İbrahim Mert ERBAŞ, Nilüfer UYAR, Özlem NALBANTOĞLU, Behzat ÖZKAN
Trends in Pediatrics - 2026;7(3):193-200
Objective: In this study, we aimed to reveal the factors that affect the clinician's preferences in the selection of the starting dose of growth hormone (GH) treatment. Methods: Patients under the age of 18 years who presented to our department between 2013 and 2022, were diagnosed with isolated GH deficiency, and started treatment were included in the study. Relevant data were collected retrospectively from the medical records of the patients. Data are presented as median (interquartile range). Results: Eighty-eight patients (56.8% male; 65.9% prepubertal) with a chronological age (CA) of 10.4 (7.4-12.8) years were included in the study. The median bone age (BA) of the patients was 8 (5-10) years and height standard deviation score (SDS) was -2.7 [(-3.3) - (-2.3)]. Somatropin treatment was started at a median dose of 35 (30-35) µg/kg/day. Patients were divided into two groups according to the treatment dose as <35 µg/kg/day (n=36) and >=35 µg/kg/day (n=52). In the univariate analyses, the target height SDS was lower (p=0.033), the annual growth rate was lower (p=0.010), and the CA-BA difference was greater (p=0.018) in the high-dose group, whereas the BA/CA ratio was similar between groups (p=0.730). However, in the multivariable analysis, only lower pre-treatment annual growth rate remained independently associated with a higher prescribed initial GH dose (p=0.028). Other anthropometric measurements, peak GH response in stimulation tests, and serum insulin-like growth factor 1 (IGF-1) and IGF binding protein-3 (IGFBP-3) levels did not differ between the groups (p>0.05). The initial dose of somatropin correlated negatively with annual growth rate (p=0.006) and positively with the CA-BA difference (p=0.009). Conclusions: Lower pre-treatment annual growth rate was the only factor independently associated with a higher prescribed initial GH dose after adjustment for potential confounders. Although lower target height SDS and greater BA delay were associated with higher prescribed doses in the univariate analyses, these associations were not independently maintained. These findings provide real-world evidence that clinicians primarily rely on auxological severity, particularly impaired growth velocity, when individualizing the initial GH dose in children with isolated growth hormone deficiency.
