REDUCED LEVELS OF GROWTH-HORMONE, INSULIN-LIKE GROWTH-FACTOR-I AND BINDING PROTEIN-3 IN PATIENTS WITH SHUNTED HYDROCEPHALUS

Objective-Children with hydrocephalus are characterised by slow linear growth in prepuberty, accelerated physical maturation during puberty, and reduced final height. We aimed to study the possible roles of gro wth hormone, insulin-like growth factor-I (IGF-I), and IGF binding pro tein-3 (IGFBP-3) in this growth pattern. Study design-One hundred and fourteen patients with shunted hydrocephalus (62 males) aged 5 to 20 y ears, of whom 17 had spina bifida (six males), and 73 healthy controls (38 males) were studied. Anthropometric measures, body mass index, an d body fat mass were assessed and the stage of puberty was determined. Serum growth hormone and plasma IGF-I and IGFBP-3 concentrations were measured. Results-The patients comprised 44 (26 males) who were prepu bertal and 70 (36 males) pubertal or postpubertal, while 32 of the con trols (19 males) were prepubertal and 41 (19 males) pubertal or postpu bertal. The prepubertal children with hydrocephalus had lower IGF-I (p = 0.002) and IGFBP-3 concentrations (p< 0.001) than the controls, and the pubertal children had four times lower basal growth hormone conce ntrations (p< 0.001). There was a correlation between height SD score and IGF-I levels in the total patientpopulation (r = 0.23; p = 0.01). Peripheral IGF-I concentrations peaked at pubertal stages 23 in the fe male patients and at stage 4 in the controls. The prepubertal patients on antiepileptic treatment, carbamazepine in most cases (73%), had hi gher IGF-I (p = 0.01) and IGFBP-3 concentrations (p = 0.03) than those who had never been treated with antiepileptic drugs, but still lower IGFBP-3 levels than the controls (p = 0.01). Conclusion- Based on thes e findings, it can be concluded that reduced growth hormone secretion may contribute to the pattern of slow linear growth and reduced final height observed in these patients.