Rapid cardiovascular effects of growth hormone treatment in short prepubertal children: impact of treatment duration.
OBJECTIVE
Previous studies show that growth hormone (GH) treatment increases cardiac dimensions in short children with GH deficiency (GHD) and has diverse cardiac effects in children with idiopathic short stature (ISS). This study was performed to assess the effect of GH on the cardiovascular system in short children with a broad range of GH secretion and GH sensitivity/responsiveness.


METHODS
In this prospective, multicentre study, short prepubertal children diagnosed with isolated GHD (89) or ISS (38) were followed during 2 years of GH treatment. They were randomized to receive either a standard (43 μg/kg/day) or an individualized GH dose (range 17-100 μg/kg/day) based on GH responsiveness estimated by a prediction model and distance to target height. Echocardiography, blood pressure and electrocardiography were performed at baseline, 3, 12 and 24 months.


RESULTS
Left ventricular mass (LVM) indexed to body surface area increased significantly during 2 years of GH treatment in both GHD and ISS irrespective of randomized dose. This change was already apparent at 3 months, when standard deviation scores (SDS) of wall thickness and diameter were increased. At 24 months, left ventricular diameter SDS remained increased, whereas myocardial thickness SDS returned to baseline values. There was no impairment of systolic or diastolic function. There was no correlation with treatment dose and LVM SDS at 24 months.


CONCLUSIONS
Irrespective of GH status, there was a rapid increase in LVM during GH treatment in short children. At 3 months, wall thickness and diameter were increased, whereas only diameter remained increased at 24 months.
Department of Pediatrics, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. anders.nygren@vgregion.se
Anders
A
Nygren
Jan
J
Sunnegårdh
Dag
D
Teien
Anders
A
Jonzon
Gudrun
G
Björkhem
Sven
S
Lindell
Kerstin
K
Albertsson-Wikland
Berit
B
Kriström
D001794:Blood Pressure; D001827:Body Height; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000473:pathology; D002648:Child; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy*; D019382:Human Growth Hormone / Q000008:administration & dosage / Q000009:adverse effects* / Q000172:deficiency*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000139:chemically induced / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D013997:Time Factors
D019382:Human Growth Hormone