ARM SPAN, SERUM IGF-1 AND IGFBP-3 LEVELS AS SCREENING PARAMETERS FOR THE DIAGNOSIS OF GROWTH-HORMONE DEFICIENCY IN PATIENTS WITH MYELOMENINGOCELE - PRELIMINARY DATA

Short stature is a common problem in patients with myelomeningocele (M MC) and hydrocephalus. We evaluated auxological and laboratory paramet ers to differentiate short stature due to neurological defect from sho rt stature additionally caused by growth hormone deficiency (GHD). In a group of 38 prepubertal patients with MMC and hydrocephalus aged 3.8 -11.0 years, auxological parameters, including arm span and bone age, and serum insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels were measured. Patients wit h normal supine length (n = 15) had normal arm span. Serum IGF-1 and I GFBP-3 levels were normal (greater than or equal to 10th percentile) i n 14/15 patients. Twenty-three MMC patients had short stature (height SDS < -2), 11/23 patients had reduced arm span(SDS < -2), and 12/23 ha d normal arm span. Serum IGF-1 and IGFBP-3 levels were normal in 10/12 of short statured patients with normal arm span, but low (< 10th perc entile) in those patients with reduced arm span (IGF-1: 8/11 patients, P < 0.05; IGFBP-3: 9/11 patients, P < 0.005). In 7/11 short statured MMC patients with reduced arm span and low serum IGF-1 and IGFBP-3 lev els, growth hormone secretion was investigated. All had a disturbed gr owth hormone secretion (GHD: n = 4; neurosecretory dysfunction: n = 3) . Conclusion Arm span, serum IGF-1 and IGFBP-3 levels are estimated to be appropriate screening parameters for GHD in patients with MMC. Ini tiating growth hormone therapy should be considered hot only according to endocrine findings but also with respect to neurological and ortho paedic anomalies.