THE EFFECT OF A CONTINUOUS-INFUSION OF A SOMATOSTATIN ANALOG (OCTREOTIDE) FOR 2 YEARS ON GROWTH-HORMONE SECRETION AND HEIGHT PREDICTION IN TALL CHILDREN
THE EFFECT OF A CONTINUOUS-INFUSION OF A SOMATOSTATIN ANALOG (OCTREOTIDE) FOR 2 YEARS ON GROWTH-HORMONE SECRETION AND HEIGHT PREDICTION IN TALL CHILDREN
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DOI：
10.1111/j.1365-2265.1995.tb02670.x
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发表时间：
1995-05-01
影响因子：
3.2
通讯作者：
BROOK, CGD
中科院分区：
文献类型：
--
作者：
HINDMARSH, PC;PRINGLE, PJ;BROOK, CGD
目的限制尾仔最终身高的策略主要集中在使用高剂量的性类固醇来促进骨骼成熟。这将治疗限制在青春期前后，而身高的最大增加是在青春期前。青春期前生长主要依赖于生长激素，以前的工作记录了一次或两次皮下注射生长抑素类似物奥曲肽对生长激素分泌的调节。在这项研究中，我们已经确定了夜间注射奥曲肽对身高预测，GH和TSH分泌的高个子儿童的影响。设计：一项患者对照研究，在8年的治疗计划中，以1-1.5 μ g/kg体重的剂量进行奥曲肽的夜间皮下注射，在治疗前和治疗过程中比较身高预测和24小时OH和TSH分泌。（4名男性; 5 F）年龄在7-14岁，女孩的最终身高预测为179 cm或更高，男孩的最终身高预测为183和202 cm之间。治疗2年之前和结束时的怀特豪斯系统。24小时血清On和TSH浓度曲线，甲状腺素，IGF-1和GH对GHRH（1-29）NH 2的反应在治疗的第一年之前和结束时进行了研究。结果奥曲肽治疗导致8名完成治疗的儿童中有7名的身高预测显著降低（中位数降低3.5 cm，范围+2.8至-11.5; Wilcoxon，P=0.05）。治疗期间24小时平均血清GH浓度下降50%（MANOVA，P=0.03），同时伴有数值小于0.5 mU/l的样本百分比增加（MANOVA，P=0.02）。血清GH对GHRH（1-29）N-2或血清IGF-I浓度的反应没有总体变化。夜间血清TSH浓度降低到白天观察到的水平，但这些变化对血清甲状腺素值没有影响。一名患者在治疗过程中出现胆结石。结论：夜间输注奥曲肽可降低高个子儿童的GH分泌和身高预测。用生长抑素类似物治疗可以降低青春期前的生长速度，降低青春期生长突增的实际身高。
OBJECTIVE Strategies to limit the final height of tail children have centred on the use of high doses of sex steroids to advance skeletal maturation. This limits therapy to the peripubertal years whereas the greatest gain in height is in the prepubertal years. Prepubertal grows is largely GH dependent and previous work has documented modulation of GH secretion by once or twice dairy subcutaneous injection of the somatostatin analogue octreotide. In this study we have determined the effects of a nocturnal infusion of octreotide on height prediction, GH and TSH secretion in tall children. DESIGN A patient controlled study in which height prediction and 24-hour OH and TSH secretion were compared prior to and during the course of a 8-year treatment programme with a nocturnal infusion of octreotide in a dose of 1-1.5 mu g/kg body weight given subcutaneously.PATIENTS Nine tall children (4 M; 5 F) aged 7-14 years with final height predictions of 179 cm or greater in the girls and between 183 and 202 cm in the boys were studied.MEASUREMENTS Height prediction using the Tanner-Whitehouse system prior to and at the end of 2 years of treatment. Twenty-four-hour serum On and TSH concentration profiles, thyroxine, IGF-l and GH responses to GHRH(1-29)NH2 were studied prior to and at the end of the first year of therapy.RESULTS Treatment with octreotide led to a significant reduction in height prediction in 7 of the 8 children who completed treatment (median reduction 3.5 cm, range +2.8 to -11.5; Wilcoxon, P=0.05). Twenty-four-hour mean serum GH concentration decreased By 50% (MANOVA, P=0.03) during therapy and this was accompanied by an increase in the percentage of samples giving values less than 0.5 mU/l (MANOVA, P=0.02). There was no overall change in the serum GH response to GHRH(1-29)N-2 or serum IGF-I concentrations. Nocturnal serum TSH concentrations were reduced to levels observed during the daytime but these changes had no effect an serum thyroxine values. One patient developed gallstones during the course of therapy.CONCLUSIONS A nocturnal Infusion of octreotide reduces GH secretion and height prediction in tall children. Therapy with somatostatin analogues allows a reduction in growth rate to be instigated in the prepubertal years reducing the actual height from which will commence the pubertal growth spurt.