title: Decreased GH dose after the catch-up growth period maintains metabolic outcome in short prepubertal children with and without classic GH deficiency.
abstract: OBJECTIVE
  Few studies have evaluated metabolic outcomes following growth hormone (GH) treatment in short prepubertal children during different periods of growth. Previously, we found that individualized GH dosing in the catch-up period reduced the variation in fasting insulin levels by 34% compared with those receiving a standard GH dose. We hypothesized that the GH dose required to maintain beneficial metabolic effects is lower during the prepubertal growth phase after an earlier catch-up growth period.
  
  
  METHODS
  Short prepubertal children with isolated GH deficiency or idiopathic short stature were randomized to individualized GH treatment (range, 17-100 μg/kg/day) or a standard dose in a preceding 2-year study. After achieving near mid-parental height(SDS) , children receiving an individualized dose were randomized to either a 50% reduced individualized dose (RID, n = 28) or an unchanged individualized dose (UID, n = 37) for 2 years. The dose remained unchanged in 33 children initially randomized to receive a standard dose (FIX, 43 μg/kg/day).We evaluated whether the variations in metabolic parameters measured during maintenance growth diminished in RID compared with UID or FIX.
  
  
  RESULTS
  We observed less variation in fasting insulin levels (-50%), insulin sensitivity as assessed by homoeostasis model assessment (-55·1%), lean soft tissue (-27·8%) and bone mineral content (-31·3%) in RID compared with UID (all P < 0·05), but no differences compared with FIX.
  
  
  CONCLUSIONS
  Continued reduced individualized GH treatment after the catch-up growth period is safe and reduces hyperinsulinism. Individualized GH dose can be reduced once the desired height(SDS)  is achieved to avoid overtreatment in terms of metabolic outcome.
authors.affiliation: Gothenburg Pediatric Growth Research Center (GP-GRC), Institute of Clinical Sciences, Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Gothenburg, Sweden. ralph.decker@vgregion.se
authors.forename: Ralph
authors.initials: R
authors.lastname: Decker
authors.forename: Kerstin
authors.initials: K
authors.lastname: Albertsson-Wikland
authors.forename: Berit
authors.initials: B
authors.lastname: Kriström
authors.forename: Maria
authors.initials: M
authors.lastname: Halldin
authors.forename: Jovanna
authors.initials: J
authors.lastname: Dahlgren
mesh_terms: D000293:Adolescent; D045930:Anabolic Agents / Q000008:administration & dosage; D001827:Body Height / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects; D002648:Child; D002657:Child Development / Q000187:drug effects; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D019382:Human Growth Hormone / Q000008:administration & dosage* / Q000172:deficiency*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008066:Lipolysis / Q000187:drug effects; D008297:Male; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage
chemical_list: D045930:Anabolic Agents; D007328:Insulin; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I