Tratamento da baixa estatura idiopática : experiência da unidade de endocrinologia pediátrica

Abstract

Resumo : Objective: To evaluate the efficacy of treatment of children and adolescents with idiopathic short stature (ISS) attended at a Public University Hospital in Brazil. Patients and methods: Review of 134 charts of patients with indication for recombinant growth hormone (GHr) between May 2007 and May 2017 and collection of the following data: sex, chronological age, weight and length at birth, pubertal stage, Z-score of target stature (TS), GH peak with clonidine and/or insulin hypoglycemia, prescribed GHr dose, adjuvant treatment, duration of treatment, final stature (FS) Z-score. Stature Z-score and Z-score of the final stature prevision (FSP) were obtained pre-treatment and annually. Results: 65 patients fulfilled the ISS criteria; 33 were on treatment (> 12 months) and 10 reached FS. IGF-1 was normal in 92.3% and all had one or both of the responsive stimulus tests (peak > 5.0 ng/mL). The Z-score of stature at the 1st, 2nd, 3rd, 4th (p <0.01) and 5th (p = 0.01) years of treatment were higher than the Z-score of initial stature. The FSP Z-score at the 1st, 2nd, 3rd (p <0.01) and 4th years (p = 0.01) of treatment was higher than the Z-score of the initial FSP. All patients who achieved FS used adjuvant treatment. The FS Z-score was not different from the TS Z-score (p = 0.24). Stature gain ranged from 0.9 to 7.9 cm. Conclusion: The treatment of children with ISS is safe and effective, but with great variability of response. Its administration should be individualized considering psychosocial benefits, adverse effects and costs.