Investigation of growth pattern in children treated with growth hormone
Abstract
The main aims of the PhD work were to examine the biological and birth status of children treated with growth hormone, to develop national height-for-age growth charts, to analyse their growth patterns, and to identify the key factors influencing their growth trajectory. The data of 123 children with growth hormone deficiency (85 boys and 38 girls) and 45 children with Turner syndrome, who attended the endocrinology clinic at the North Buda St. John’s Centre Hospital, were retrospectively reviewed.
The analyses of the biological status of children treated with growth hormone revealed that, compared to other European nations, hormone treatment for children in Hungary was initiated later and after a more pronounced height deficiency. However, early hormone replacement was critical for achieving target height. Additionally, we presented previously unavailable data on the biological status of Hungarian girls with Turner syndrome, which are highly relevant to assessing treatment efficiency. In our examination of birth status, we were the first who applied the MDN-percentile matrix in children treated with growth hormone. This approach confirmed that the method is effective in identifying children who are likely to require growth hormone treatment in the future. Furthermore, the application of this method revealed that a significant proportion of children with growth hormone deficiency fell into the "PN-LWR category", which was associated with the highest rates of stillbirth and infant mortality. It is worth to explore whether a common underlying cause might be responsible, of which the impaired GH production is a milder outcome.
Using the Preece–Baines I model, we were the first to develop disease-specific height-for-age growth references for boys and girls with growth hormone deficiency, both nationally and internationally. Additionally, we were the first to create height-for-age growth references for GH-treated girls with Turner syndrome in Hungary. We were also the first to analyse growth trajectories among growth hormone-treated children by categorizing them by their growth rate. Furthermore, in our investigation of the factors influencing growth, the existing scientific literature was validated and extended by incorporating variables that had previously received little attention.
The results of our analyses may contribute to the early diagnosis of children requiring growth hormone treatment, allow for more precise monitoring of growth by using disease-specific growth references, assist in the planning of treatment protocols, and optimize treatment strategies, ultimately improving the long-term health outcomes and quality of life for these children.
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