| 1. |
- Ankarberg-Lindgren, Carina, 1963, et al.
(författare)
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Nocturnal application of transdermal estradiol patches produces levels of estradiol that mimic those seen at the onset of spontaneous puberty in girls.
- 2001
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Ingår i: The Journal of clinical endocrinology and metabolism. - 0021-972X .- 1945-7197. ; 86:7, s. 3039-44
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Tidskriftsartikel (refereegranskat)abstract
- The objective of pubertal induction in children with hypogonadism is to mimic spontaneous puberty in terms of physical and psychological development. In a clinical observation study, we induced puberty in 15 girls with hyper- or hypogonadotropic hypogonadism using low doses of transdermal estradiol patches attached only during the night and compared the estradiol concentrations obtained with those in healthy girls. Pubertal induction was started between the ages of 12.3 and 18.1 yr. A transdermal matrix patch of 17beta-estradiol (25 microg/24 h; Evorel, Janssen Pharmaceuticals-Cilag) was cut into pieces corresponding to 3.1, 4.2, or 6.2 microg/24 h initially and attached to the buttock. After 4-14 months, the dose was increased gradually. Serum 17beta-estradiol concentrations were measured every 2 h by RIA (detection limit, 6.0 pmol/L; 1.6 pg/mL). The results show that it is possible to mimic the spontaneous levels as well as the diurnal pattern of serum 17beta-estradiol in early puberty, by cutting a transdermal 17beta-estradiol matrix patch and attaching a part of it, corresponding to 0.08-0.12 microg estradiol/kg BW, to the buttock nocturnally. In most of the girls, breast development occurred within 3-6 months of the start of treatment.
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| 2. |
- Chaplin, John, 1955, et al.
(författare)
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When Do Short Children Realize They Are Short? : Prepubertal Short Children's Perception of Height during 24 Months of Catch-Up Growth Hormone Treatment
- 2012
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Ingår i: Hormone Research in Paediatrics. - : S. Karger AG. - 1663-2818 .- 1663-2826. ; 77:4, s. 241-249
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To examine perceived height during the first 24 months of growth hormone (GH) treatment in short prepubertal children. Methods: Ninety-nine 3- to 11-year-old short prepubertal children with either isolated GH deficiency (n = 32) or idiopathic short stature (n = 67) participated in a 24-month randomized trial of individualized or fixed-dose GH treatment. Children's and parents' responses to three perceived height measures: relative height (Silhouette Apperception Test), sense of height (VAS short/tall), and judgment of appropriate height (yes/no) were compared to measured height. Results: Children and parents overestimated height at start (72%, 54%) and at 24 months (52%, 30%). Short children described themselves as tall until 8.2 years (girls) and 9 years (boys). Prior to treatment, 38% of children described their height as appropriate and at 3 months, 63%. Mother's height, parental sense of the child's tallness and age explained more variance in children's sense of tallness (34%) than measured height (0%). Conclusion: Short children and parents overestimate height; a pivotal age exists for comparative height judgments. Even a small gain in height may be enough for the child to feel an appropriate age-related height has been reached and to no longer feel short.
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| 3. |
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| 4. |
- Decker, Ralph, 1968, et al.
(författare)
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Decreased GH dose after the catch-up growth period maintains metabolic outcome in short prepubertal children with and without classic GH deficiency
- 2012
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Ingår i: Clinical endocrinology. - : Wiley. - 0300-0664 .- 1365-2265. ; 77:3, s. 407-15
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Tidskriftsartikel (refereegranskat)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. DESIGN: Short prepubertal children with isolated GH deficiency or idiopathic short stature were randomized to individualized GH treatment (range, 17-100 mug/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 mug/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 homeostasis 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 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.
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| 5. |
- Decker, Ralph, 1968, et al.
(författare)
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GH dose reduction maintains normal prepubertal height velocity after initial catch up growth in short children.
- 2019
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Ingår i: The Journal of clinical endocrinology and metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 104:3, s. 835-844
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Tidskriftsartikel (refereegranskat)abstract
- GH responsiveness guides GH dosing during the catch-up growth (CUG) period; however, little is known regarding GH dosing during the prepubertal maintenance treatment period.To evaluate if standard deviation score (SDS) channel parallel growth with normal height velocity can be maintained following CUG by reducing GH dose by 50% in children receiving doses individualized based on estimated GH-responsiveness during the catch-up period.and settings: Prepubertal children (n=98; 72 boys) receiving GH during CUG (GH-deficient (n=33); non-GH-deficient (n=65)), were randomized after 2-3 years to either a 50% reduced individualized (GHRID; n=27; 20 boys) or unchanged individualized dose (GHUID; n=38; 27 boys). Another 33 children (25 boys) continued on a standard weight-based dose, 43 µg/kg/day (GHFIX).The primary endpoint was the proportion of children with ΔheightSDS within ±0.3 at 1 year after GH-dose reduction, versus two control groups: GHUID and GHFIX. The hypothesis was that heightSDS could be maintained within ±0.3 with a reduced individualized GH dose.For the intention-to-treat population at 1 year, 85% of the GHRIDgroup maintained ΔheightSDS within ±0.3 versus 41% in the GHUIDgroup, p=0.0055 and 48% in the GHFIXgroup, p=0.0047. ΔIGF-ISDS in the GHRIDgroup was (mean±SD) -0.75±1.0 at 3 months, p=0.003 and at 1 year -0.72±1.2, compared to the GHUIDgroup 0.15±1.2, p=0.005, and for the GHFIXgroup 0.05±1.0, p=0.02.Channel parallel growth, i.e. normal height velocity, and IGFSDS levels within ±2 were maintained after completed CUG using a 50% lower individualized dose than used during the CUG period.
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| 6. |
- Decker, Ralph, 1968, et al.
(författare)
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Individualized GH treatment reduces the variation in insulin levels and in body composition during the maintenance growth phase in prepubertal children
- 2011
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Ingår i: Horm Res Paediatr. - 9783805598354 ; 2011:76 (suppl)
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Konferensbidrag (refereegranskat)abstract
- Background: Few studies have evaluated the metabolic outcomes of growth hormone (GH) treatment in prepubertal short children during different growth phases. We have studied individualized GH treatment in the catch-up growth phase and found a reduction in variation of fasting insulin levels by 34% compared to unchanged standard dose. Thereafter, GH-treated children appear to need lower GH doses to maintain SDscore channel-parallel growth. The individualized approach using prediction models for estimation of GH responsiveness has the advantage of narrowing the range of growth response around mid-parental heights, avoiding too low or high GH doses. Methods: Short prepubertal children with either isolated GHD or ISS participated in a 2-year randomized trial of either individualized GH treatment (range, 17–100 μg/kg/day) or a unchanged (USD) standard dose. After achieving near mid-parental height, children with individualized dosage were randomized to either reduced individualized dose (RID, n=28) (i.e. 50% decreased dose) or unchanged individualized dose (UID, n=37) for 2 more years. The 33 children randomized to the USD (43 μg/kg/day) at start of treatment remained unchanged. Objective and hypotheses: To evaluate if bisection of the reduced individualized GH dose (RID) diminishes the variation in the metabolic parameters measured during maintenance growth compared to reduced individualized GH dose. Hypothesis: Reduction of GH dosage reduces the range of metabolic outcomes without decreasing growth velocity during the maintenance growth phase. Results: : We observed a narrower variation in fasting insulin levels (-50%) and in insulin sensitivity as assessed by homoeostasis model assessment, HOMA (-55.1%), lean soft tissue, LST (-27.8%) and bone mineral content, BMC (-31.3%), in RID compared to UID (p<0.05).
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| 7. |
- Kriström, Berit, et al.
(författare)
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Growth hormone (GH) dosing during catch-up growth guided by individual responsiveness decreases growth response variability in prepubertal children with GH deficiency or idiopathic short stature
- 2009
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 94:2, s. 483-490
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Weight-based GH dosing results in a wide variation in growth response in children with GH deficiency (GHD) or idiopathic short stature (ISS). OBJECTIVE: The hypothesis tested was whether individualized GH doses, based on variation in GH responsiveness estimated by a prediction model, reduced variability in growth response around a set height target compared with a standardized weight-based dose. SETTING: A total of 153 short prepubertal children diagnosed with isolated GHD or ISS (n = 43) and at least 1 SD score (SDS) below midparental height SDS (MPH(SDS)) were included in this 2-yr multicenter study. INTERVENTION: The children were randomized to either a standard (43 microg/kg.d) or individualized (17-100 microg/kg.d) GH dose. MAIN OUTCOME MEASURE: We measured the deviation of height(SDS) from individual MPH(SDS) (diffMPH(SDS)). The primary endpoint was the difference in the range of diffMPH(SDS) between the two groups. RESULTS: The diffMPH(SDS) range was reduced by 32% in the individualized-dose group relative to the standard-dose group (P < 0.003), whereas the mean diffMPH(SDS) was equal: -0.42 +/- 0.46 and -0.48 +/- 0.67, respectively. Gain in height(SDS) 0-2 yr was equal for the GH-deficient and ISS groups: 1.31 +/- 0.47 and 1.36 +/- 0.47, respectively, when ISS was classified on the basis of maximum GH peak on the arginine-insulin tolerance test or 24-h profile. CONCLUSION: Individualized GH doses during catch-up growth significantly reduce the proportion of unexpectedly good and poor responders around a predefined individual growth target and result in equal growth responses in children with GHD and ISS.
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| 8. |
- Lundgren, Maria, 1973-
(författare)
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Born Small for Gestational Age : Impact of Linear Catch-up Growth
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purposes of the thesis were to study associations between size at birth, short adult stature and risks of subnormal intellectual performance, high blood pressure, and overweight among males, and to study associations between size at birth, short adult stature and risk of overweight and giving birth to small for gestational age (SGA) infants among females.The effect of short adult stature on intellectual performance among males was analyzed in two population-based cohort studies. Data were obtained from the Swedish Birth Register which was individually linked to the Swedish Conscript Register. Being born SGA was associated with increased risks of subnormal intellectual performance in all four dimensions included in the test, and lack of catch-up growth leading to short adult stature further increased this risk. If anything, logical performance was found to be most affected.To estimate the risk of high blood pressure in males born SGA we used the Birth Register linked to the Conscript Register. Being born SGA was associated with a slightly increased risk of high systolic blood pressure, and being born light and ending up with short adult stature further increased this risk.Association between short adult stature and overweight was analyzed in both males and females born SGA, in two different studies. In the male cohort data from the Birth Register was linked to the Conscript Register. In females the Birth Register was used twice, when the females were born and when they gave birth to their first child. In both the male and female cohort, there was an increased risk of becoming overweight among those born SGA who also ended up with short adult stature.Finally, an intergeneration study was performed using the Birth Register to analyze associations between being born short for gestational age and giving birth to short infants. Catch-up growth to normal adult stature among women born short-for-gestational age was associated with reduced risk of giving birth to a short-for-gestational age infant.Conclusions. Among males born SGA, short adult stature is associated with increased risk of subnormal intellectual performance, high blood pressure and overweight compared to those with normal adult stature. Similarly, among females born SGA, there is an increased risk of becoming overweight in those with short adult stature, compared with those not short as adult. Females born short for gestational age, with short adult stature are at increased risk of giving birth to a short infant.
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