CF and growth hormone (GH)

Question

Hi! My 11 years-old daughter visited the endocrinologist who proposed to treat her with GH because her expected adult height will be 1.45m. Supposing she will not be again treated with itraconazole, a period responsible for a 2 years of bad weight and height gain, my question is: the CF treatment of my daughter is already important and the endocrinologist said that GH treatment was at least for 4 years with daily injections, is the GH treatment useful ? What are the side effects of this treatment ? Thanks.

Answer

Hello! Thanks for your question.
Children with CF have sometimes a worsened gain in weight and height. This is linked to an important loss of energy found both in CF children and in adults with stable CF. Growth hormone (GH) improves this aspect (anabolizing effect, i.e. useful effect for building muscles and reducing the increased catabolism – protein degradation in energy and waste – found in CF). Several clinical studies have shown that treating prepubertal CF children having weight and height below the 25th percentile with human recombinant GH for 1 or 2 years, compared with similar children with no treatment, improved their weight and height, decreased their number of hospitalized days, may decrease their antibiotics requirement, and may improve their quality of life. These effects are persistent after stopping GH treatment. A positive effect on lung function is variable depending on the studies. A decrease in inhaled corticosteroids before GH treatment and regular glycaemia controls are recommended.
Concerning the side-effects, GH therapy in general can rarely lead to skin reactions (itching, redness), oedema, increase in blood glucose levels/ diabetes, pain in the joints and muscles, stiffness of the legs and arms. In CF patients, receiving GH therapy, the data shows that most patients did not develop glucose intolerance or diabetes over the duration studied. Injection side-reactions were a rare and insignificant adverse effect. They may rarely experience a transient increase in liver transaminase levels.
Don’t hesitate to contact your medical doctors (endocrinologist and your CF-MD) to have more information.
With my best regards,
Pr Jean-Christophe Dubus

09.12.2010