Pediatric Growth Parameters in Inflammatory Bowel Disease at Endocrine Referral

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Submission ID :
ESPR327
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Abstract: :

Background: Pediatric inflammatory bowel disease (IBD), Crohn's Disease (CD) and Ulcerative Colitis (UC), have been associated with poor linear growth ultimately leading to poor final stature and quality of life. IBD remission is imperative to ensure appropriate growth acceleration and puberty. Patients are often referred to endocrinology for evaluation of poor growth, despite no approved intervention. Growth hormone therapy remains controversial with variable success. It is unclear, however, what factors in addition to IBD predispose children to worse growth and eventually suboptimal height outcomes.

Objective: The aim of our study is to evaluate possible negative predictors that impact growth in children diagnosed with IBD.

Design/Methods We retrospectively studied medical records of 14 IBD patients referred to pediatric endocrinology for growrh concerns. Patient height, weight and BMI at time of diagnosis were compared to measurement at initial endocrine evaluation. In addition, growth velocity (GV), bone age, insulin-like growth factor 1 (IGF-1) levels and difference in predicted adult height (PAH) and mid-parental target height were reviewed. PAH was estimated using the Bayley-Pinneau method; target height was calculated using parental heights.

Results: At initial endocrine visit ages were 8-15 years (10 males and 4 females). 50% of patients had delayed bone ages. Height measured was on average -0.85 SD; however, 28% of the patients had a height less than -2 SD. Average SD at initial endocrine visit for weight and BMI were -0.72 and -0.12 SD, respectively. Average PAH calculated based on initial bone age was 1.02 SD lower than calculated mid-parental target height, but this was not significant. The average follow-up height SD was not significantly different (- 0.83), although 28% of patients continued to measure less than -2 SD for height, despite IBD treatment. 29% of patents were on rhGH at the time of endocrine follow-up. Average SDs for weight, BMI and growth velocity were -0.43, +0.25 and -0.15 respectively. As expected, serum IGF-1 correlates with BMI SD (R=0.5). BMI at follow-up positively correlates with GV (R=0.66).

Conclusion(s): Patients diagnosed with IBD despite mode of treatment appear to be at a disadvantage for growth. Parameters such as improvement of BMI and IGF-1 levels appear to suggest a better height prognosis. In our practice, a minority of patients were treated with rhGH. Whether treatment of IBD is sufficient to sustain normal growth vs intervention such as rhGH could better final outcomes remains to be studied.

Icahn School of Medicine at Mount Sinai Hospital
Icahn School of Medicine at Mount Sinai
Icahn School of Medicine at Mount Sinai

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