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Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia.
The GH Research Society held a Consensus Workshop in Sydney, Australia, 2007 to incorporate the important advances in the management of GH deficiency (GHD) in adults, which have taken place since the inaugural 1997 Consensus Workshop. Eur J Endocrinol. 2007 Dec;157(6):695-700.
The workshop participants concluded: Testing for GHD should be extended from hypothalamic–pituitary disease and cranial irradiation to include traumatic brain injury. Testing may indicate isolated GHD; however, idiopathic isolated GHD occurring de novo in the adult is not a recognized entity. The insulin tolerance test, combined administration of GHRH (growth hormone releasing hormone) with arginine or growth hormone-releasing peptide, and glucagon are validated GH stimulation tests in the adult. A low IGF-I is a reliable diagnostic indicator of GHD in the presence of hypopituitarism, but a normal IGF-I does not rule out GHD. GH status should be reevaluated in the transition age for continued treatment to complete somatic development. Interaction of GH with other axes may influence thyroid, glucocorticoid, and sex hormone requirements. Response should be assessed clinically by monitoring biochemistry, body composition, and quality of life. There is no evidence that GH replacement increases the risk of tumor recurrence or de novo malignancy.
Three girls with normal growth hormone secretion had received renal transplantation when aged 2 to 6 years. They had had severely retarded growth (SD for height score was -7.4 to -3.7) at the time of transplantation. After renal transplantation, steroid was withdrawn and they were treated with recombinant human growth hormone; they subsequently reached adult heights of 145 to 156 cm. The SD for adult height score was -2.6 to -0.3. The adult height in two patients was over their target height, calculated using the mean of the parents' height. This report shows the efficacy of steroid withdrawal and recombinant human growth hormone therapy in achieving adult height in these three girls after renal transplantation.
Growth hormone and erythropoiesis. review of the literature. Petri A, Ferraris M, Binotti M, Tardivo I, Bona G, Miniero R. Minerva Pediatr. 2007 Dec;59(6):787-800. Clinica Pediatrica, Università del Piemonte Orientale, Novara, Italy gianni.bona@maggioreosp.novara.it.
In this analysis of hematopoiesis, the regrowth of colony-forming cells in the bone marrow was examined in patients who had undergone medullary ablation and bone marrow transplant. The various stages of erythropoeisis and the factors that influence blood cell production are discussed: hematopoietic microenvironment, cytokines, tissue oxygen. Drawing on results from rodent and human studies, growth hormone factor (GH) function is explained, its interaction with insulin-like growth factors I and II (IGF I and II), and their effects on hematopoiesis. The aim of the study was to show the close link between GH, IGF I and II and erythropoiesis, because patients with GH deficit may present with partially impaired erythyroid proliferation that leads to the onset of anemia.
Growth hormone as concomitant treatment in severe fibromyalgia associated with low IGF-1 serum levels. A pilot study. Cuatrecasas G, Riudavets C, Guell MA, Nadal A. BMC Musculoskelet Disord. 2007 Nov 30;8(1):119.
There is evidence of functional growth hormone (GH) deficiency, expressed by means of low insulin-like growth factor 1 (IGF-1) serum levels, in a subset of fibromyalgia patients. The efficacy of GH versus placebo has been previously suggested in this population. We investigated the efficacy and safety of low dose GH as an adjunct to standard therapy in the treatment of severe, prolonged and well-treated fibromyalgia patients with low IGF-1 levels.
METHODS: Twenty-four patients were enrolled in a randomized, open-label, best available care-controlled study. Patients were randomly assigned to receive either 0.0125 mg/kg/d of GH subcutaneously (titrated depending on IGF-1) added to standard therapy or standard therapy alone during one year. The number of tender points, the Fibromyalgia Impact Questionnaire (FIQ) and the EuroQol 5D (EQ-5D), including a Quality of Life visual analogic scale (EQ-VAS) were assessed at different time-points.
RESULTS: At the end of the study, the GH group showed a 60% reduction in the mean number of tender points (pairs) compared to the control group (p<0.05; 3.25+/-0.8 vs. 8.25+/-0.9). Similar improvements were observed in FIQ score (p<0.05) and EQ-VAS scale (p<0.001). There was a prompt response to GH administration, with most patients showing improvement within the first months in most of the outcomes. The concomitant administration of GH and standard therapy was well tolerated, and no patients discontinued the study due to adverse events.
CONCLUSIONS: The present findings indicate the advantage of adding a daily GH dose to the standard therapy in a subset of severe fibromyalgia patients with low IGF-1 serum levels. Trial Registration: NCT00497562 (ClinicalTrials.gov).
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