Near normalization of adult height and body proportions by growth hormone in pycnodysostosis.
BACKGROUND
Mutations in the cathepsin K gene (CTSK) cause a very rare form of short-limb dwarfism called pyknodysostosis (online inheritance in man 265800) that reduces adult height to 130-150 cm.


OBJECTIVE
To study the effects of GH in children with pyknodysostosis.


METHODS
This was a pilot open study of three children with pyknodysostosis (P1, P2, P3) and 16 age-matched children with idiopathic short stature (ISS) treated with a similar IGF-I-based dosing of GH therapy. P1, P2, and P3 received a mean GH dose of 29, 67, and 120 microg/kg x d, respectively, during 12, 6.5, and 5 yr, whereas the ISS group received a mean dose of 62 +/- 21 microg/kg x d during 5.4 +/- 2 yr.


RESULTS
P1, P2, and P3 had the typical clinical and radiological features of pyknodysostosis. They were shown to carry three different homozygous missense mutations of the CTSK gene. After onset of GH at 4.5, 5.4, and 10.9 yr of age, respectively, height increased from -2, -4.2, and -3 SD score to -1, -0.5, and -1 SD score after a 12, 6.5, and 5 yr GH treatment. Remarkably, body disproportion was largely corrected by GH treatment. IGF-I levels in P1, P2, and P3 were within the range of the ISS group.


CONCLUSIONS
Pyknodysostotic patients can reach near-normal stature and skeletal proportions with a personalized GH treatment targeted at appropriate IGF-I levels. Given the severity of this rare dwarfism, we propose that GH should be offered to affected children.
Rothenbühler
Anya
A
Department of Pediatric Endocrinology, Hôpital Saint Vincent de Paul, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Descartes, 75014 Paris, France.
Piquard
Catherine
C
Gueorguieva
Iva
I
Lahlou
Najiba
N
Linglart
Agnès
A
Bougnères
Pierre
P
D000293:Adolescent; D001827:Body Height / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects / Q000502:physiology; D056657:Cathepsin K / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D004247:DNA / Q000235:genetics; D004413:Dysostoses / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D005260:Female; D006128:Growth / Q000187:drug effects / Q000502:physiology*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000378:metabolism; D008297:Male; D020125:Mutation, Missense; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome
D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D004247:DNA; D056657:Cathepsin K