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Exp Clin Endocrinol Diabetes 2011; 119(09): 544-548
DOI: 10.1055/s-0031-1285913
Article
© J. A. Barth Verlag in George Thieme Verlag KG Stuttgart · New York

Impact of Overweight on Effectiveness of Treatment with Human Growth Hormone in Growth Hormone Deficient Children: Analysis of German KIGS Data

T. Reinehr
1   Vestische Hospital for Children and Adolescents, Datteln, University of Witten/Herdecke, Germany
,
S. Bechtold-Dalla Pozza
2   University Children’s Hospital, Munich
,
M. Bettendorf
3   University Hospital for Children and Adolescents, Heidelberg
,
H.-G. Doerr
4   University Hospital for Children and Adolescents, Erlangen
,
B. Gohlke
5   University Children’s Hospital, Bonn
,
B. P. Hauffa
6   Department of Paediatric Endocrinology and Diabetes, University Hospital for Children and Adolescents, Duisburg-Essen
,
S. Kaspers
7   Pfizer Ltd, Medical Affairs, Tadworth, UK
,
C. Land
8   Paediatric Endocrinology, Endokrinologikum, Munich/Hamburg
,
O. Mehls
3   University Hospital for Children and Adolescents, Heidelberg
,
K.-O. Schwab
9   University Children’s Hospital, Freiburg
,
N. Stahnke
8   Paediatric Endocrinology, Endokrinologikum, Munich/Hamburg
,
M. B. Ranke
10   Department of Paediatrics and Endocrinology, University Children’s Hospital, Tuebingen, Germany
,
on behalf of the German KIGS Study Board › Author Affiliations
Further Information

Publication History

received 08 December 2010
first decision 21 June 2011

accepted 03 August 2011

Publication Date:
17 October 2011 (online)

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Abstract

Background:

We hypothesized that overweight children with growth hormone deficiency (GHD) demonstrate a lower response to growth hormone (GH) as a result of a misclassification since obesity is associated with lower GH peaks in stimulation tests.

Methods:

Anthropometric data, response, and responsiveness to GH in the first year of treatment were compared in 1.712 prepubertal children with GHD from the German KIGS database according to BMI (underweight=group A, normal weight=group B, overweight=group C) (median age: group A, B, C: 7.3, 7.28, and 8.4 years).

Results:

Maximum GH levels to tests (median: group A, B, C: 5.8, 5.8, and 4.0 µg/ml) were significantly lower in group C. IGF-I SDS levels were not different between the groups. Growth velocity in the first year of GH treatment was significantly lower in the underweight cohort (median: group A, B, C: 8.2, 8.8, and 9.0 cm/yr), while the gain in height was not different between groups. The difference between observed and predicted growth velocity expressed as Studentized residuals was not significantly different between groups. Separating the 164 overweight children into obese children (BMI>97th centile; n=71) and moderate overweight children (BMI>90th to 97th centile, n=93) demonstrated no significant difference in any parameter.

Conclusions:

Overweight prepubertal children with idiopathic GHD demonstrated similar levels of responsiveness to GH treatment compared to normal weight children. Furthermore, the IGF-I levels were low in overweight children. Therefore, a misclassification of GHD in overweight prepubertal children within the KIGS database seems unlikely. The first year growth prediction models can be applied to overweight and obese GHD children.

Key words

growth hormone deficiency - growth hormone treatment - obesity - prediction model - index of responsiveness
 

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