Background: Since the 1980s, recombinant human GH (rhGH) has been used to treat children with GH deficiency (GHD) and growth failure. In the past, a high incidence of anti-GH antibody development in patients treated with first generation formulations of rhGH was reported. More recently, improvements in recombinant DNA technology have led to rhGH formulations with low antigenicity and rarely do patients treated with rhGH develop antibodies. Case report: A 12.5-year-old Italian girl was referred to our Institute for progressive growth failure from the age of 6 years, with a height of 128.2 cm (-3.37 SDS) and bone age of 9 years. Results: Endocrinological evaluation revealed a partial growth hormone deficiency (GHD) and GH therapy was started at the dosage of 0.25 mg/kg/week. During the first three years, she showed an increase in growth rate and experienced pubertal development onset. Then, a poor growth rate (2 cm/years=0.43 SDS) was observed notwithstanding an increase in GH dosage (0.35 mg/kg/week) and good compliance. We found a positive anti-GH antibody titre (1:1850, cut-off 1/100), confirmed six months later (1:2035); the antibodies had low binding capacity (0.63 μg/ml), only partially capable of inhibiting the GH effect. However, GH treatment was discontinued and after three months the antibody titre decreased (1:950). Conclusions: In conclusion, we suggest evaluation of anti-GH antibodies in GH treated idiopathic GHD children in whom growth response decreases after some years of therapy.
Development of antibodies against growth hormone (GH) during rhGH therapy in a girl with idiopathic GH deficiency: a case report.
MEAZZA, CRISTINA;PAGANI, SARA;CALCATERRA, VALERIA;BOZZOLA, MAURO
2013-01-01
Abstract
Background: Since the 1980s, recombinant human GH (rhGH) has been used to treat children with GH deficiency (GHD) and growth failure. In the past, a high incidence of anti-GH antibody development in patients treated with first generation formulations of rhGH was reported. More recently, improvements in recombinant DNA technology have led to rhGH formulations with low antigenicity and rarely do patients treated with rhGH develop antibodies. Case report: A 12.5-year-old Italian girl was referred to our Institute for progressive growth failure from the age of 6 years, with a height of 128.2 cm (-3.37 SDS) and bone age of 9 years. Results: Endocrinological evaluation revealed a partial growth hormone deficiency (GHD) and GH therapy was started at the dosage of 0.25 mg/kg/week. During the first three years, she showed an increase in growth rate and experienced pubertal development onset. Then, a poor growth rate (2 cm/years=0.43 SDS) was observed notwithstanding an increase in GH dosage (0.35 mg/kg/week) and good compliance. We found a positive anti-GH antibody titre (1:1850, cut-off 1/100), confirmed six months later (1:2035); the antibodies had low binding capacity (0.63 μg/ml), only partially capable of inhibiting the GH effect. However, GH treatment was discontinued and after three months the antibody titre decreased (1:950). Conclusions: In conclusion, we suggest evaluation of anti-GH antibodies in GH treated idiopathic GHD children in whom growth response decreases after some years of therapy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
