The growth hormone-insulin-like growth factor axis in glycogen storage disease type 1: evidence of different growth patterns and insulin-like growth factor levels in patients with glycogen storage disease type 1a and 1b

Daniela Melis; Rosario Pivonello; Giancarlo Parenti; Roberto Della Casa; Mariacarolina Salerno; Francesca Balivo; Pasquale Piccolo; Carolina Di Somma; Annamaria Colao; Generoso Andria

doi:10.1016/j.jpeds.2009.10.032

The growth hormone-insulin-like growth factor axis in glycogen storage disease type 1: evidence of different growth patterns and insulin-like growth factor levels in patients with glycogen storage disease type 1a and 1b

J Pediatr. 2010 Apr;156(4):663-70.e1. doi: 10.1016/j.jpeds.2009.10.032. Epub 2009 Dec 21.

Authors

Daniela Melis¹, Rosario Pivonello, Giancarlo Parenti, Roberto Della Casa, Mariacarolina Salerno, Francesca Balivo, Pasquale Piccolo, Carolina Di Somma, Annamaria Colao, Generoso Andria

Affiliation

¹ Department of Pediatrics, Federico II University, Naples, Italy.

PMID: 20022338
DOI: 10.1016/j.jpeds.2009.10.032

Abstract

Objectives: To investigate the growth hormone (GH)-insulin-like growth factor (IGF) system in patients with glycogen storage disease type 1 (GSD1).

Study design: This was a prospective, case-control study. Ten patients with GSD1a and 7 patients with GSD1b who were given dietary treatment and 34 sex-, age-, body mass index-, and pubertal stage-matched control subjects entered the study. Auxological parameters were correlated with circulating GH, either at basal or after growth hormone releasing hormone plus arginine test, insulin-like growth factors (IGF-I and IGF-II), and anti-pituitary antibodies (APA).

Results: Short stature was detected in 10.0% of patients with GSD1a, 42.9% of patients with GSD1b (P = .02), and none of the control subjects. Serum IGF-I levels were lower in patients with GSD1b (P = .0001). An impaired GH secretion was found in 40% of patients with GSD1a (P = .008), 57.1% of patients with GSD1b (P = .006), and none of the control subjects. Short stature was demonstrated in 3 of 4 patients with GSD1b and GH deficiency. The prevalence of APA was significantly higher in patients with GSD1b than in patients with GSD1a (P = .02) and control subjects (P = .03). The GH response to the provocative test inversely correlated with the presence of APA (P = .003). Compared with levels in control subjects, serum IGF-II and insulin levels were higher in both groups of patients, in whom IGF-II levels directly correlated with height SD scores (P = .003).

Conclusion: Patients with GSD1a have an impaired GH secretion associated with reference range serum IGF-I levels and normal stature, whereas in patients with GSD1b, the impaired GH secretion, probably because of the presence of APA, was associated with reduced IGF-I levels and increased prevalence of short stature. The increased IGF-II levels, probably caused by increased insulin levels, in patients with GSD1 are presumably responsible for the improved growth pattern observed in patients receiving strict dietary treatment.

Publication types

Comparative Study

MeSH terms

Adolescent
Biomarkers / blood
Body Height / physiology*
Body Mass Index
Case-Control Studies
Child
Cross-Sectional Studies
Enzyme-Linked Immunosorbent Assay
Female
Follow-Up Studies
Glycogen Storage Disease Type I / blood*
Glycogen Storage Disease Type I / complications
Glycogen Storage Disease Type I / physiopathology
Growth Disorders / epidemiology
Growth Disorders / etiology*
Growth Disorders / physiopathology
Growth Hormone / blood*
Humans
Immunoradiometric Assay
Italy / epidemiology
Male
Prevalence
Prognosis
Prospective Studies
Risk Factors
Somatomedins / metabolism*
Time Factors
Young Adult

Substances

Biomarkers
Somatomedins
Growth Hormone