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Growth Hormone Treatment in Prepubertal Children With Celiac Disease and Growth Hormone Deficiency

Giovenale, Diletta*; Meazza, Cristina*; Cardinale, Giuliana M; Farinelli, Edorado; Mastrangelo, Costanzo§; Messini, Beatrice||; Citro, Giuseppe#; Del Vecchio, Maurizio; Di Maio, Salvatore**; Possenti, Ilaria*; Bozzola, Mauro*

Journal of Pediatric Gastroenterology & Nutrition: October 2007 - Volume 45 - Issue 4 - p 433–437
doi: 10.1097/MPG.0b013e3180de5e0a
Original Articles: Gastroenterology

Objective: To evaluate the growth response to growth hormone (GH) replacement therapy during a gluten-free diet in patients with celiac disease (CD) associated with GH deficiency (GHD).

Patients and Methods: A total of 14 prepubertal children affected by CD and GHD with no catch-up growth after ≥12 months of gluten-free diet and a reversion to seronegativity for antiendomysium antibodies and 10 age-matched prepubertal children with idiopathic GHD (IGHD) entered the study. All of the patients were treated with the same GH dosage (0.25 mg/kg subcutaneously each week). Height, growth rate, and body mass index were measured at the time of diagnosis of CD, at the time of endocrinological evaluation, and after the first, second, and third year of GH replacement therapy.

Results: Growth rate strikingly increased (P < 0.005) during the first year of therapy in a similar way in subjects with CD/GHD and IGHD (from a median standard deviation score [SDS] of −2.34 to an SDS of 3.25 and from an SDS of −1.29 to an SDS of 2.79, respectively). During the second and third years of GH treatment, the growth rate tended to decrease but the values at the third year were always positive (CD/GHD, median SDS, 1.10; IGHD, median SDS, 0.11), indicating continued catch-up growth.

Conclusions: In patients with CD with GH deficiency confirmed after ≥12 months of gluten-free diet, GH replacement therapy should be started to allow complete catch-up growth in children. In addition, the effect of GH treatment in patients who comply with a gluten-free diet seems to be comparable to that observed in children with IGHD.

*Department of Pediatric Science, Università degli Studi di Pavia, Fondazione IRCCS San Matteo, Pavia

Pediatrics Department, Ospedale “F. Ferrari,” Lecce

Clinica Pediatrica Monteluce, Perugia

§Pediatric Unit, Ospedali Riuniti, Foggia

||Pediatric Unit, Ospedale di Foligno, Foligno

#Endocrinology Unit, Ospedale San Carlo, Potenza

Department of Developmental Biomedicine, Università degli Studi di Bari, Bari

**Departments of Pediatrics and Rehabilitation, Azienda Ospedaliera Pediatrica “Santobono-Pausilipon,” Napoli, Italy

Received 2 February, 2006

Accepted 1 May, 2007

Address correspondence and reprint requests to Mauro Bozzola, MD, Dipartimento di Scienze Pediatriche, Università di Pavia, Fondazione IRCCS San Matteo, Piazzale C. Golgi 2, 27100 Pavia, Italy (e-mail: mauro.bozzola@unipv.it).

© 2007 Lippincott Williams & Wilkins, Inc.