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Publisher: Cochrane Collaboration
Languages: English
Types: Article
Subjects:
: Idiopathic short stature (ISS) refers to children who are very short compared with their peers for unknown or hereditary reasons. Recombinant human growth hormone (GH) has been used to increase growth and final height in children with ISS.
: To assess the effects of recombinant human GH on short-term growth and final height in children with ISS.
: Studies were obtained from computerised searches of MEDLINE, EMBASE, The Cochrane Library, Science Citation Index, BIOSIS and Current Controlled Trials. Article reference lists were assessed for trials and experts and pharmaceutical companies were contacted.
: Randomised controlled trials were included if they were carried out in children with ISS with normal GH secretion. GH had to be administered for a minimum of six months and be compared with placebo or no treatment. A growth or height outcome measure had to be assessed.
: Two reviewers assessed studies for inclusion criteria and for methodological quality. Data were extracted by one reviewer and checked by a second. The primary outcome was final height and secondary outcomes included short term growth, health related quality of life and adverse effects. To estimate summary treatment effects, data were pooled, when appropriate using a random effects model.
: Ten RCTs were included. One trial reported near final height in girls and found that girls treated with GH were 7.5 cm taller than untreated controls (GH group, 155.3 cm +/- 6.4; control, 147.8 cm +/- 2.6; P = 0.003); another trial which reported adult height standard deviation score found that children treated with GH were 3.7 cm taller than children in a placebo-treated group (95% confidence intervals 0.03 to 1.10; P < 0.04). The other trials reported short term outcomes. Results suggest that short-term height gains can range from none to approximately 0.7 SD over one year. One study reported health related quality of life and showed no significant improvement in GH treated children compared with those in the control group, whilst another found no significant evidence that GH treatment impacts psychological adaptation or self-perception in children with ISS. No serious adverse effects of treatment were reported.
: GH therapy can increase short-term growth and improve (near) final height. Increases in height are such that treated individuals remain relatively short when compared with peers of normal stature. Large, multicentre RCTs are required which should focus on final height and address quality of life and cost issues.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • We searched the following electronic databases: • The Cochrane Library (issue 4, 2005); • MEDLINE (Ovid; 1981 to December 2005); • PubMed (searched 7 June 2006); • Science Citation Index (searched 7 June 2006); • BIOSIS (searched 7 June 2006).
    • Searches were not conducted for trials before 1980 because recom-
    • binant growth hormone (GH) was not introduced until 1985. For
    • details of the search strategy see Appendix 1.
    • Trials (www.controlled-trials.com; 7 June 2006).
    • Leschek 2004 {published data only} ∗ Leschek EW, Rose SR, Yanovski JA, Troendle JF, Quigley CA, Chipman JJ, Crowe BJ, Ross JL, Cassorla FG, Blum WF, Cutler GB, Baron J. Effect of growth hormone treatment on adult height in peripubertal children with idiopathic short stature: a randomised, doubleblind, placebo-controlled trial th. The Journal of Clinical Endocrinology & Metabolism 2004;89(7):3140-8.
    • McCaughey 1994 {published data only} ∗ McCaughey ES, Mulligan J, Voss LD, Betts PR. Growth and metabolic consequences of growth hormone treatment in prepubertal short normal children. Archives of Disease in Childhood 1994;71(3):201-6. [MEDLINE: 36]
    • McCaughey 1998 {published data only} ∗ McCaughey ES, Mulligan J, Voss LD, Betts PR. Randomised trial of growth hormone in short normal girls. Lancet 1998;351(9107):940-4. [MEDLINE: 16]
    • Ross 2004 {published data only} ∗ Ross JL, Sandberg DE, Rose SR, Leschek EW, Baron J, Chipman JJ, Cassorla FG, Quigley CA, Crowe BJ, Roberts K, Cutler GB. Psychological adaptation in children with idiopathic short stature treated with growth hormone or placebo. The Journal of Clinical Endocrinology & Metabolism 2004;89(10):4873-8.
    • Soliman 1996 {published data only} ∗ Soliman AT, abdul-Khadir MM. Growth parameters and predictors of growth in short children with and without growth hormone (GH) deficiency treated with human GH: a randomized controlled study. Journal of Tropical Pediatrics 1996;42(5):281-6. [MEDLINE: 89]
    • Theunissen 2002 {published data only} ∗ Theunissen NC, Kamp GA, Koopman HM, Zwinderman AH, Vogels T, Wit J. Quality of life and self-esteem in children treated for idiopathic short stature. The Journal of Pediatrics 2002;140:507-15.
    • Volta 1993 {published data only} ∗ Volta C, Bernasconi S, Tondi P, Salvioli V, Ghizzoni L, Baldini A, Alberini A, Carani C. Combined treatment with growth hormone and luteinizing hormone releasing hormone-analogue (LHRHa) of pubertal children with familial short stature. Journal of Endocrinological Investigation 1993;16(10):763-7. [MEDLINE: 82]
    • Child Growth 2000 Child Growth Foundation. Child Growth. www.eguidelines.co.uk (July 2002) 2000.
    • Finkelstein 1998 Finkelstein BS, Silvers JB, Marrero U, Neuhauser D, Cuttler L. Insurance coverage, physician recommendations, and access to emerging treatments. Journal of the American Medical Association 1998;279(9):663-8.
    • Finkelstein 2002 Finkelstein BS, Imperiale TF, Speroff T, Marrero U, Radcliffe DJ, Cuttler L. Effect of growth hormone therapy on height in children with idiopathic short stature. A metaanalysis. Archives of Pediatric and Adolescent Medicine 2002; 156:230-40.
    • Frindik 1999 Frindik JP, Baptista J. Adult height in growth hormone deficiency: Historical perspective and examples from the National Cooperative Growth Study. Pediatrics 1999;104 (4):1000-4.
    • Frisch 1997 Frisch H. Pharmacovigilance: The use of KIGS (Pharmacia and Upjohn International Growth Database) to monitor the safety of growth hormone treatment in children. Endocrinology and Metabolism Supplement 1997;4((B)): 83-6.
    • Gault 2001 Gault EJ, Donaldson MD. Efficacy of growth hormone therapy in Turner's Syndrome. http://bsped.shef.ac.uk/ XONICE.html (July 2002) 2001.
    • GH Soc 2001 Growth Hormone Research Society. Consensus critical evaluation of the safety of recombinant human growth hormone administration: Statement from the Growth Hormone Research Society. Journal of Clinical Endocrinology and Metabolism 2001;86(5):1868-70.
    • Hilken 2001 Hilken J. UK audit of childhood growth hormone prescription, 1998. Archives of Disease in Childhood 2001; 84:387-9.
    • Kelnar 1999 Kelnar C, Albertsson-Wikland K, Hintz R, Ranke M, Rosenfeld R. Should we treat children with idiopathic short stature?. Hormone Research 1999;52:150-7.
    • Kirk 2001 Kirk J. BSPED consensus guidelines: Use of growth hormone in non-licensed indications. http://bsped.shef.ac.uk/ ULNICE.html (July 2002) 2001.
    • Lee 2006 Lee JM, Davis MM, Clark SJ, Hofer TP, Kemper AR. Estimated cost-effectiveness of growth hormone therapy for idiopathic short stature. Arch Pediatr Adolesc Med 2006;160 (3):263-9.
    • Preece 2000 Preece MA. Disorders of Growth. In: Ledingham JGG, Warrell DA editor(s). Concise Oxford textbook of medicine. Oxford: Oxford University Press, 2000.
    • Price 1996 Price DA. Spontaneous adult height in patients with idiopathic short stature. Hormone Research 1996;45 Suppl 2:59-63.
    • Ranke 1995 RANKE MB, Grauer ML, Kistner K, Blum WF, Wollmann HA. Spontaneous adult height in idiopathic short stature. Hormone Research 1995;44(4):152-7.
    • Ranke 1996 RANKE MB. Towards a consensus on the definition of idiopathic short stature. Hormone Research 1996;45(Suppl 2):64-6.
    • Taback 1999 Taback SP, Guyda HJ, Van Vliet G. Pharmacological manipulation of height: qualitative review of study populations and designs. Clinical Investigation in Medicine 1999;22(2):53-9.
    • Wit 1996 Wit JM, Kamp GA, Rikken B. Spontaneous growth and response to growth hormone treatment in children with growth hormone deficiency and idiopathic short stature. Pediatric Research 1996;39(2):295-302.
  • No related research data.
  • No similar publications.

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