부산대학교 도서관

Children born Small for Gestational Age (SGA) without catch-up growth can be treated with growth hormone (GH), which allows them to reach an adult height less than 2 standard deviations (SD). The aims of this study were to assess the long-term growth and the pubertal development compared to the reference population [Spanish Growth Studies 2010 (SGS 2010)], to evaluate the variability of the response to GH therapy, and to report changes in the metabolic profile. Patients and Methods: descriptive, longitudinal, observational, retrospective, multicenter study. GH was started at least 2 years before the onset of puberty. Mean daily GH dose was 30 mcg /kg/day. Onset of puberty was defined by an increase in growth velocity. There was a cohort of 95 patients (64 boys and 31 girls), 21% of them were preterm babies. Mean weight and length at birth were -1.9±0.8SD and -2.5±0.8SD, respectively. 78 patients reached adult-height. Results: Chronological age at the start of GH therapy was 6.98±2.1 years for boys and 5.94±1.74 for girls. Boys were treated for a mean of 8.34 years and girls for 7.81 years. Puberty onset was at mean age of 12.03 years for boys and 10.17 years for girls. Mean age of menarche was 13.04 years. Height-SD at start of GH therapy was -3.35SD, at pubertal growth spurt onset was -1.78SD and at adult-height was -1.73SD. The most important gain height was during the prepubertal period (+ 1.60SD). No differences at adult height gain were found among patients classified by being preterm, by being light, short or both at birth, by their response to GH stimulation test or by having had treatment discontinuation. Puberty onset of SGA patients and classification in their own growth standards were similar to the SGS 2010. SGA were shorter at puberty onset and also at adult-height compared to SGS 2010. Total pubertal height gain was lower in SGA. Depending on the individual height gain from the start of treatment until adult-height, patients were divided into five groups: 1: <0.5SD (13%), 2:>0.5 andn≤1SD (13%), 3:>1 and ≤2SD (39%), 4:>2 and ≤3SD (26%), 5:>3SD (9%). Three growth patterns were identified in groups 1, 2 and 3: A) poor response from the beginning of the treatment, B) height loss during puberty, C) height loss from the end of treatment to adult-height. Adult height gain was negatively correlated with weight at baseline (R2= 0.225) and positively with growth velocity during the first year of treatment (R2= 0.225). There was a progressive increase of IGF-1 values during treatment that remained at the normal range afterwards. Increased fast plasmatic glucose levels were observed at puberty and at the end of treatment and no changes in lipid profile were reported. Conclusions: SGA without catch-up growth with GH therapy reached an adult height less than 2 SD. The greatest height gain was during the prepubertal period. Puberty onset of the SGA patients and classification in their own growth standards were similar to the reference population. Response to GH therapy is variable and should be individualized. Adult-height gain was negatively correlated with growth velocity during the first year of treatment. GH release after stimuli does not predict better response to GH therapy. No changes in the metabolic profile were reported.