Growth hormone treatment of short stature and metabolic dysfunction in juvenile chronic arthritis

Severe growth retardation and profoundly altered body composition are obser ved in children treated with glucocorticoids for systemic forms of juvenile chronic arthritis. The aim of this study was to assess the effects of 1 ye ar of treatment with growth hormone (GH) on height velocity and body compos ition, and the potential effects of such treatment on glucose tolerance. Fo urteen children receiving steroid therapy fur juvenile chronic arthritis we re treated with GH, 1.4 IU/kg/week (0.47 mg/kg/week), for 1 year and were t hen followed up for 1 year after cessation of treatment. Baseline GH secret ion and plasma levels of insulin-like growth factor I (IGF-I) and IGF-bindi ng protein-3 (IGFBP-3) were at the lower limit of normal, but increased wit h GH treatment. During the year of GH treatment, mean height velocity incre ased from 1.9 to 5.4 cm/year (p < 0.001). mean lean body moss increased by 12% (p < 0.01) and mean fat mass fell by 20% (p < 0.01) compared with basel ine. Decreased glucose tolerance and increased glycosylated haemoglobin lev els were also observed, This may have been a result of insulin resistance. as indicated by induced hyperinsulinaemia. Following the 1-year GH treatmen t period, height velocity fell to pretreatment values, and the height SDS a t the end of the second year was lower (p < 0.01) than before treatment, We ight and fat mass increased markedly after cessation of GH treatment. These results suggest that GH may partially counteract the adverse effects of gl ucocorticoids on growth and metabolism in patients with chronic inflammator y disease. Long-term controlled studies are needed to determine the risks a nd benefits of GH therapy in such patients.