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Abstract
BACKGROUND: One of the significant causes of short stature is Growth hormone deficiency (GHD). While recombinant human growth hormone (rhGH) therapy is effective, region-specific data from Iraq is limited. This study evaluated the effect of rhGH therapy on growth velocity, insulin-like growth factor-1 (IGF-1) levels, and advancement in bone age in Iraqi children with GHD.
MATERIALS AND METHODS: A retrospective cohort study was conducted on 100 children with confirmed GHD (57 males, 43 females; mean age 9.7±2.7 years) who were treated with rhGH (mean dose 0.037 mg/kg/day) at Sulaymaniyah Teaching Hospital. Growth velocity, IGF-1 standard deviation scores (SDS), and bone age were assessed at baseline and over two years of therapy. Statistical analysis employed paired t-tests, correlation analysis, and subgroup comparisons.
RESULTS: Growth velocity significantly increased from a baseline of 2.51±1.44 cm/year to 4.93±1.93 cm/year at 1 year and 5.35±1.80 cm/year at 2 years (p<0.001 for all). IGF-1 SDS normalized rapidly, from -1.57±1.35 at baseline to -0.06±1.05 at 1 month and 1.04±0.71 at 1 year (p<0.001). Bone age advanced by 1.07±0.59 years in the first year (slightly faster than chronological age, p<0.001) but by only 1.46±0.81 years over two years, resulting in a favorable net advancement rate of 0.73 years per chronological year (p<0.001). A significant correlation was found between \DeltaIGF-1 SDS and \Deltagrowth velocity (r=0.300, p=0.002). Males showed a significantly better growth response than females (p=0.040).
CONCLUSIONS: rhGH therapy is highly effective and safe for Iraqi children with GHD, leading to significant improvements in growth velocity and normalization of IGF-1 levels without premature acceleration of skeletal maturation. These findings provide crucial local evidence to support and optimize treatment protocols in Iraq.
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Copyright (c) 2026 Bahadin Qader Ahmed, Ibrahim Khasraw Ghafoor
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
- Grimberg A, DiVall SA, Polychronakos C, Allen DB, Cohen LE, Quintos JB, et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency. Horm Res Paediatr. 2016;86(6):361-397. doi: https://doi.org/10.1159/000452294
- Stanley T. Diagnosis of growth hormone deficiency in children and adults. Curr Opin Endocrinol Diabetes Obes. 2012;19(1):47-52. doi: https://doi.org/10.1097/MED.0b013e32834ec952
- Growth Hormone Research Society. Critical evaluation of the safety of recombinant human growth hormone use: statement from the Growth Hormone Research Society. J Clin Endocrinol Metab. 2000;85(11):3990-3993. doi: https://doi.org/10.1210/jcem.85.11.3990
- Richmond EJ, Rogol AD. Current indications for growth hormone therapy for children and adolescents. Pituitary. 2010;11(2):115-120. doi: https://doi.org/10.1007/s11102-008-0102-0
- Finkelstein BS, Silvers JB, Marrero U, Neuhauser D, Cuttler L. Growth hormone therapy for short stature: status of baseline characteristics and clinical outcomes. Arch Pediatr Adolesc Med. 2002;156(3):230-240. doi:https://doi.org/10.1001/archpedi.156.3.230
- Ranke MB, Lindberg A. Efficacy and safety of growth hormone therapy in children with growth hormone deficiency. Horm Res Paediatr. 2017;79(2):51-67. doi: https://doi.org/10.1159/000346534
- Al-Jurayyan NA, Al-Herbish AS, Al-Salloum AA. Growth hormone therapy in children with growth hormone deficiency: a regional experience. J Pediatr Endocrinol Metab. 2018;31(1):23-29. doi: https://doi.org/10.1515/jpem-2017-0241
- Al-Zubaidi MA, Al-Rubaee AA. Efficacy of recombinant human growth hormone in Iraqi children with short stature. Curr Pediatr Res. 2021;25(1):378-383.
- Al-Abdulrazzaq D, Shaltout A. Growth hormone deficiency in children: clinical characteristics and response to therapy. J Pediatr Endocrinol Metab. 2015;28(9-10):1073-1078. doi: https://doi.org/10.1515/jpem-2014-0412
- Blethen SL, Allen DB, Graves D, August G, Moshang T, Rosenfeld R. Safety of recombinant deoxyribonucleic acid-derived growth hormone: The National Cooperative Growth Study experience. J Clin Endocrinol Metab. 1997;82(2):418-420. doi: https://doi.org/10.1210/jcem.82.2.3732
- Cohen P, Rogol AD, Deal CL, Saenger P, Reiter EO, Ross JL, et al. Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology workshop. J Clin Endocrinol Metab. 2014;99(11):3773-3780. doi: https://doi.org/10.1210/jc.2008-1614
- Clemmons DR. Role of insulin-like growth factor-I in skeletal growth and bone mineral density accrual. Endocr Rev. 2018;39(5):719-738. doi: https://doi.org/10.1210/er.2018-00084
- Nwosu BU, Maranda L. The effect of growth hormone therapy on bone age advancement in children with growth hormone deficiency. Bone. 2021;143:115648. doi: https://doi.org/10.1016/j.bone.2020.115648
References
Grimberg A, DiVall SA, Polychronakos C, Allen DB, Cohen LE, Quintos JB, et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency. Horm Res Paediatr. 2016;86(6):361-397. doi: https://doi.org/10.1159/000452294
Stanley T. Diagnosis of growth hormone deficiency in children and adults. Curr Opin Endocrinol Diabetes Obes. 2012;19(1):47-52. doi: https://doi.org/10.1097/MED.0b013e32834ec952
Growth Hormone Research Society. Critical evaluation of the safety of recombinant human growth hormone use: statement from the Growth Hormone Research Society. J Clin Endocrinol Metab. 2000;85(11):3990-3993. doi: https://doi.org/10.1210/jcem.85.11.3990
Richmond EJ, Rogol AD. Current indications for growth hormone therapy for children and adolescents. Pituitary. 2010;11(2):115-120. doi: https://doi.org/10.1007/s11102-008-0102-0
Finkelstein BS, Silvers JB, Marrero U, Neuhauser D, Cuttler L. Growth hormone therapy for short stature: status of baseline characteristics and clinical outcomes. Arch Pediatr Adolesc Med. 2002;156(3):230-240. doi:https://doi.org/10.1001/archpedi.156.3.230
Ranke MB, Lindberg A. Efficacy and safety of growth hormone therapy in children with growth hormone deficiency. Horm Res Paediatr. 2017;79(2):51-67. doi: https://doi.org/10.1159/000346534
Al-Jurayyan NA, Al-Herbish AS, Al-Salloum AA. Growth hormone therapy in children with growth hormone deficiency: a regional experience. J Pediatr Endocrinol Metab. 2018;31(1):23-29. doi: https://doi.org/10.1515/jpem-2017-0241
Al-Zubaidi MA, Al-Rubaee AA. Efficacy of recombinant human growth hormone in Iraqi children with short stature. Curr Pediatr Res. 2021;25(1):378-383.
Al-Abdulrazzaq D, Shaltout A. Growth hormone deficiency in children: clinical characteristics and response to therapy. J Pediatr Endocrinol Metab. 2015;28(9-10):1073-1078. doi: https://doi.org/10.1515/jpem-2014-0412
Blethen SL, Allen DB, Graves D, August G, Moshang T, Rosenfeld R. Safety of recombinant deoxyribonucleic acid-derived growth hormone: The National Cooperative Growth Study experience. J Clin Endocrinol Metab. 1997;82(2):418-420. doi: https://doi.org/10.1210/jcem.82.2.3732
Cohen P, Rogol AD, Deal CL, Saenger P, Reiter EO, Ross JL, et al. Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology workshop. J Clin Endocrinol Metab. 2014;99(11):3773-3780. doi: https://doi.org/10.1210/jc.2008-1614
Clemmons DR. Role of insulin-like growth factor-I in skeletal growth and bone mineral density accrual. Endocr Rev. 2018;39(5):719-738. doi: https://doi.org/10.1210/er.2018-00084
Nwosu BU, Maranda L. The effect of growth hormone therapy on bone age advancement in children with growth hormone deficiency. Bone. 2021;143:115648. doi: https://doi.org/10.1016/j.bone.2020.115648