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Vitamin D and growth hormone treatment.

Konferensbidrag (offentliggjort, men ej förlagsutgivet)
Författare Björn Andersson
Diana Swolin-Eide
Publicerad i 9th Joint meeting of Paediatrics Endocrinology, Milan , Italy.
Volym 19-22
Nummer/häfte Sept
Sidor P2-d2-836
Publiceringsår 2013
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för pediatrik
Sidor P2-d2-836
Språk en
Ämneskategorier Ortopedi, Pediatrik

Sammanfattning

Background: Living in Sweden which is in the northern part of the world, above 35° of latitude implies a major risk of vitamin D deficiency. Prepubertal children show a marked seasonal variation in growth parallel to hours of sunshine. Vitamin D shows a similar pattern with the highest levels during late summer. Growth hormone (GH) promotes longitudinal growth in short prepubertal children. Objective and hypotheses: The aim was to study the influence of seasonal variation in vitamin D levels on pretreatment growth and first year growth response to GH treatment. Methods: The study group consisted of 279 short prepubertal children, 223 boys age 9.08±2.6 SD, 56 girls age 7.79±1.65, belonging to registered clinical trials in Sweden. GH was given in the range 17-100 µg/kg/day, mean 0.42 µg/ kg/day. 82 children were GHD (GHmaxAITT/24h profile ≤ 10 µg/L). n=24/104 (23%), of whom n=63/104 (60.5%) had Isolated GHD whereas n=41/104 (39.4%) had Multiple Pituitary Hormone Deficiency (MPHD). Median age at CO-GHD diagnosis was 11.2yr (0.3 -16.6) with initial GH peak 2.2µg/l (0.1 - 6.5); and initiation of GH therapy at 9.5 (0.4 -16.9) yrs. Result: At final height, n=60/104(57.6%) CO-GHD adult were re-evaluated at a median age 18.2 yr (15-27.5), 0.5 (0.1-12) years after withdrawal of GH therapy at age 16 (9 -21) yr. Median duration of treatment was 7.6 (0.4-16.3)yr. At retesting median GH peak was 1.7µg/l (0.1-23.7) and IGF1 level 79ug/l (15-560). Of those re-evaluated 52/60(86.8%) remained GHD and were eligible for adult GH replacement, with 45/60(75%) re-starting GH and 7/60(11.6%) declining GH. The remaining CO-GHD treated patients n=44/104(42.3%) were not re-evaluated either because they were transferred to adult services without re-evaluation (n=21), stopped treatment without reevaluation (n=6), were lost to follow up while on treatment (n=10), or had missing data in (n=7). Conclusions: A substantial proportion of CO-GHD patients remain GHD and most opt for GH therapy as adults, yet not all are re-evaluated. A consensus standardised pathway for re-evaluation of the GH axis between paediatric and adult services has not yet been reached. There is a need to study

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