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Objectives 1. To determine BMI, obesity/overweight rates, glucose and lipids at baseline, during GnRHa treatment and shortly after therapy discontinuation in female children with CPP and EP. 2. To compare this response to that seen in a similar group of untreated patients. Methods A retrospective analysis of 71 children with either CPP (n = 37) or EP (n = 34) was undertaken. Forty three were treated with a GnRHa for at least 2 years, while 28 were followed without treatment. Results At the time of diagnosis, a higher BMI (z-score of 1.1 ± 0.8 vs. 0.6 ± 0.7, p = 0.004) and a higher prevalence of obesity/overweight (72.9 vs. 35.3%, p = 0.001) was observed in subjects with CPP when compared to those with EP. Children with EP had higher fasting glucose and total cholesterol than those with CPP. BMI z-score, obesity/overweight rates, fasting glucose and lipids did not change significantly in girls with CPP or EP during 3 yrs of follow up, regardless of treatment. Weight z-scores were higher at 3 years in treated than in untreated girls with CPP (p = 0.02), while it was higher in untreated than in GnRHa-treated patients with EP at baseline, 1, 2 and 3 years (p = 0.007, p = 0.002, p = 0.02 and p = 0.04, respectively) and remained so shortly after stopping therapy (p = 0.03). Conclusions There is a high prevalence of obesity/overweight in girls with CPP and EP at diagnosis. However, this risk is greater in CPP than in EP girls. BMI, Obesity/overweight rates, fasting glucose and lipids remained stable in CPP and EP girls regardless of therapy. Weight z-scores were found to be higher in treated CPP girls and in untreated girls with EP. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the effect of combined therapy with growth hormone (GH) and luteinizing hormone-releasing hormone agonist (LHRHa) on the near-final height (NFH) of children with idiopathic short stature (ISS) and growth hormone deficiency (GHD) in early puberty. Methods: A retrospective analysis of 20 patients with ISS and 9 patients with GHD treated with combined therapy was undertaken. Twelve children with ISS and ten with GHD, treated with GH alone, served as controls. Patients were matched at baseline for chronological age, bone age, height standard deviation score (SDS), and pubertal development. Results: Patients with ISS or GHD treated with combined therapy improved both their predicted adult height (PAH) at 2 years of therapy (ISS, p<0.001; GHD, p=0.03) and their NFH (ISS, p<0.05; GHD, p=0.05). Treatment with combined therapy did not generate additional benefits on the PAH after 2 years of therapy (ISS children, an increase of 7.9±4.9 cm with combined therapy vs. 7.3±6.0 cm with GH; GHD children, an increase of 6.8±7.8 cm with combined therapy vs. 5±5.9 cm with GH). The total height gain SDS was higher in patients treated with GH alone compared with those with combined therapy, but the difference was not significant (ISS children, a gain of 2.4 SDS with GH vs. 0.8 SDS with combined therapy; GHD children, a gain of 1.8 SDS with GH vs. 0.6 SDS with combined therapy). Conclusions: Although 2 years of combined treatment with GH and LHRHa improved the PAH and the NFH of ISS and GHD patients in early puberty, this improvement was not significant compared with that observed in similar subjects treated with GH alone. [ABSTRACT FROM AUTHOR]

The article discusses a study which analyzed the influence of two common genetic variations in growth hormone receptor (GHR) and vitamin D receptor (VDR) genes on two-year response to recombinant human growth hormone (rhGH) in patients with growth hormone deficiency (GHD) and Turner syndrome (TS). The study included 53 prepubertal Venezuelan children with GHD and TS. Study authors concluded that GHR and VDR genotypes are not influential in rhGH response.

Background/Aims: Significant endothelial dysfunction as determined by lower flow-mediated vasodilation of the brachial artery was recently reported by us in growth hormone-deficient (GHD) adolescents. The circulating concentrations of markers of vascular endothelial cell and platelet activation and their relationship to inflammatory markers have not been previously evaluated in this group of patients. Objective: To assess the relationship between circulating levels of high-sensitivity C-reactive protein (CRP) and soluble markers of vascular endothelial cell activation in GHD adolescents. Design/Methods: Twenty-eight GHD children on GH treatment with a chronological age of 15.7 ± 2.6 years and 16 untreated GHD adolescents with a chronological age of 16.6 ± 3.3 years were studied. Concentrations of CRP, as an inflammatory marker, were measured in all patients and the association between CRP and the fasting soluble markers of vascular endothelial cell activation intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin and P-selectin levels was evaluated. Sixteen healthy adolescents with a mean chronological age of 15.1 ± 2.2 years served as controls. Results: CRP and P-selectin levels were significantly higher in untreated GHD adolescents than in treated GHD subjects or in healthy controls (p < 0.02), while VCAM-1 concentrations were increased in both untreated and treated GHD adolescents when compared to controls (p < 0.007). E-selectin and ICAM-1 levels were similar in all three groups. CRP was found to be associated with BMI (r: 0.62; p < 0.001), P-selectin (r: 0.43; p < 0.01), E-selectin (r: 0.27; p < 0.03), ICAM-1 (r: 0.23; p < 0.05) and VCAM-1 (r: 0.40; p < 0.001) concentrations in untreated GHD adolescents and with P-selectin (r: 0.88; p < 0.001) and E-selectin (r: 0.29; p < 0.01) in treated GHD subjects. A weak inverse association was observed in a subgroup of patients between brachial artery endothelium-dependent dilation and P-selectin (r: –0.56; p < 0.07). Conclusions: Low-grade inflammation as manifested by increased circulating levels of CRP seems to be associated with the early activation of vascular endothelial cells in GHD adolescents Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Summary Objective We recently reported that children with idiopathic short stature (ISS) have decreased lumbar spine bone mineral density (BMD) that increases after 1 year of GH therapy. The aim of this study was to confirm these short-term results and to evaluate the effect of long-term GH therapy on the BMD of children with ISS. Patients and Design We treated a group of 16 short, slow-growing but otherwise healthy non-GH-deficient prepubertal children (8 girls and 8 boys) with a chronological age of 9·5 ± 0·9 years, a bone age of 8·1 ± 1·2 years and a height of 124·3 ± 6·3 cm (height-SDS of -2·1 ± 0·6) with GH at a dose of 0·1 IU/kg/day for 3 consecutive years. Measurements Height was determined at 3-month intervals and annual growth velocities were calculated. Bone ages and BMD were measured every 12 months by dual-energy X-ray absorptiometry, as were serum concentrations of the carboxy-terminal propeptide of type 1 collagen (PICP) and the carboxy-terminal cross-linked telopeptide of type 1 collagen (ICPT). Results Growth velocity increased from 4·0 ± 0·8 cm/year to 8·7 ± 1·5 and 8·0 ± 1·7 cm/year at 12 and 36 months of GH therapy, respectively, while height-SDS improved from -2·1 ± 0·6 to -1·6 ± 0·4 after 36 months of GH (P < 0·0001). Baseline lumbar spine BMD was decreased when compared to that of a control group of healthy children paired for gender, bone age and height (0·640 ± 0·08 g/cm2 vs. 0·730 ± 0·08 g/cm2 ; P < 0·003). Lumbar spine BMD increased after 1 year of GH from 0·640 ± 0·08 to 0·749 ± 0·08 g/cm2 (P < 0·05), reaching levels similar to that of controls followed for 1 year without therapy (0·749 ± 0·04 g/cm2 vs. 0·760 ± 0·08 g/cm2 ). During this... [ABSTRACT FROM AUTHOR]

Comments on the article by Bognetti et al. which analyzed the changes in growth of children and adolescents with type 1 diabetes during the first several years with the disease. Publication of the article in the August 1998 issue of `Diabetes Care'; Findings of the study; Comparison of the article to a 1996 study on the effect of glycemic control on the growth of children and adolescents with type 1 diabetes.

OBJECTIVECombined gonadotrophin-releasing hormone analogue and recombinant human growth hormone therapy has been used in an attempt to improve the final height of short non-GH deficient adolescents with normally timed puberty; its use, however, is still controversial as only short-term studies in a very limited number of patients have been undertaken, with either improvement in height prognosis or no beneficial effect on predicted growth. We have treated a group of extremely short healthy children with very low predicted adult heights entering into normally timed puberty with combined therapy, in order to determine whether we could improve their final height above their pretreatment predicted adult height. PATIENTS We treated 10 healthy adolescent short children (7 girls and 3 boys) simultaneously for 30.0 ± 5.2 months with the GnRH analogue leuprolide acetate (0.3 mg/kg im every 28 days) and with rhGH (0.1 U/kg/day, sc, 6 days a week). The mean chronological age of our patients was 11.8 ± 1.3 years, with a mean bone age of 11.2 ± 0.9 years, height of 128.9 ± 7.5 cm (- 2.4 ± 0.4 SD below the mean) and a predicted adult height of 150.7 ± 9.8 cm; they were all in Tanner stage II-III of puberty. Ten healthy short children (7 girls and 3 boys) in the early stages of puberty with a mean chronological age of 11.4 ± 1.0 years, a mean bone age of 11.0 ± 0.8 years, height of 128.9 ± 7.8 cm(- 2.3 ± 0.4 SD below the mean) and a mean adult predicted height of 151.8 ± 10.1 cm served as controls and were simultaneously followed without therapy for the same study period. MEASUREMENTSHeight and pubertal status were followed every 3 months during combined therapy and until final height of our patients was reached; bone ages were obtained every 6 months. Growth hormone deficiency was ruled out in all our subjects prior to beginning of the study by a normal response to oral clonidine and normal IGF-1 levels. Basal serum... [ABSTRACT FROM AUTHOR]

Presents an argument underlying the support for a study of the performance of an ultralow 0.1 milligram adrenocorticotropic hormone (ACTH) stimulation test in patients with secondary hypoadrenalism. Evidence that administration of ACTH intravenously results in a peak plasma ACTH concentration exceeding 60,000 ng/l; Investigation of the clinical utility of alternative stressors of the axis; Detection of subtle degrees of adrenal atrophy.

Presents a study on bone mineral density until adulthood in girls with Turner's syndrome (TS) participating in a growth hormone (GH) injection frequency-response trial. GH treatment in combination with low dose estrogen; Evidence that untreated or GH treated girls and adolescents with TS have normal bone mineral densities; Finding that some patients with TS may not achieve adequate peak bone mass despite estrogen replacement.

Discusses sensitivity of low dose adrenocorticotropic hormone (ACTH) stimulation test for the diagnosis of secondary hypoadrenalism. Major obstacle to the proposal for the ultra low-dose short Synacthen test; Exploration of more useful sensitivities, specificities and positive predictive values of other dynamic tests; Abandonment of inflexible pass/fail diagnostic cut-off level.

Comments on the letter from Ramachandran et al. which reported GAD65 antibodies in the classification of Asian Indian diabetic subjects with onset between 20 and 40 years of age. Rate of GAD antibody (Ab) in insulin-deficient Asian diabetic subjects initially diagnosed with type 2 diabetes; Uses for GAD Ab; Publication of the letter in a 1999 issue of `Diabetes Care.'