IMPE Abstracts

Background: Children born SGA/IUGR are at increased risk of long term endocrine-metabolic disorders. In addition, treatment with supra-physiological doses of rhGH in those without postnatal catch-up growth is associated with insulin resistance. However, studies evaluating glucose metabolism (GM) under rhGH treatment showed variable results.

Objectives: To analyze GM in SGA/IUGR patients with short stature in basal conditions and under rhGH treatment. To determine the usefulness of oral glucose tolerance test (OGTT) predictor models for long-term GM risk.

Methods: Perinatological (prematurity, birth weight and length), anthropometric (weight, height, BMI), and biochemical (glucose, insulin, IGF-1) data from SGA/IUGR patients treated with rhGH in the Endocrinology Department of a tertiary level hospital were retrospectively examined. Glycemic response to OGTT according to WHO criteria was evaluated at baseline and during rhGH treatment. Sensitivity and specificity of models derived from OGTT were analyzed as predictors of altered GM: shape of the glucose response curve (mono/biphasic), one-hour post-load hyperglycemia, and latent class trajectory analysis.

Results: 80 SGA/IUGR patients on rhGH treatment were included. All patients had good response to treatment (first year D-SDS height 0,71 ± 0,4). 19 (23,7%) patients (12 males/7 females, 7 prepubertal/12 pubertal) presented impaired glucose tolerance (IGT) at median 1,55 (0,32-9,93) years of treatment, most of them (57,9%) during the first 2 years. Perinatological, anthropometric, and biochemical data were similar among subjects irrespective of OGTT response. Glucose intolerance was reversible under medical intervention in all but one patient. Among baseline predictors (n=62), latent class trajectory with pattern of class ≥2 showed a higher sensitivity (77%) to predict IGT.

Conclusion: A reversible and early IGT under rhGH was found with higher prevalence in our cohort. Standarized OGTT evaluation should be considered at baseline and after two years of rhGH treatment. The influence of pubertal status on these results needs to be deeply analyzed. Further studies are required to determine the validity and clinical application of predictor models in this population.