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PubMed1994

Infant growth charts.

Detection and monitoring childhood growth disorders requires the correct use of growth charts. A check on the accuracy of every point plotted on Gairdner-Pearson growth charts of premature infants in a hospital paediatric department was carried out. Errors beyond set limits were recorded. Of 611 points plotted on the growth charts of 50 premature infants who were at least 1 year of age at the time of the study, there were 173 (28.5%) points plotted in error. Altogether 94.7% of the errors occurred when plotting the age along the horizontal (X) axis of the growth chart, irrespective of whether weight, length, or head circumference was being measured. There was no evidence that the errors caused appreciable changes in clinical management. Potential sources of error identified were failure to adjust for prematurity correctly, inaccuracy in calculating age, and the use of the logarithmic scale. These errors could be serious and it is important that there should be greater vigilance in using growth charts. The use of age calculators or improved chart design is recommended. Assessment of the use of other growth charts in different settings is also suggested.

Anthropometry↗
PubMed1990

Who is treated with growth hormone today? The Executive Scientific Committee of the Kabi International Growth Study.

The present demographic data from the Kabi International Growth Study (KIGS) database are summarized. Of the 2580 patients included, 85% have growth hormone deficiency (GHD) and 15% have other causes of growth failure. Idiopathic GHD is present in 78.5% of the patients, the remaining 21.5% have organic GHD. Isolated GHD is common in idiopathic GHD whereas multiple pituitary hormone deficiencies occur in at least 50% of the organic GHD patients. A preponderance of boys is observed in most groups of patients. Median chronological age (CA) at start of treatment is 10 years and median duration of therapy is 2.3 years. However, a wide range is observed. In most cases growth retardation is severe. In most patients with GHD height SDS for chronological age at start of therapy is at or below -3. The median difference between idiopathic and organic GHD is 1 SDS. Most patients have 6 or 7 injections of growth hormone (GH) per week. The median total weekly dose is approximately 0.5 IU/kg/week, but it is lower in older patients. It is concluded that steadily increasing numbers of patients with idiopathic and organic GHD are being treated with human GH (hGH). In addition, many patients with other growth disorders not necessarily associated with GHD receive hGH therapy. Chronological age at start of treatment still appears to be (too) high in most patients and growth retardation severe. The frequency of hGH injections has been increased to nearly daily administration. However, the total weekly dose appears to be low, especially in the older patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Effect of neonatal head X-irradiation on growth of costal and tibial cartilage in rats: a histochemical and electron microscopic study.

Long-Evans rats were exposed to a single dose of head X-irradiation (600 rads) at 2 days of age. Experimental and sham irradiated rats were sacrificed at 14, 20-21, 23, 41-45, and 70-71 days. Tibial epiphyseal width and the number of cells in the epiphyseal plate were determined. Histochemical and electron microscopic studies were carried out on both costal and epiphyseal cartilage. Histochemical techniques revealed a reduction in chondroitin sulfate at 14 days in both costal and epiphyseal cartilage of X-irradiated rats. Epiphyseal cartilage demonstrated recovery subsequently, and this was followed by a normal decrease of chondroitin sulfate with increasing age, but costal cartilage did not recover. Collagen synthesis was also reduced in both costal and epiphyseal cartilage, but not as dramatically as chondroitin sulfate. Except for some electron dense cells and reduced scalloping of the cell membrane, costal chondrocytes from irradiated rats did not show major ultrastructural alterations. In contrast, epiphyseal chondrocytes demonstrated radiation induced alterations in organelles, in enhanced glycogen deposition, and in retardation of chondrocyte maturation. Extracellularly in both costal and epiphyseal cartilage of irradiated rats, collagen density and matrix granules were reduced, while calcification of the matrix was enhanced. Beyond 45 days, the effects of irradiation were markedly reduced. Comparisons of the histochemical results with metabolic studies carried out previously in cartilage from the same animals indicated a more direct concordance of the histochemical results with the pattern of physical growth and supported the usefulness of morphologic and histochemical techniques in the analysis of the growth disorder in the head-irradiated rat.

Animals↗
PubMed1992

The definition of a spontaneous growth hormone (GH) peak: studies in normally growing and GH-deficient children.

GH spontaneous peaks and their diagnostic utility have not been previously evaluated by means of a 24-h continuous withdrawal (CW) procedure in children with growth disorders. Using a CW pump, we studied the 24-h spontaneous secretion of GH in 129 prepubertal subjects grouped as follows. The control group (C) consisted of 20 children of normal height and growth rate. Group GHD consisted of 53 patients with classical GH deficiency (48 idiopathic and 5 organic). The NSD group consisted of 36 patients with a growth velocity below 4.5 cm/yr, normal GH response to provocative stimuli (PS), but a mean 24-h GH in the deficient range. Group NSS consisted of 20 short children with normal growth velocity, normal PS, and normal mean 24-h GH concentration. The mean GH levels for the 24-h period were 4.1 +/- 1.7, 1.4 +/- 0.5, 2.1 +/- 0.7, and 4.2 +/- 1.9, respectively, for the C, GHD, NSD, and NSS groups. For each subject, GH levels were determined in 48 0.5-h samples collected during the CW study, and the GH profile was analyzed by the Pulsar computer program. The mean number of peaks was 9.0 +/- 2.5 for C, 9.5 +/- 3.7 for GHD, 10.5 +/- 1.8 for NSD, and 9.5 +/- 3.2 for NSS. There was no statistical difference between groups. The mean amplitude of peaks was 9.8 +/- 8.9 for C, 1.6 +/- 1.0 for GHD, 2.9 +/- 1.3 for NSD, and 9.9 +/- 9.1 for NSS. Mean peak amplitudes in both GHD and NSD were significantly lower than in the C and NSS groups. The presence of peaks of more than 8 micrograms/L during the daytime (0800-2000 h) was a characteristic of children with normal integrated GH concentration (IC-GH) and was seen in 90% of normally growing children but in only 7% of poorly growing children with subnormal IC-GH. There was no significant difference in the number of pulses during the night between C and NSD groups. We conclude that differences in IC-GH between normally growing and poorly growing children are due to a lower amplitude of peaks during the daytime hours.

Adolescent↗
PubMed1997

Reassessment of the PAS patterns in uveal melanoma.

BACKGROUND: Previous work has highlighted the prognostic importance of patterns of periodic acid Schiff (PAS) staining (the Folberg patterns) in uveal melanoma. These patterns have been ascribed to blood vessels but the patterns are different from those seen with other staining techniques for blood vessels. It has recently been shown that microvessel density is the dominant prognostic factor in uveal melanoma. This study reinvestigates the nature and significance of the PAS patterns. METHODS: The PAS patterns were compared with the patterns seen with conventional connective tissue stains and with the patterns seen in sections stained for the presence of blood vessels (by immunohistochemistry for factor VIII related antigen). The PAS patterns were determined on a panel of 117 cases of uveal melanoma. The prognostic significance of each of these patterns was determined and, as more than one pattern can exist in a tumour, principal components analysis was performed to determine the number of underlying factors. RESULTS: Comparison of the PAS patterns with other stains demonstrates that they are based on connective tissue including fibrovascular tissue. Five of the nine PAS patterns carried prognostic significance on univariate analysis. Principal components analysis suggested that these patterns represented three underlying factors, which were tentatively identified as representing disordered growth (factor 1), emergence of rapidly growing subclones (factor 2), and section orientation (factor 3). CONCLUSIONS: The PAS patterns are based on fibrovascular tissue and can be ascribed to three underlying factors. The first two of these factors carried prognostic significance and the first (disordered growth) retained independent prognostic significance in a multivariate Cox model which included microvessel density and tumour size.

Biomarkers, Tumor↗
PubMed1986

The measurement of insulin-like growth factor I: clinical applications and significance.

Of the somatomedins so far measured, the selective quantitation of insulin-like growth factor I (IGF-I) appears to have the greatest potential in clinical diagnosis. There have been two approaches to the development of immunoassay systems. One type uses antibodies raised against synthetic fragments of IGF-I which exhibit cross-reactivity with the whole hormone. Such assay systems may be adequate for measuring normal adult plasma IGF-I levels, but the potential for the higher sensitivity required for detecting sub-normal plasma levels in young children is apparent only in methods using antibodies raised against the complete hormone. IGF-I in plasma exists as part of a high molecular weight complex in which it is bound to carrier proteins. The binding proteins may interfere with plasma IGF-I measurements by radioligand assays. Direct analysis of untreated plasma samples is claimed to be possible using disequilibrium assay conditions but in order to maximise assay sensitivity it is necessary to employ an initial extraction stage in order to eliminate binding protein interference. Whether the measurement of plasma IGF-I can or should be used in addition to, or as a replacement for, plasma growth hormone (GH) measurement in the clinical assessment of growth disorders remains a controversial issue. Available evidence indicates that a single, random plasma IGF-I level provides an accurate reflection of GH secretion. Adequate discrimination between the elevated levels in acromegaly and normal reference values has been demonstrated. However, in the investigation of growth-retarded children available radioimmunoassay (RIA) methods have proved only partially successful because of the age-related nature of normal plasma IGF-I concentrations. Existing assays appear capable of identifying sub-normal plasma levels after the age of approximately 4 years. In younger subjects an improvement in assay sensitivity is required in order to establish with greater accuracy the relevant normal ranges. Improvements in the identification of the particular lesion responsible for retarded growth in a child can be achieved by measurement of both plasma GH and IGF-I concentrations. The predictive value of the acute plasma IGF-I response to single-dose GH therapy may identify patients who will respond to long-term GH therapy. Better, more informed decisions on subsequent treatment may therefore be made. Apart from GH control, several other factors influence circulating IGF-I levels. Nutritional status can be assessed through reference to IGF-I analysis, overall catabolic or anabolic processes being associated with decreasing or increasing plasma IGF-I levels respectively.

Acromegaly↗
PubMed2003

Seeking the optimal target range for insulin-like growth factor I during the treatment of adult growth hormone disorders.

Impaired GH activity at target tissues, occurring when GH action is blocked or during suboptimal GH replacement therapy, may result in a pathological state associated with lowering of IGF-I, but not GH levels. Such a state represents functional but not necessarily actual GH deficiency (GHD). The aim of this study was to identify a range of IGF-I values commensurate with GHD, which could be used to determine the risk of functional GHD during the treatment of adult GH disorders. Centrally measured baseline IGF-I data from the Kabi International Metabolic Study European GHD database were analyzed. Inclusion criteria were adult-onset GHD and two or more additional anterior pituitary hormone deficits. Adults with childhood-onset GHD and cured acromegaly were excluded. The cohort was stratified into six gender-based age ranges. Baseline IGF-I measurements from 376 females (median age, 48 yr; range, 21-77 yr) and 434 males (median age 52 yr; range 21-80 yr) were analyzed. Data were not normally distributed and are presented as medians (quartiles). The median serum IGF-I and IGF-I SDS in males were 94.0 microg/liter (64 and 141) and -1.52 (-2.53 and -0.456; n = 434). Both were significantly greater than the equivalent values of females, which were 73 microg/liter (46 and 103.5) and -2.30 (-3.28 and -1.328; n = 376; P < 0.0001 for both). Age and gender-related 90th and 95th percentiles for IGF-I SDS were determined to generate risk estimates for functional GHD, which, in conjunction with the clinical status of the patient, may be used to aid dose titration during treatment of GH disorders in adulthood.

Adult↗
PubMed2000

[The pathogenesis of posttraumatic deformities of the mandible in the growing organism].

Experiments on developing animals showed that mandibular fractures of any location can be complicated by pronounced growth disorders and abnormal development of mandibular bone, leading to deformations of the site of fracture. Abnormal mandibular development was particularly obvious after injuries to the condyle and condylar process, after fractures of mandibular body and angle with dissection of the neurovascular bundle, and in cases with osteomyelitis. Disorders in endochondral bone formation (which is normally most active in the condyle) caused by traumatic processes and disorders in neurotrophic regulation and blood supply to the bone, developing in neurovascular obstruction, underlie the mechanisms of posttraumatic mandibular deformations. These complications were observed in patients with fractures of different sites because of improper joining and fixation of fragments. Children should be regularly checked up after mandibular fractures. Measures aimed at prevention of growth disorders and development of mandibular bone lesions are obligatory at all stages of examination.

Adolescent↗
PubMed1992

Human growth hormone. Who is a candidate for treatment?

The one accepted indication for human growth hormone (hGH) treatment is classic hGH deficiency, and girls with Turner's syndrome will soon be added to this category. The unlimited supply of recombinant hGH has expanded investigational trials to include many growth disorders and metabolic conditions, but continued investigation and accumulation of information through well-designed and controlled studies are required for these uses. I believe there is no indication to treat short, normally growing children whose predicted adult height is normal for their genetic potential. Physicians must remember that even if only children under the third percentile on growth charts are treated with hGH, a new population will be created that falls below that percentile. Two excellent, recent reviews of current use of hGH therapy are available for further reading on this subject.

Child↗
PubMed1987

[Somatomedins].

Somatomedins are peptide hormones with insulin-like structure and effects. Their synthesis is governed by growth hormone. Somatomedins stimulate growth of cartilage tissue and other tissues. Synthesis of somatomedins occurs in various tissues, predominantly in the liver. For clinical practice determinations of somatomedin C (= IGF I) levels in blood have become valuable, since they give insights into the growth hormone secretory state, being low in growth hormone deficiency and high in acromegaly. In other growth disorders somatomedin C measurements can give new insights into the underlying pathogenesis. The role of IGF II and other peptides with somatomedin-like characteristics is presently under investigation.

Acromegaly↗
PubMed2004

Growth hormone deficiency in patients with sickle cell disease and growth failure.

BACKGROUND: Growth disorders are common in children with sickle cell disease (SCD). The etiology for growth disturbances in this population appears to be multifactorial. Recent evidence suggests abnormalities in the growth hormone (GH)/insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) axis may play a role. OBJECTIVE: To measure GH levels through provocative stimulation in a group of patients with SCD with growth failure, and to evaluate response to treatment. PATIENTS AND METHODS: Growth records were reviewed of 79 children with sickle cell hemoglobinopathies to identify children with growth failure. GH levels were measured in patients with SCD with and without growth failure using arginine and L-Dopa as provocative stimulation tests. Treatment with GH was offered to GH-deficient children with SCD and these patients were followed longitudinally over 5 years. RESULTS: Of the 79 patients, 13 (16.5%, all SS) had heights less than -2 SD below the mean or a growth velocity < -2 SD below the mean for age. Seven of the 13 children with growth failure participated in this study. Five patients received GH for 3 or more years and demonstrated significant improvement in their height SDS. One of the two who declined treatment was lost to follow-up and the other had significant worsening of height SDS score. CONCLUSION: GH deficiency may be associated with growth failure in some patients with SCD. These patients may benefit from treatment with GH.

Adolescent↗
PubMed2006

Growth hormone signalling: sprouting links between pathways, human genetics and therapeutic options.

Our molecular understanding of growth hormone-induced signal transduction has improved significantly over the past decades. At the same time, human population genetics and the analysis of genetically engineered animals have led to the discovery of genes that control specific aspects of the overall growth process. Although, currently, growth disorders are still diagnosed and treated on empirical bases, it might soon be possible to stratify patients predominantly by genetic defect, with treatment based on our molecular understanding of the role of the affected gene in the disease.

Animals↗
PubMed1994

Clinical significance of growth hormone-binding protein measurements in children.

To investigate the role of growth hormone (GH) and its downstream axis in normal growth and growth disorders, we measured serum GH-binding protein (GHBP) levels in children by ligand-mediated immunofunctional assay (LIFA). Samples were taken from 512 healthy children of normal stature, 146 healthy neonates, 153 short but otherwise normal children, and 27 patients with GH deficiency. Serum GHBP showed no significant diurnal variation. Serum GHBP levels were low in neonates, acutely rose within 6 months, and gradually increased toward midpuberty in normal children (r = 0.2, P < 0.01, assessed among subjects over 1 year old). Neither significant sexual dimorphism nor rapid pubertal changes were observed. In normal short children and patients with GH deficiency, GHBP was lower than normal, but not significant. These data suggest that one of the etiologies for growth disorder in children could be resistance to, or low efficacy for, utilization of GH.

Adolescent↗
PubMed1983

[Psychiatric disorders and growth of brain tumors].

In 49 of 365 clinical and patho-anatomical intracranial tumour cases the tumours were indicated in the anamnesis only by mental disturbances before acute signs of brain pressure appeared. With reference to the relations between the psychopathological syndromes and the types of locations of tumours attention is drawn to factors that may complicate the early detection of tumours.

Adolescent↗
PubMed1993

Urinary growth hormone excretion as measured by a sensitive immunochemiluminometric assay.

A sensitive immunochemiluminometric assay with a detection limit of 1.1 microU/L was developed for the measurement of urinary growth hormone (UGH). The assay was shown to be specific and precise. There was a good correlation between serum growth hormone (GH) and UGH concentrations in 20 patients with acromegaly and six volunteers following an intravenous injection of recombinant GH. We concluded therefore that UGH measurements appear to provide a satisfactory index of GH secretion. The use of the assay in the investigation of growth disorders was assessed. We studied 11 pre-pubertal children, six of normal stature, and five of short stature, over a 6-month period. Sequential fortnightly measurements of UGH were carried out and height velocity was determined. The children of short stature grew at a slower rate and excreted less GH than the children of normal stature. However, we observed considerable within-individual variability in GH excretion in both groups (CV 22-98%). We therefore recommend that sequential UGH analyses should be carried out and the results interpreted in conjunction with growth measurements. However, further investigations into the renal handling of GH are needed to establish optimum sampling regimes.

Acromegaly↗
PubMed1990

Assessment of growth hormone secretion: what are we looking for practically?

GH is a dominant factor in determining growth during childhood. Hence, the assessment of GH secretion is of major importance in the diagnosis of growth disorders. Since GH is secreted in a pulsatile fashion, a truly accurate production rate can only be calculated by using very frequent or continuous blood sampling over a 24-hour period. Several standard provocative tests have been established to evaluate GH secretory status. They remain the cornerstone in the assessment. Recent data have shown the existence of a wide spectrum of GH secretory disturbances ranging from severe GH deficiency to partial insufficiency and neurosecretory dysfunction. There is no well-defined cut-off point at which a particular child can be regarded as GH insufficient or sufficient for optimal growth. In clinical practice, the assessment of GH secretion starts with the careful analysis of the growth chart and height velocity. Careful clinical examination of the patient is essential for the proper diagnosis, and to exclude diseases influencing GH secretion. Additional biochemical tests may be required for the differential diagnosis. Thus, assessment of GH secretion in children requires auxological, clinical and biochemical data. GH insufficiency is documented by additional testing of pituitary secretory capacity either by standard provocative tests, by studying 24-hour GH profile or by measuring 24-hour production rate. The main goal is to detect those children who will benefit from treatment with hGH. The final assessment might consist in the response of growth velocity to exogenous hGH.

Growth Disorders↗