Factors Influencing Growth Response After Treatment in Children with Growth Hormone Deficiency

INTRODUCTION: Regular monitoring of growth and weight in children is crucial for effective child health surveillance. Growth retardation is suspected when a child's height falls below -2 standard deviations (SD) for age and sex, or when there is an abnormal growth velocity. Whereas endocrine causes account for less than 10% of growth retardation cases, they are essential to identify, as they require specific treatment. Growth Hormone Deficiency (GHD) is one such endocrine cause, with a prevalence ranging from 1 in 4,000 to 1 in 10,000 in Europe and the U.S. Advancements in diagnostic methods have improved early detection, allowing more children to benefit from treatment. The objective of this study is to investigate the therapeutic aspects and outcomes for children followed for GHD to identify the factors influencing the results of GH treatment. METHODS: A descriptive retrospective study was conducted on patients hospitalized or followed for GHD at the Endocrinology Department of Farhat Hached University Hospital in Sousse from January 2000 to December 2020. Data were collected using a form that included epidemiological data, familial and personal history, clinical data at first consultation, bone age assessment, initial biological assessment, and substitutive treatment details. RESULTS: The study enrolled 102 children (63 boys and 39 girls), with a mean age of 12±3.83 years at diagnosis. The mean height at diagnosis was 128±17 cm. GH deficiency was classified as complete in 63.7% and partial in 36.3% of cases. Associated deficits were found in thyrotropic (14.7%), corticotropic (19.6%), and gonadotropic (18.6%) axes. The average weekly dose of recombinant human growth hormone (rh-GH) was 0.7±0.12 IU/kg, and the mean stature gain under treatment was 17.5±14.5 cm, with a final height of 148±14 cm on average. Notably, younger children at the start of treatment showed greater stature gains, and regular adherence to treatment significantly correlated with improved outcomes. Overall, definitive stature gain was primarily associated with the frequency of GH injections and treatment regularity. The multivariate study showed that definitive stature gain was only associated with the frequency of GH injection and the regularity of treatment. CONCLUSION: The study concludes that GH treatment can significantly enhance growth in children with GHD, but various factors, including timing of initiation, adherence to therapy, and individual patient characteristics, can affect whether the final adult height aligns with parental expectations. Stature gain can also be improved by emphasizing early diagnosis, patient education, and treatment adherence.