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Rapid cardiovascular effects of growth hormone treatment in short prepubertal children: impact of treatment duration

Authors

  • Anders Nygren,

    Corresponding author
    1. Pediatric Cardiology at Department of Pediatrics, Institute of Clinical Science, The Sahlgrenska Academy at University of Gothenburg, Gothenburg
    • Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Science, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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  • Jan Sunnegårdh,

    1. Pediatric Cardiology at Department of Pediatrics, Institute of Clinical Science, The Sahlgrenska Academy at University of Gothenburg, Gothenburg
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  • Dag Teien,

    1. Department of Clinical Science, Paediatrics, Umeå University, Umeå, Sweden
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  • Anders Jonzon,

    1. Pediatric Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden
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  • Gudrun Björkhem,

    1. Department of Pediatrics, Skåne University Hospital/Lund, Lund
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  • Sven Lindell,

    1. Department of Pediatrics, County Hospital Halmstad, Halmstad, Sweden
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  • Kerstin Albertsson-Wikland,

    1. Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Science, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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  • Berit Kriström

    1. Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Science, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
    2. Department of Clinical Science, Paediatrics, Umeå University, Umeå, Sweden
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Correspondence: Anders Nygren, Department of Cardiology, The Queen Silvia Children's Hospital, SE-416 85 Göteborg, Sweden. Tel.: +46 31 343 40 00; Fax: +46 31 845029; E-mail: anders.nygren@vgregion.se

Summary

Objective

Previous studies show that growth hormone (GH) treatment increases cardiac dimensions in short children with GH deficiency (GHD) and has diverse cardiac effects in children with idiopathic short stature (ISS). This study was performed to assess the effect of GH on the cardiovascular system in short children with a broad range of GH secretion and GH sensitivity/responsiveness.

Design and patients

In this prospective, multicentre study, short prepubertal children diagnosed with isolated GHD (89) or ISS (38) were followed during 2 years of GH treatment. They were randomized to receive either a standard (43 μg/kg/day) or an individualized GH dose (range 17–100 μg/kg/day) based on GH responsiveness estimated by a prediction model and distance to target height. Echocardiography, blood pressure and electrocardiography were performed at baseline, 3, 12 and 24 months.

Results

Left ventricular mass (LVM) indexed to body surface area increased significantly during 2 years of GH treatment in both GHD and ISS irrespective of randomized dose. This change was already apparent at 3 months, when standard deviation scores (SDS) of wall thickness and diameter were increased. At 24 months, left ventricular diameter SDS remained increased, whereas myocardial thickness SDS returned to baseline values. There was no impairment of systolic or diastolic function. There was no correlation with treatment dose and LVM SDS at 24 months.

Conclusions

Irrespective of GH status, there was a rapid increase in LVM during GH treatment in short children. At 3 months, wall thickness and diameter were increased, whereas only diameter remained increased at 24 months.

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