title: Analysis of craniofacial and extremity growth in patients with growth hormone deficiency during growth hormone therapy.
abstract: OBJECTIVE
  There are many controversies regarding side effects on craniofacial and extremity growth due to growth hormone (GH) treatment. Our aim was to estimate GH action on craniofacial development and extremity growth in GH-deficient patients.
  
  
  METHODS
  Twenty patients with GH deficiency with a chronological age ranging from 4.6 to 24.3 years (bone age from 1.5 to 13 years) were divided in 2 groups: group 1 (n = 6), naive to GH treatment, and group 2 (n = 14), ongoing GH treatment for 2-11 years. GH doses (0.1-0.15 U/kg/day) were adjusted to maintain insulin-like growth factor 1 and insulin-like growth factor binding protein 3 levels within the normal range. Anthropometric measurements, cephalometric analyses and facial photographs to verify profile and harmony were performed annually for at least 3 years.
  
  
  RESULTS
  Two patients with a disharmonious profile due to mandibular growth attained harmony, and none of them developed facial disharmony. Increased hand or foot size (>P97) was observed in 2 female patients and in 4 patients (1 female), respectively, both not correlated with GH treatment duration and increased levels of insulin-like growth factor 1.
  
  
  CONCLUSIONS
  GH treatment with standard doses in GH-deficient patients can improve the facial profile in retrognathic patients and does not lead to facial disharmony although extremity growth, mainly involving the feet, can occur.
authors.affiliation: Divisão de Odontologia do Instituto Central, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil. mejfaria@uol.com.br
authors.forename: Maria Estela Justamante
authors.initials: ME
authors.lastname: de Faria
authors.forename: Luciani R
authors.initials: LR
authors.lastname: Carvalho
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Rossetto
authors.forename: Terezinha Sampaio
authors.initials: TS
authors.lastname: Amaral
authors.forename: Karina
authors.initials: K
authors.lastname: Berger
authors.forename: Ivo Jorge Prado
authors.initials: IJ
authors.lastname: Arnhold
authors.forename: Berenice Bilharinho
authors.initials: BB
authors.lastname: Mendonca
mesh_terms: D000293:Adolescent; D000328:Adult; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000254:growth & development*; D005145:Face / Q000033:anatomy & histology; D005260:Female; D005528:Foot / Q000254:growth & development; D006130:Growth Disorders / Q000188:drug therapy*; D006225:Hand / Q000254:growth & development; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008445:Maxillofacial Development / Q000187:drug effects / Q000502:physiology; D008954:Models, Biological; D012886:Skull / Q000254:growth & development*; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone