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Re: [HGF/P] First Post, Long Story

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Posted
Posted

>References:

>Date: Wed, 18 Aug 1999 16:12:49 +0000

>Reply-To: Human Growth Foundation Pediatric Support List

>Sender: Human Growth Foundation Pediatric Support List

>

>Subject: Re: [HGF/P] First Post, Long Story

>To: HGF-PEDS@...

>

>Hi everybody,

>

>ette, very interesting article! I have a few comments and will look

forward

>to what others have to say-

>

>The first, and most important, is the dose used in the study. It is almost

HALF

>of what our ped endo uses...they used 0.17mg/kg/week, Philip (and many

others, at

>least the kids at UCLA) gets 0.3mg/kg/week.

>

>The second involves a phenomenon called " negative feedback " . (I'm putting my

> " pharmacist " hat on for a minute, please bear with me!) In a normal scenario,

>the hypothalamus sends a hormonal signal to the pituitary to produce growth

>hormone, the pituitary does so, and the presence of growth hormone " loops " a

>signal back to the hypothalamus telling it to stop sending it's hormonal

signal.

>In a diagram, it looks like this:

>

> Normal chain of events

>

>HYPOTHALAMUS----------->PITUITARY--------------->GROWTH HORMONE

>

>^

>^

>

>^

>^

> <<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<

> Negative feedback " loop "

>

>Now, the beauty of this is that, for kids with functioning pituitaries (non

>panhypopit) this allows for two areas for intervention-you can either

administer

>the growth hormone the way we do now, OR soon the hormone produced by the

>hypothalamus (I think it's called growth hormone stimulating hormone) will

also be

>available (this may be GEREF, but I'm not sure).

>

>However, if you look at the diagram, you can see that giving someone growth

>hormone will turn off the hypothalamus, effectively turning even a NON-ghd kid

>into a ghd kid.

>I remember this very well because Philip was only " partially deficient " and I

>asked Dr. Geffner if he could use a lower dose. He said NO, in effect the

>supplemental gh would make Philip completely gh deficient by turning off

his own

>production.

>

>SO-this is my question-IF these NON-ghd kids received enough gh to " turn off "

>their OWN production but NOT enough to grow adequately, couldn't this

account for

>the results of the study? I'll try to remember to ask Dr. Geffner, we see

him on

>the 31st.

>

>Thanks again for getting this out-very interesting! And Earl, if this

posting is

>rejected because it's too long I'll have a spasm :0)

>

>

>mom/pharmacist to Philip, 7 1/2 ghd

>na, 5

>Santa , CA

>

><HTML>

>Hi everybody,

>

><P>ette, very interesting article! & nbsp; I have a few comments and

>will look forward to what others have to say-

>

><P>The first, and most important, is the dose used in the study. & nbsp;

>It is almost HALF of what our ped endo uses...they used 0.17mg/kg/week,

>Philip (and many others, at least the kids at UCLA) gets 0.3mg/kg/week.

>

><P>The second involves a phenomenon called " negative feedback " . (I'm putting

>my " pharmacist " hat on for a minute, please bear with me!) & nbsp; In a normal

>scenario, & nbsp; the hypothalamus sends a hormonal signal to the pituitary

>to produce growth hormone, the pituitary does so, and the presence of growth

>hormone " loops " a signal back to the hypothalamus telling it to stop sending<I>

>it's</I> hormonal signal. & nbsp; In a diagram, it looks like this:

>

><P> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbs

p; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n

bsp; & nbsp; & nbsp; & nbsp;<I>

>Normal chain of events</I>

>

><P>HYPOTHALAMUS----------->PITUITARY--------------->GROWTH HORMONE

><BR> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

>^ & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbs

p; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbs

p; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

>^

><BR> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

>^ & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbs

p; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbs

p; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

>^

><BR> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp

; & nbsp;

> & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt

; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt; & lt

; & lt; & lt; & lt; & lt; & lt; & lt;

><BR> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp

; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nb

sp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; &

nbsp; & nbsp; & nbsp; & nbsp; & nbsp;<I>

>Negative feedback " loop " </I><I></I>

>

><P>Now, the beauty of this is that, for kids with functioning pituitaries

>(non panhypopit) this allows for two areas for intervention-you can either

>administer the growth hormone the way we do now, OR soon the hormone produced

>by the hypothalamus (I think it's called growth hormone <I>stimulating</I>

>hormone) will also be available (this <I>may</I> be GEREF, but I'm not

>sure).<I></I>

>

><P>However, if you look at the diagram, you can see that giving someone

>growth hormone will turn off the hypothalamus, effectively turning even

>a NON-ghd kid <I>into</I> a ghd kid.

><BR>I remember this very well because Philip was only " partially deficient "

>and I asked Dr. Geffner if he could use a lower dose. & nbsp; He said NO,

>in effect the supplemental gh would make Philip completely gh deficient

>by <I>turning off his own production.</I>

>

><P>SO-this is my question-IF these NON-ghd kids received enough gh to " turn

>off " their OWN production but NOT enough to grow adequately, couldn't this

>account for the results of the study? & nbsp; I'll try to remember to ask

>Dr. Geffner, we see him on the 31st.

>

><P>Thanks again for getting this out-very interesting! & nbsp; And Earl,

>if this posting is rejected because it's too long I'll have a spasm :0)

>

><P>

><BR>mom/pharmacist to Philip, 7 1/2 ghd

><BR>na, 5

><BR>Santa , CA

><BR> & nbsp;</HTML>

>

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Posted
Posted

>Date: Wed, 18 Aug 1999 10:16:00 EDT

>Reply-To: Human Growth Foundation Pediatric Support List

>Sender: Human Growth Foundation Pediatric Support List

>

>Subject: Re: [HGF/P] First Post, Long Story

>To: HGF-PEDS@...

>

>In a message dated 99-08-17 15:14:07 EDT, you write:

>

><< I then began my questioning of his decisions, and he once again stated

> during this Q & A session that his concern was that the gh can give

> short term results, but inhibit the final stature. >>

>

>,

>Yes, I am familiar with a study from Japan that did show that GH can detract

>from the final height when given to Non-GHD children. This is the abstract:

>

> " Unfavorable effects of growth hormone therapy on the final height of boys

>with short stature not caused by growth hormone deficiency " Kawai M, - Dept

>of Ped, Faculty of Medicine, Kyoto Universtiy, Japan. (abstract as follows:)

>

>A group of 18 boys with non-growth hormone deficient short stature without GH

>therapy (Group A) and another group of 9 boys with non-GH-Deficient short

>stature with GH therapy in doses of 0.5 IU (0.17mg)/kg per week administered

>5 to 6 times weekly (group B) were observed until they reached their final

>height The mean duration of GH therapy was 4.2 years (range 3.2 to 5.0

>years). These two groups were matched with respect to their standard

>deviation score (SDS) for bone age at the start of observation. Mean +/- SD

>of the final height for group A and group B was 162.0 +/- 5.4 cm and 154.2

>+/- 4.2cm, respectively. During the prepubertal period, height SDS for bone

>age of these two groups was not affected by GH therapy. During the pubertal

>period, however, height SDS for bone age remained constant for group A but

>decreased gradually for group B. Our observation indicates that for boys with

>non-GH-deficient short stature GH therapy does not improve height SDS for

>bone age during the prepubertal period, and in fact reduces it during the

>pubertal period, possibly resulting in a shorter final height than might have

>been attained naturally. (the end)

>

>As I understand, is 13y,7mos, 54 " tall, no puberty, and bone age when

>last tested was 2 1/2 yrs behind. This in combination with your history does

>sound like CGD, but what would be the harm in have the stim tests to rule out

>GHD? Hopefully, this will be suggested at ped endo appt in September. This

>would definitely help in making your decision of whether or not to use GH for

>him.

>Best of luck and keep us posted about the next appointment,

>ette (, age 13y,3m 56 " on GH, started puberty)

>

>

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