Reduced levels of growth hormone, insulin-like growth factor-I and binding protein-3 in patients with shunted hydrocephalus
a University
of Oulu, Oulu, Finland: Department of Paediatrics, b Department of Clinical Chemistry
Correspondence to: Dr Tuija Löppönen, Department of Paediatrics, University of Oulu, Kajaanintie 52 A, FIN-90220 Oulu, Finland.
Accepted 25 March 1997
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 growth hormone, insulin-like growth factor-I
(IGF-I), and IGF binding protein-3 (IGFBP-3) in this growth pattern.
STUDY DESIGNOne hundred and fourteen patients
with shunted hydrocephalus (62 males) aged 5 to 20 years, of whom 17 had spina bifida (six males), and 73 healthy controls (38 males) were
studied. Anthropometric measures, body mass index, and 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.
RESULTSThe patients comprised 44 (26 males) who were prepubertal and 70 (36 males) pubertal or postpubertal,
while 32 of the controls (19 males) were prepubertal and 41 (19 males)
pubertal or postpubertal. 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 concentrations (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 2-3 in the female patients and at stage 4 in
the controls. The prepubertal patients on antiepileptic treatment,
carbamazepine in most cases (73%), had higher 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 these 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.
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Key messages
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Prepubertal children with shunted hydrocephalus have reduced
circulating IGF-I and IGFBP-3 concentrations
© 1997 by Archives of Disease in Childhood
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