Hgh how much taller

Delbert A. Fisher; One of the limitations of our study is the lack of controls. Fortunately, there are, presently, a number of randomized and nonrandomized controlled studies that would permit assessment of the benefit, by comparisons of the adult height attained and AH gain in our treated children with those of historical untreated controls.

The adult height and adult height gain AH minus Baseline height are measurements that the investigators obtain and should be more accurate than comparisons based on attainments of PAH or MPH see later. MPH was not used to calculate benefit of treatment. The adult height gain corrects for baseline differences in the different studies in treated subjects and controls, provides information on the benefit of treatment, and permits comparison of groups not matched for baseline heights.

The comparison of adult heights provides also information on the benefit, and when the baselines heights are not different or the AHs are corrected for baseline heights differences, yields the same results as the adult height gain. The reports on SDS permit comparisons of different populations and calculation of the benefit in centimeters based on the centimeters for SD of adults in a particular population. In this presentation we used 6. The benefit in centimeters would be different in different populations depending on the centimeters for SD of adults.

Adult height and adult height gain of treated children in our study versus published untreated controls. Adult height of controls of published studies versus adult height of treated children in our study. The numbers for the different studies for the baseline, adult height and adult height gain of controls and our treated subjects are in Table 8.

Adult height gain of controls of published studies versus adult height gain of treated children in our study. The benefit from treatment for the adult height for our children The analysis of the adult height gain, Table 8 , showed somewhat similar results. The average baseline height of the 9 published studies, Table 8 , was In the study of Rekers-Mombarg et al.

The adult height of our 47 treated NFSS boys of Actually, the adult height of our 47 NFSS boys of This benefit of 8. Comparisons of our results with published Adult Heights of controls and treated children.

Table 9 shows the benefit of different doses of growth hormone on the adult height. In published studies the benefit obtained in adult height was usually less than 4 cm over controls with doses of less than 0. And it was more than 5 cm 6. In our study, the benefit with a dose of 0. The benefit in adult height gain that corrects for differences in baseline heights of our treated children were higher than the adult height gain of the controls in the published studies by 1.

Of interest is that the results in the only two studies that have been published are similar, Table This was also the conclusion of Dahlgren J [ 12 ] in his analysis of these 2 studies. This observation seems to be consistent in the three different studies and has implications for interpretation of results with treatment, in studies where the number of children with FSS in the controls and treated subjects is not known, and in the selection of controls for non-randomized or randomized studies.

The reported impression, by review of published studies, is that the benefit of treatment of children with ISS is less than in other conditions for which GH has been licensed [ 20 , 21 , 61 ]. Our results compare well with those obtained in GH treated children in other conditions for which GH has been approved, growth hormone deficiency GHD , small for gestational age SGA , or Turner syndrome. The adult height of our 88 children with ISS of In a review of four randomized controlled trials RCTs comprising children with SGA treated with growth hormone range of 0.

There was no difference between the 2 dose regimens. The adult height gain in our study exceeded controls by 1. Our results of an increase of 7. In 61 patients with Turner syndrome [ 64 ], treated with 0. Despite this increase, the adult height of treated patient with Turner syndrome was still outside the normal range.

Our experience with the growth hormone treatment of children with ISS was a positive one, with the normalization of the height and growth during childhood and adolescence after 2 or 3 years of treatment and the attainment of a normal adult height of There were no significant adverse effects. All the parents of the children and the children in our study who attained adult heights were pleased with the results, happy for their children to be normal and grateful for the treatment.

The most consistent perception of the parents of the benefit was the improvement of self-esteem in their children, and of the children to be happy to be normal and not different. Other benefits perceived were cessation of teasing, bullying and psychological stress.

The reason for the children lost to follow-up, all growing well and benefiting from treatment, is not known. One can speculate that some were content to be within normal range in height, some may have had difficulty with copays, may have moved, did not care to have more injections, even though all reported that the injections were not painful, and so on. The benefit obtained in our study seems to be better than that reported in a number of previous studies and there must be some reason.

Care was taken in the selection of children to be certain they met qualifications, in the measurements, in the analysis of data and compilation of results. By our observations, there may be two possible reasons, among others; namely the dose of growth hormone used dose dependent effect , and the effect of including an unknown number of children with FSS in the group in previous studies.

Our observations in 88 children clearly show a significant benefit of GH treatment 0. The benefit in the adult height of our treated subjects over the adult height of published historical controls was 9. This benefit is higher by 5 or 6 cm than the benefit obtained in subjects treated with 0. The benefit was only 1. This dose dependent effect has been reported previously in studies using 0.

A dose effect for children with ISS was shown by Wit et al. Also in a randomized controlled study by McCaughey et al. In view of the aforementioned, it is possible that the stated modest benefit of 4 cm with the treatment of ISS is related to the low dose of GH used and to averaging the results without taking in consideration the difference in the benefit from different doses.

In the meta-analysis conducted by Finkelstein et al. The reported benefit of treatment over controls, on the average was 5. Two of the studies used dosages of GH of 0. In the review of Guyda H et al. Seven of the studies used doses of GH ranging from 0. The difference of the adult height range from In three of the studies using 0.

So the difference of adult height from As a consequence of the averaging, the improved benefit obtained, in SDS or cm, with the higher doses of GH is not reflected in the reports, as is illustrated in Table 9 , averaging results of published studies with no benefit By our results, the adult height and adult height gain were significantly higher by 0. This seems to be a consistent finding in different studies and has implications for the interpretation of the results observed in published studies.

The inclusion of a high number of children with FSS in the treated cohort will yield lower results. And also, it has implications for the selection of controls in randomized or non-randomized controlled studies, since the number of children with FSS in the treated or control groups may affect the results. It is difficult to assess how this has affected the results of previous studies, since most or practically all of the published studies included all the children as ISS and did not mention whether they were NFSS or FSS.

The assessment of the benefit from treatment with GH is sometimes difficult, even in controlled studies, because the proportion of children with FSS and NFSS, normal and delayed puberty, and at times IUGR, may not be the same in the treated and control groups. As previously mentioned, to assess the benefit of treatment, comparison of the AH gain adult height minus the baseline height and the AH attained of the treated and control groups would seem to be the best method, because they are based on measurements by the investigator.

Also useful would be the comparison between the groups on the attainment of target height. Target heights, however, are often based on self-reported parental heights. In addition, children with FSS may attain heights near or equal to the MPH without treatment, so the inclusion of a different number of children with FSS in the group may influence the attainment of MPH and render the interpretation as benefit of treatment inaccurate. Furthermore, there are a number of reported methods to calculate MPH [ 47 ], which may give different results for the benefit when comparing AHs and MPHs.

It would also be difficult to compare the benefit of different studies using different methods for calculating MPH. Commonly used methods tend to over-predict AH, especially in young males and in children with delayed bone age, and under-predict if the bone age is not delayed [ 69 ]. Also, the individual variability of the tempo of progression of the bone age, either faster or slower than usually expected, as illustrated in Figure 1 , affects the accuracy of the PAH.

Recent critical reviews [ 20 , 21 , 61 ] concluded that to date no study has fulfilled the criteria for high quality and strong recommendations, in part owing to the small number of children in the studies, and felt that additional high quality trials up to the achievement of adult height would be necessary to determine the efficacy, ideal dosage, long term safety of growth hormone therapy and to address health related quality of life and cost issues. There is agreement with their recommendations.

Even though rhGH has proven to be a remarkably safe medication for 27 years at the doses recommended, long surveillance studies have been suggested by many, because of the mitogenic effect of IGF Regarding the dose, there has been many and probably enough trials with a dose of less than 0. Doses higher than 0. Additional genetic studies may give useful information to explain the variability of response.

In the past 27 years, since rhGH became available in , there have been 3 or 4 randomized studies, up to the achievement of adult height, and, apparently, they did not provide the answers. It may take 8 or more years to get results from more randomized trials.

It is hoped that we do not wait for the answer; many children could benefit while we wait. One of the main problems that has been often addressed in the past is the significant cost, which limits the availability to children who may need it, raises questions about the use of health resources, and a number of ethical considerations [ 25 ]. One may question whether studies would seem applicable to solve the problem of cost; participation from the pharmaceutical industry would be required.

The high cost of biopharmaceuticals is a problem concerning public health services around the world, is in the public domain a , and to reduce cost and increase affordable access to treatment may not be as simple as one may think [ 70 - 72 ]. This is based on the pharmacy bills given to the family for the purchase of GH b.

This cost is applicable to any child treated with GH, whether it be growth hormone deficiency, Turner syndrome, intrauterine growth retardation or ISS. If the price was reasonable, many of the objections to treatment, concerns for use of heath resources, and ethical considerations would subside.

Cost influences pediatric endocrinologists in their decision to treat [ 75 ], and third party payers private insurances or health agencies, state or national in their decision to support treatment [ 74 ].

Also, if the price was reasonable, it, probably, would be the right thing to do to help the children to attain an adult height within the range judged to be normal by National Health Standards and by society. It would not harm anybody. Children with ISS do not attain a normal adult height: adult heights of Growth hormone treatment significantly increases the adult height, but the benefit obtained with doses of less than 0.

The benefit obtained seems dose dependent and a benefit of 7, 7. The treatment was quite helpful with normalization of the height and growth during childhood and attainment of normal adult heights. Eighty eight 68 males, 20 females attained an adult height of Similar results were obtained in the only 2 studies previously reported.

No difference was found in the cohorts with normal or delayed puberty in any of the subgroups, except between the NFSS and FSS subgroups. This has implications for the interpretation of the benefit of treatment in studies where the number of children with FSS in the controls or treated subjects is not known.

There have been, probably, enough trials with a dose of less than 0. Studies with doses from 0. Additional high quality studies have been suggested to determine the efficacy, ideal dosage, health related quality of life, long term safety of GH therapy, and cost.

There is agreement among investigators for these recommendations. In the past 27 years, since rhGH became available in , there have been 3 or 4 randomized studies to adult height, but, apparently, did not provide the answers. It is the hope that we do not wait for the answer; many children could benefit while we wait. See The Economist Economist. JFS contributed to conception and design, treatment of subjects, acquisition, analysis and interpretation of data, drafting and final approval of the manuscript and agrees to be accountable for all aspects of the work.

NJT contributed to testing, acquisition, analysis, and interpretation of data, drafting of the manuscript and final approval of the version to be published. The adult heights reported were adult or near adult heights.

There was a potential growth remaining of children whose heights were obtained before closure of the epiphyses near adult height and before growth ended. Based on the last bone age available on the record, the predicted adult height was calculated i. The effect on the average adult height of the group is shown. This potential growth remaining was not included in the figures reported for adult heights, but could be taken into consideration to determine final adult height and the benefit of growth hormone treatment.

Genentech was kind enough to provide us with the correlation they obtained in their laboratory of GH samples assayed by both methods. All ISS males, B. NFSS males, C. FSS males, D. The results of the individual heights prior to treatment and AHs are plotted at the respective ages after treatment and the MPHs are plotted to the right: A.

ISS males, B. ISS females. National Center for Biotechnology Information , U. Int J Pediatr Endocrinol. Published online Jul Author information Article notes Copyright and License information Disclaimer. Corresponding author. Juan F Sotos: gro. Received Jan 30; Accepted Jun This article has been cited by other articles in PMC. Objective The objective was to conduct a retrospective analysis of our experience with children with ISS treated with 0.

Results Eighty eight of our children 68 males and 20 females attained an adult height or near adult height of Conclusion Our experience was quite positive with normalization of the heights and growth of the children during childhood and the attainment of normal adult heights, the main two aims of treatment.

Keywords: Idiopathic short stature, Growth hormone, Short children, Short stature. Introduction Children with idiopathic short stature ISS do not attain a normal adult height. Subjects Of the children with idiopathic short stature treated with rhGH 0. Open in a separate window. Statistics Paired and unpaired, two-tailed Student T test was used to compare the means of the different groups. Results A few growth charts in Figure 1 illustrate what we observed in many children: a catch up growth for the first 3 or more years of treatment to a level expected for the midparental height, a subsequent normal growth, the growth spurt with puberty and the attainment of a normal adult height.

Figure 1. The damage could have occurred in childhood or adulthood. Other causes include :. Problems in the pituitary with producing growth hormone are commonly due to a pituitary tumor.

The pituitary can be damaged by the tumor itself or by treatment such as surgery and radiotherapy. In adults, a lack of HGH can cause a number of different problems including :. These include :. The most common treatment in both adults and children is growth hormone therapy using lab-developed HGH injections. Doses occur several times per week or on a daily basis depending on how severe the deficiency is.

Manufacturers designed the growth hormone to mimic the behavior of natural growth hormone in the body. It will be prescribed by a doctor. HGH treatments can be self-administered or given by a doctor. Treatments are often given for several years. Patients will see their doctor every month or so to check their condition.

Blood tests will be carried out to see if extra growth hormone is needed and if treatments should be increased, decreased, or stopped.

Cholesterol levels, blood sugar levels, and bone density will also be checked to see if they are healthy. Growth hormone deficiency can also lead to high cholesterol and brittle bones if it is not treated. The earlier the lack of growth hormone is treated in children, the better chance they have to grow to a near normal adult height. Children can gain as many as 4 inches or more over the first 3 years of treatment.

Another 3 inches or more can grow during the next 2 years. Anyone taking HGH will undergo regular monitoring to assess the safety and effectiveness of the hormone. The goal of growth hormone treatments in adults and children is to restore energy, metabolism, and enhance body development or shape. It can help to reduce total body fat, especially around the belly.

HGH injections can also help to improve strength and exercise tolerance and reduce the risk of heart disease in those who lack growth hormone. Many people experience an increase in overall quality of life. Most people tolerate HGH injection treatments well with few problems.

Those who experience these symptoms or other problems should talk to their doctor. They can change the dose if necessary to help remedy the symptoms. HGH injections are not recommended for people who have:. HGH can affect insulin usage in the body, so people with diabetes should monitor their blood sugar levels carefully.

Surgery or radiation may be necessary to treat a tumor in the pituitary. Pituitary hormones may also have to be taken to correct a gland that is not working properly. If the levels of HGH are too high in adults, they may experience:.

Long-term use of HGH injections can cause a condition called acromegaly. Adults cannot grow taller by using the synthetic growth hormone. This is the exact mechanism that allows children to grow. With that stated if we add additional HGH to a child that is under developing it will help them grow to a normal height.

But why can we not do this for adults wanting to gain height? This is due to the fact that after puberty our growth plates begin to fuse with the bones they are associated with. When this fusion takes place there is no place for human growth hormone to stimulate new bone to be added. At this point in time, when the growth plates are closed, HGH therapy will not increase height.

This typically is seen around the age of 18 when growth plate fusion is occurring or has finished. For a young adult, roughly at the age of , there is still a slight chance their growth plates will be open. Premature birth or slow aging can lead to slowly developing bones. This slower than normal development will leave the growth plates unable to fuse for a longer period of time and allowing height to be achieved.

A simple test can be done to see if the growth plates are still open called a bone age test.