AUTHOR=Straetemans Saartje , Rooman Raoul , De Schepper Jean 

TITLE=Is a Two-Year Growth Response to Growth Hormone Treatment a Better Predictor of Poor Adult Height Outcome Than a First-Year Growth Response in Prepubertal Children With Growth Hormone Deficiency?

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2021.678094

DOI=10.3389/fendo.2021.678094

ISSN=1664-2392

ABSTRACT=Objective  
The first year response to growth hormone (GH) treatment is related to the total height gain in GH treated children, but an individual poor first year response is a weak predictor of a poor total GH effect in children with GH deficiency (GHD). We therefore investigated whether an underwhelming growth response after 2 years might be a better predictor of a poor adult height outcome after GH treatment in children with GHD. 
Design and methods
Height data of GHD children treated with GH for at least 4 consecutive years of which at least 2 were prepubertal and who had attained (near) adult height (nAH) were retrieved from the Belgian Register for GH treated children (n=110, 63% boys). In ROC analyses, the change in height (∆Ht) SDS after the first and second GH treatment year were tested as predictors of a poor adult height outcome defined as : (1) nAH SDS <-2.0, or (2) nAH SDS minus mid-parental height (MPH) SDS <-1.3, or (3) total ∆Ht SDS <1.0. The cut-offs for ∆Ht SDS and its sensitivity at a 95% specificity level to detect a poor AH outcome were determined. 
Results
Eleven percent of the studied cohort had a poor AH outcome, defined by total ∆Ht SDS <1.0. ROC curve testing of the first and second year ∆Ht SDS as a predictor for total ∆Ht SDS <1.0 had an AUC >70 %. First-year ∆Ht SDS <0.41 correctly identified 42% of the patients with a poor AH outcome at a 95% specificity level, resulting in respectively 5/12 (4.6%) correctly identified poor final responders and 5/98 (4.5%) misclassified good final responders (ratio 1.0). ∆Ht SDS after 2 prepubertal years had a cut-off level of 0.65 and a sensitivity of 50% at a 95% specificity level, resulting in respectively 6/12 (5.5%) correctly identified poor final responders and 5/98 (4.5%) misclassified good final responders (ratio 1.2). 
Conclusion
In prepubertal GH treated children with non-acquired GHD the growth response after 2 prepubertal years of GH treatment did not meaningfully improve the prediction of poor adult height outcome after GH treatment compared to first-year growth response parameters.