TITLE:
Growth Hormone Treatment, Cardiovascular Risk and Autonomic Maturation in Children and Adolescents with Growth Hormone Deficiency or Born Small for Gestational Age
AUTHORS:
Reiner Buchhorn, Christian Willaschek
KEYWORDS:
Growth Hormone, Cardiovascular Risk, Short Stature, Small for Gestational Age, Heart Rate Variability, Autonomic Nervous System, ADHD
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.10 No.1,
January
19,
2020
ABSTRACT: Introduction: The impact of growth hormone therapy in children with short stature on
cardiovascular prognosis seems to be unpredictable from big databases. The
enhanced cardiovascular risk in this group of patients may be related to adverse autonomic imprinting by early life stress. Autonomic dysfunction and possible
effects of growth hormone therapy on the autonomic nervous system can be
measured easily by calculating heart rate variability (HRV) from Holter
electrocardiogram monitoring. Methods: We performed HRV analysis prior to growth hormone therapy (N = 33), within the first year of growth hormone therapy
between 4 and 10 years of age (N = 19), at
least a further HRV measurement between 10 and 15 years (N = 30). Additional measurements were performed before
and after cessation of growth hormone therapy (N = 14).
Data were compared to untreated pediatric patients with short stature and to age matched healthy controls. Results: Untreated patients with short stature due to growth hormone deficiency or
intrauterine growth restriction in early childhood have significantly increased
heart rates most of all at night and concomitantly reduced global HRV indicated
as Standard Deviation of Normal to Normal Intervals (SDNN). Growth hormone treated adolescents and the untreated patients
with short stature show significantly elevated mean heart rates and
concomitantly reduced vagus activities measured as reduced Route Mean Square
Standard Deviation (RMSSD). After cessation of growth hormone treatment SDNN
significantly increases and heart rate decreases to normal values in formerly
treated patients with catch-up
growth. Conclusion: There is a comparable autonomic dysfunction in treated and untreated
children with short stature as an indicator for enhanced cardiovascular risk. After cessation of growth hormone therapy, we
found a significant improvement of reduced HRV to normal values.