This SR highlights the lack of long-term RCTs reporting final height data and other important qualitative outcomes , such as quality of life .
ABSTRACT Genotropin ( somatropin ) is licensed for the treatment of children with growth hormone deficiency , Prader-Willi syndrome , Turner syndrome , chronic renal insufficiency and in children born small for gestational age .
This systematic review ( SR ) evaluated the clinical efficacy and effectiveness of Genotropin in these conditions to inform a NICE Technology Appraisal of growth hormone for the treatment of growth failure in children .
High-dose growth hormone (GH) treatment in non-GH-deficient children born small for gestational age induces growth responses related to pretreatment GH secretion and associated with a reversible decrease in insulin sensitivity.
GH therapy variably reduces the height deficit of short children born small for gestational age ( SGA ) but is associated with hyperinsulinemia . Intermittent , higher-dose GH regimens may be alternatives to continuous , lower-dose treatment . We examined whether the growth response to GH therapy is related to pre-treatment indices of endogenous somatotropic activity , and studied the reversibility of the insulin resistant state induced by GH . 13 non-GH deficient short SGA children were r and omised to high-dose GH ( 100 mcg/kg/day ) by daily sc injection ( n = 9 ) , or no GH treatment ( n = 4 ) for 2 years ( 2/4 controls subsequently received GH treatment ) .  Overnight GH profiles  were performed at baseline ;  intravenous glucose tolerance tests  were performed at baseline , yearly on GH treatment , and 3 months post-GH treatment . Fasting glucose , insulin and proinsulin levels were measured , insulin sensitivity estimated using Bergman 's minimal model , and glucose tolerance calculated from rate of glucose disappearance . In all GH-treated children , gain in height SDS ( mean gain yr 1 = + 1.2 SDS ) was inversely related to baseline peak overnight GH ( r = -0.88 , n = 10 , p = 0.0008 ) , IFG-I ( r = -0.74 , n = 11 , p = 0.009 ) , and fasting insulin levels ( r = -0.71 , n = 11 , p = 0.014 ) . GH treatment increased fasting glucose ( means : baseline vs. yr 2 : 3.7 vs. 4.4 mmol/l , p = 0.005 ) , insulin ( 3.8 vs. 13.9 mU/l , p = 0.0002 ) , and proinsulin levels ( 1.7 vs. 4.5 pmol/l , p = 0.004 ) , and decreased insulin sensitivity ( 26.9 vs. 4.0 per min/mU/1 x 10(4 ) , p = 0.002 ) . Glucose tolerance initially decreased ( baseline : 2.62 min(-1 ) ; yr 1 : 2.18 , p = 0.02 ; yr 2 : 2.39 , p = 0.12 ) . However , by 3 months post-GH treatment significant improvements were seen in fasting insulin ( post-GH : 5.2 mU/1 , p = 0.0003 vs. yr 2 ) , proinsulin ( 1.7 pmol/l , p = 0.002 ) , and insulin sensitivity ( 17.6 per min/mU/1 x 10(4 ) , p = 0.0001 ) . Post-GH treatment , fasting glucose levels ( 4.1 mmol/l , p = 0.04 ) and glucose tolerance ( 2.49 min(-1 ) , p = 0.4 ) were similar to baseline , and the slight increase in fasting insulin levels ( 5.2 mU/1 , p = 0.04 ) was similar to that observed in non-GH treated children over the 2 yr study period ( baseline vs. 2 years : 3.9 vs. 5.9 mU/1 , n = 4 ) . In conclusion , in this study of 13 short non-GH-deficient SGA children , high-dose GH therapy induced growth responses that were associated with reversible decreases in insulin sensitivity , and that were predicted by pretreatment markers of endogenous , but not stimulated , somatotropic activity
This SR highlights the lack of long-term RCTs reporting final height data and other important qualitative outcomes , such as quality of life .
ABSTRACT Genotropin ( somatropin ) is licensed for the treatment of children with growth hormone deficiency , Prader-Willi syndrome , Turner syndrome , chronic renal insufficiency and in children born small for gestational age .
This systematic review ( SR ) evaluated the clinical efficacy and effectiveness of Genotropin in these conditions to inform a NICE Technology Appraisal of growth hormone for the treatment of growth failure in children .