Growth hormone therapy

[Worried mama]

Anybody use GHT for their kids? Our endo thinks it might be a good idea for us since my son is entering puberty but still isn't growing much. We will have to pay $$ for it...he's had all the tests done and the tests were all neg.

Son is already on remicade, mtx, tube feeding....ugh, what's one more needle?

Experience with GHT?

 

[my little penguin]

Most won't treat with ght if crohns is active( which seems to be in your sons case - I thought it won't work since there is active inflammation but could be wrong

Tagging jmrogers

 

[crohnsinct]

If all his levels were normal I would think fixing the Crohn's will fix his growth. I forget, did you have a bone age xray done? What did it say? If he is delayed then you have lots of opportunity for catch up growth.

FWIW - our endo seriously tried to discourage use of the hormones BUT I have a girl so maybe the hormone therapy affects them differently...but I also thinks endo's are more willing to accept smaller stature with girls as there is less pressure on them.

You could ask how long you have to make the decision and then try to make sure the Crohn's is fixed and then if nothing happens add the therapy.

 

[my little penguin]

Abstract
Objectives—Growth hormone (GH) may reduce symptoms and improve growth in Crohn's Disease (CD). The effect upon mucosal inflammation is not known. We hypothesized that GH would improve both clinical and mucosal disease activity, and stimulate linear growth, in pediatric CD.
Methods—Twenty patients aged 7-18 receiving corticosteroids (CTX) for active CD were randomized to begin GH, 0.075 mg/kg/day (group A), or continue CTX alone (group B). Clinical and endoscopic disease activity were assessed after 12 weeks. Group B began GH at 12 weeks and clinical disease activity was assessed at 24 weeks. Subjects who experienced a clinical response after 12 weeks of GH therapy continued treatment for an additional 52 weeks, and linear growth was assessed.
Results—65% of patients receiving GH achieved clinical remission, compared to 20% treated with CTX alone (p=0.03). While endoscopic disease activity trended towards an improvement at week 12 in group A, this did not differ between the groups. 61% of week 12 GH responders maintained their clinical response through week 64. Mean (95th CI) height Z score on GH increased from -1.1 (-1.6,-0.6) to -0.4 (-1,0.2), p=0.004 during this 52 week extension phase. GH was well tolerated with no unexpected safety signals.

From
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910806/pdf/nihms-172891.pdf

 

[Worried mama]

Yes, could be the Crohns, but endo feels our window of opportunity is getting smaller..my son is 14 and 55.5inches. Endo wasn't pushing the GHT but he said we could do it if we wanted. His bone age was delayed some which is good I guess. We are trying to have a call or meeting with both GI and endo first to make sure all agree this is ok, safe, etc. article above seems like GHT can actually help remission? Did I read that correctly?

 

[my little penguin]

http://www.nature.com/nrgastro/journal/vaop/ncurrent/abs/nrgastro.2014.102.html

 

[Mehita]

We considered it when my son as 14 and about the same size as yours. In the end, the endocrinologist said it was up to us, but she typically didn't encourage IBD kids to do it, because they need to be super healthy at the time (solid remission). She said once a child reaches remission and is doing well, they often have "catch up" growth and can sometimes return to their pre-dx percentages. We chose not to do the hormones and my son did grow quite a bit, but not to pre-dx percents.

The other factor in our decision was that my son was only two months behind in his bone scan, so we figure he's just going to be on the small side.

It's probably worth a call or visit just to get your questions answered though.

 

[Jmrogers4]

Yeah, we were kind of a wait and see since all testing at endo was negative and would decide at subsequent follow up appointments by our 3rd follow up he had grown so much and his growth velocity was off the top of the chart instead of dropped off the bottom. Endo said it was up to us but we did not need to see him again.
We were also told the GHT wouldn't give him drastic amounts of additional height but I think at a certain height even an additional inch or two is desired. For what it's worth Jack was just about 2 years behind.
Good luck whatever you decide.

 

[malorymug]

All of my son's endo tests results were within normal limits and our doc said that supplemental hormones would not be beneficial. His bone scan also showed he was a year behind his chronological age. That was last summer. He and puberty have been slow dancing on and off since then. He has grown 2 inches since then and needs to shave every so often. His BMI is still around 15 and I understood that puberty can't get going until 17.

Good luck with your decision. Let us know what you decide.

 

[Jenn]

We haven't tried it yet. We check in once/year with the endocrinologist and a bone age xray. My son is 14, 59" and 2 years delayed in bone age (along with pubertal markers and height). The key is the bone age, his doc feels he'll grow continue to grow past 18 even, because of that delay, as long as we continue to control his IBD. You don't want to close the growth plates too soon with the growth hormone and skip potential growth.