Reduced levels of growth hormone, insulin-like growth factor-I and binding protein-3 in patients with shunted hydrocephalus

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...

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Bibliographic Details
Published in:Archives of disease in childhood 1997-07, Vol.77 (1), p.32-37
Main Authors: Löppönen, Tuija, Saukkonen, Anna-Liisa, Serlo, Willy, Tapanainen, Päivi, Ruokonen, Aimo, Knip, Mikael
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Body Height
Case-Control Studies
Cerebrospinal Fluid Shunts
Child
Child, Preschool
Congenital Impairments
Female
Growth Disorders - blood
growth hormone
Growth Hormone - blood
Growth hormones
Humans
hydrocephalus
Hydrocephalus - blood
Hydrocephalus - therapy
Insulin-Like Growth Factor Binding Protein 3 - blood
insulin-like growth factor binding protein-3
Insulin-Like Growth Factor I - analysis
insulin-like growth factor-I
Insulin-like growth factors
Intelligence Quotient
Male
Malformations of the nervous system
Medical sciences
Neurology
Original
Physical growth
Pituitary gland
Puberty
Puberty - blood
Spinal Dysraphism - blood
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Summary: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 DESIGN One 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. RESULTS The 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. Key messages • Prepubertal children with shunted hydrocephalus have reduced circulating IGF-I and IGFBP-3 concentrations • Pubertal children with shunted hydrocephalus have reduced basal serum growth hormone concentrations • Reduced growth hormone secretion may contribute to slow linear growth and reduced final height in hydrocephalic children • Carbamazepine treatment may increase IGF-I and IGFBP-3 concentrations in the peripheral circulation
ISSN:0003-9888
1468-2044
DOI:10.1136/adc.77.1.32