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- Decker, Ralph, 1968, et al.
(författare)
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Hyperbolic function shows close correlation between growth hormone (GH) sensitivity and GH secretion
- 2013
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Ingår i: Hormone Research in Paediatrics. 9th Joint Meeting of Paediatric Endocrinology. - 1663-2818 .- 1663-2826. - 9783318025040 ; 80:suppl 1, s. 301-302
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Konferensbidrag (refereegranskat)abstract
- Background Impressive similarities exist between the insulin resistance-associated metabolic syndrome and untreated growth hormone (GH) deficiency in both children and adults. Central findings are visceral obesity and cardiovascular morbidity. Children with lower GH sensitivity but normal GH secretion like in idiopathic short stature (ISS) belong to a continuous spectrum of imbalanced GH secretion in relation to GH sensitivity. Hypothesis The relationship between secretion and sensitivity is similar for GH and insulin. Materials & methods 153 short prepubertal children with a broad range of secretion and sensitivity were included. From the 24-hour GH profile (72 x 20 min), the 24h GH secretion rate was estimated with a deconvolution method. The secretion rates above the basal level was calculated by PULSAR (GHb). The prediction model estimated the growth response, predicted delta height SDS, a measure of GH sensitivity/ responsiveness. Discussion GH treatment is neither individualized like insulin treatment with adaption to individual sensitivity nor applied in children with ISS. In order to fill gaps in knowledge, we have previously shown that individualized GH treatment is beneficial in reducing the range of growth response and metabolic responses in both GHD and ISS prepubertal children(2, 5, 6). Thus, despite administering higher doses to children being less sensitive to GH, individualized GH treatment is safe in metabolic terms. As insulin dosing is individualized in type-2 diabetes mellitus, it can be recommended to individualize GH dosing in ISS children. The metabolic impact of untreated versus treated ISS in the long term is an issue of further studies. Conclusion Our data confirms similarities between insulin and GH regarding the hyperbolic function between secretion and sensitivity.
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- 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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- Kriström, Berit, 1949, et al.
(författare)
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GH dosing guided by individual responsiveness decreases variability in growth response and insulin in GHD and ISS children
- 2010
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Ingår i: New Inroads to Child Health (NICHe).
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- GH responsiveness on growth can be estimated before treatment by use of prediction models in GHD and ISS children, and may be used for individualizing the GH dose to reach a set goal for catch-up growth, i.e. Midparental Height (MPH) SDS. Conclusions: The prospective randomized study shows that by using the GH responsiveness estimated by our prediction model for individualizing the GH dose during 2 years of catch-up growth, too low and too high growth response can be avoided, and the variance in fasting insulin and HOMA was reduced.
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