Growth hormone/insulin-like growth factor-1 axis: a possible non-nutritional factor for growth retardation in children with cerebral palsy

• Published in: Jornal de pediatria 2012-05, Vol.88 (3), p.267-74
• Main Authors: Hegazi, Moustafa A, Soliman, Othman E, Hasaneen, Bothina M, El-Arman, Mohammed, El-Galel, Nawal Abd, El-Deek, Basem S
• Format: Article
• Language: English
• Subjects: Body Height; Body Weight; Case-Control Studies; Cerebral Palsy - blood; Cerebral Palsy - complications; Cerebral Palsy - physiopathology; Chi-Square Distribution; Energy Intake; Female; Growth Disorders - blood; Growth Disorders - etiology; Growth Disorders - physiopathology; Hormone Replacement Therapy - methods; Human Growth Hormone - blood; Humans; Infant; Insulin - administration & dosage; Insulin-Like Growth Factor I - analysis; Male; Protein-Energy Malnutrition - blood; Sample Size; Statistics, Nonparametric
• ISSN: 0021-7557; 1678-4782
• DOI: 10.2223/JPED.2197

To assess growth hormone (GH)/insulin like growth factor-1 (IGF-1) axis as a possible non-nutritional factor for growth retardation in children with cerebral palsy (CP). A case-control study was conducted at a tertiary university hospital. Thirty children with CP (seven children with normal growth [CP-N] and 23 with retarded growth [CP-R]), 30 children with protein energy malnutrition (PEM), and 30 healthy children (REF group) underwent an assessment of growth parameters, serum IGF-1, basal GH, and peak GH after stimulation with insulin. PEM patients had higher basal GH levels than CP-N, CP-R and REF groups (p = 0.026, p < 0.001, and p < 0.001 respectively). After insulin stimulation, CP-N, CP-R, and PEM patients had lower GH levels compared to the REF group (p = 0.04, p = 0.007, and p = 0.036 respectively). IGF-1 levels were lower in CP-R group compared to CP-N and REF groups (p = 0.037 and p < 0.001 respectively), and in PEM group compared to CP-N and REF groups (p < 0.001 and p < 0.001 respectively). CP-R patients failed to demonstrate the same high basal GH response as PEM patients, and responded inadequately to the insulin stimulation test, but they had IGF-1 levels comparable to those of PEM patients. On the other hand, CP-N patients behaved as controls regarding their basal GH and IGF-1 levels, but failed to respond adequately to the insulin stimulation test. The PEM group presented high basal GH and low IGF-1 levels. These findings suggest that non-nutritional factors contribute to growth retardation in CP children.