ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2018) 15 4.3 | DOI: 10.1530/ey.15.4.3

ESPEYB15 4 Growth and Growth Factors Important for clinical practice (5 abstracts)

4.3 Cardiovascular risk factors and carotid intima media thickness in young adults born small for gestational age after cessation of growth hormone treatment: a 5-year longitudinal study

van der Steen M , Kerkhof GF , Smeets CCJ & Hokken-Koelega ACS


Erasmus University Medical Center, Department of Paediatrics, Subdivision of Endocrinology, Rotterdam, Netherlands


To read the full abstract: Lancet Diabetes Endocrinol 2017;5:975-985

Whereas most SGA children experience spontaneous catch-up growth leading to the achievement of normal adult height, approximately 10% remain short and are candidates for GH therapy. SGA subjects have increased cardio-metabolic disease risk [17] and the effects of GH treatment on blood pressure, body composition, glucose metabolism and lipid profile have been investigated [18]. Recently, interest has been focused on the cardiovascular disease risk in adults treated with GH during childhood. Data from the French SAGhE (Safety and Appropriateness of GH therapy in Europe) study cohort have shown increased cerebrovascular mortality rate [19], although not confirmed in other SAGhE cohorts [20]. In theory, children born SGA, having intrinsic higher cardio-metabolic risk, might be at even higher risk if exposed to long-term GH therapy.

This longitudinal study evaluated cardiovascular disease risk factors in SGA young adults, treated with GH during childhood and followed-up for 5 years after therapy discontinuation. Five years after cessation of GH therapy, blood pressure and cIMT were similar between treated and untreated SGA. Furthermore, after an initial increase probably due to gains in fat mass, lipid levels tended to be lower in treated than in untreated SGA. Finally, GH treatment was not associated with increased risk of metabolic syndrome. These findings are consistent with previous data showing no adverse effect of GH therapy on the metabolic profile of young adults treated with GH during childhood and observed for 5 years after cessation of treatment [21].

Overall, these results are reassuring, showing no potential adverse effect of GH therapy on cardio-metabolic health of SGA subjects and suggest that GH treatment may be even beneficial for lipid profile. However, longer follow-up studies are needed to monitor the possible occurrence of cardio-metabolic diseases many years after GH therapy cessation.

17. Saenger P, Czernichow P, Hughes I, Reiter EO. Small for gestational age: short stature and beyond. Endocr Rev. 2007;28:219-51.

18. Delemarre EM, Rotteveel J, Delemarre-van de Waal HA. Metabolic implications of GH treatment in small for gestational age. Eur J Endocrinol. 2007;157 Suppl 1:S47-50.

19. Carel JC, Ecosse E, Landier F, Meguellati-Hakkas D, Kaguelidou F, Rey G, et al. Long-term mortality after recombinant growth hormone treatment for isolated growth hormone deficiency or childhood short stature: preliminary report of the French SAGhE study. J Clin Endocrinol Metab. 2012;97:416-25.

20. Savendahl L, Maes M, Albertsson-Wikland K, Borgstrom B, Carel JC, Henrard S, et al. Long-term mortality and causes of death in isolated GHD, ISS, and SGA patients treated with recombinant growth hormone during childhood in Belgium, The Netherlands, and Sweden: preliminary report of 3 countries participating in the EU SAGhE study. J Clin Endocrinol Metab. 2012;97:E213-7.

21. van der Steen M, Smeets CC, Kerkhof GF, Hokken-Koelega AC. Metabolic health of young adults who were born small for gestational age and treated with growth hormone, after cessation of growth hormone treatment: a 5-year longitudinal study. Lancet Diabetes Endocrinol. 2017;5:106-16.

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