Anti-Human Growth Hormone (HGH) Antibody Determination in HGH-treated Patients
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Keywords:
Antibody titer
Human growth hormone
Antibody response
Human growth hormone
Health Care Delivery
Delivery system
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Although the importance of the pituitary gland for growth was recognized in late 19th century, Growth hormone (GH) therapy was made available for severely GH-deficient children and adolescents only in late 1950s. Use of GH for other conditions was limited because of the limited supply of human pituitary-derived hormone. With unlimited availability of recombinant human GH (rhGH), the scenario of GH treatment has been changed enormously. Currently there is ever increasing list of indications of GH treatment in children, adolescents, and adults.
Human growth hormone
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A 16-5/12 year-old male was diagnosed with classical growth hormone (GH) deficiency at the age of 8-6/12 years and was treated with recombinant methionyl human growth hormone (m-hGH). Height increased from 104.0 cm to 107.4 cm over the first 6 months. After that, for 1 year, he demonstrated poor growth velocity which was found to be secondary to a high titer of GH antibodies with GH binding capacity >2 mg/l. After a 7-month washout period during which no GH was given, at age 11 years he was placed on recombinant methionyl-free human growth hormone (met-free hGH). His height increased 14.9 cm in 11 months (annualized growth rate of 16.2 cm/year). This report illustrates that evaluation of growth failure during GH therapy should include measurement of anti-GH antibodies so that an appropriate alteration of GH therapy can be made if indicated.
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Growth rates of 50 hypopituitary dwarfs averaged 0.25 cm/mo before and 0.65 cm/mo during initial treatment with human growth hormone (HGH). Studies by 11 groups of investigators showed growth rates on treatment decreased with time in at least one third of the patients and were slower or nil following therapy. The wide range of growth response made it impossible to relate responses to chronological age, bone age, or to specific HGH preparations. There was some evidence that growth responses were best in those patients receiving 20 to 45 mg of HGH per month.
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This paper reviews the difficulties in diagnosing a true deficiency of growth hormone (GH), the long-term results of therapy, the Canadian experience in treating GH deficiency, including the contributions made by the Medical Research Council's Therapeutic Trial of Human Growth Hormone, and the occurrence of Creutzfeldt-Jakob disease in recipients of GH therapy. It also speculates on potential alternatives to treatment with GH derived from human pituitaries.
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Hormone Therapy
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Natural sequence of human growth hormone (r-hGH) prepared by Eli Lilly and Company using recombinant DNA technology has been used to treat 226 patients with growth hormone deficiency in the United States and Canada. The data from this multicenter study are sufficient to analyze for the efficacy of r-hGH in 156 of the patients, with a complete safety analysis of all patients. The patients had growth hormone deficiency as a growth rate <4cm/yr (5% for age by Tanner growth curves) and failure to respond to two provocative stimuli for growth hormone release. The patients had no previous treatment with hGH or anabolic steroids. Other possible explanations for the growth failure or conditions that might interfere with the growth response were basis for exclusion from the study. The dosage of growth hormone was 0.06mg/kg given by intramuscular injection t. i. w. with a maximum dose of 8mg/wk. Other hormone deficiencies were treated in the usual fashion but cortisol replacement was limited to <10mg/m2. At the time of this report 156, 111 and 41 patients had completed 1, 3 and 6 months of therapy, respectively.
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Intramuscular injection
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Human growth hormone (GH) has until recently been prepared commercially from pituitary glands collected at autopsy. Availability has been limited and cost high, so the indications for GH treatment have had to be “tight.” Owing to recent development in hybrid DNA technology, the availability of GH has increased dramatically. At the same time, the manufacturers have maintained constant prices, so that treatment costs continue to influence decision making about its use. This rapid transition has generated an interesting change of strategy, which is outlined in this review.
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Human growth hormone
Body height
Growth hormone treatment
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Human growth hormone
Turner's syndrome
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Growth rates of 50 hypopituitary dwarfs averaged 0.25 cm/mo before and 0.65 cm/mo during initial treatment with human growth hormone (HGH). Studies by 11 groups of investigators showed growth rates on treatment decreased with time in at least one third of the patients and were slower or nil following therapy. The wide range of growth response made it impossible to relate responses to chronological age, bone age, or to specific HGH preparations. There was some evidence that growth responses were best in those patients receiving 20 to 45 mg of HGH per month.
Human growth hormone
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