertal RD patients with growth retardation and/or decreased BMD. The hGH group (n = 10) received treatment with hGH 4 IU/m2/day (approximately 0.045 mg/kg/day) during two years. The controls (n = 7) received no GH treatment.


RESULTS
During the two year study period the disease activity, and use of CS and methotrexate (MTX) did not differ between the groups. There was a significant mean increase in height standard deviation score (HSDS) in the hGH group (0.42+/-0.16 SDS) and a non-significant decrease in the controls (-0.18+/-0.11 SDS). Change in BMD did not differ significantly between the groups, although the increase in BMD for lumbar spine within the hGH group was significant. Lean body mass improved significantly in the hGH group compared to controls (0.64+/-0.19 SDS versus -0.20+/-0.17 SDS), while the decrease in percentage fat was not significant.


CONCLUSIONS
There was a significant effect of hGH on growth and lean body mass, but a longer duration of treatment might be necessary to evaluate the effect of hGH on BMD.
Grote
F K
FK
Dept of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands. f.k.grote@lumc.nl
Van Suijlekom-Smit
L W A
LW
Mul
D
D
Hop
W C J
WC
Ten Cate
R
R
Oostdijk
W
W
Van Luijk
W
W
Jansen-van Wijngaarden
C J A
CJ
De Muinck Keizer-Schrama
S M P F
SM
D000293:Adolescent; D000886:Anthropometry; D001823:Body Composition / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects; D001851:Bone Diseases, Metabolic / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006130:Growth Disorders / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012216:Rheumatic Diseases / Q000188:drug therapy*; D012720:Severity of Illness Index
D005938:Glucocorticoids; D019382:Human Growth Hormone; D011241:Prednisone