ORIGINAL ARTICLE A preliminary trial of the effect of recombinant human growth hormone on short-term linear growth and glucose homeostasis in children with Crohn’s disease S. C. Wong*, P. Kumar†, P. J. Galloway‡, J. C. Blair†, M Didi†, A. M. Dalzell§, K. Hassan–, P. McGrogan– and S. Faisal Ahmed* *Developmental Endocrinology Research Group, Royal Hospital for Sick Children, Glasgow, †Department of Endocrinology, Royal Liverpool Children’s Hospital, Liverpool, ‡Department of Biochemistry, Royal Hospital for Sick Children, Glasgow, §Department of Gastroenterology, Royal Liverpool Children’s Hospital, Liverpool and –Department of Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK Summary Background It is unclear whether recombinant human growth hormone (rhGH) improves linear growth in children with Crohn’s disease (CD). Aims To investigate the effects of rhGH on height velocity (HV) and glucose homeostasis over a 6-month period. Design and setting Randomized controlled trial in two tertiary children’s hospitals in 22 children with inflammatory bowel disease amongst whom 21 had CD. Duration of disease from diagnosis and number of acute relapses requiring either exclusive enteral nutri- tion or therapeutic dose of oral prednisolone were similar in the treatment and control groups. Intervention Either rhGH (0Æ067 mg/kg per day) as daily subcu- taneous injections (rhGH group; n, 11) or no rhGH, (Ctrl; n, 11) for 6 months. Main outcome measure Percentage change in HV after 6 months in the two groups. Auxology, puberty, skeletal age, dis- ease factors, treatment and glucose homeostasis were also assessed. Results Median HV increased from 4Æ5 (range, 0Æ6, 8Æ9) at base- line to 10Æ8 (6Æ1, 15Æ0) cm/year at 6 month (P =0Æ003) in the rhGH group, whereas in the Ctrl group, it was 3Æ8 (1Æ4, 6Æ7) and 3Æ5 cm/year (2Æ0, 9Æ6), respectively (P =0Æ58). Median percentage increase in HV after 6 months in the rhGH group was 140% (16Æ7, 916Æ7) compared with 17Æ4% ()42Æ1%, 97Æ7%) in the Ctrl group (P <0Æ001). There were no significant differences in disease activ- ity and proinflammatory cytokines at baseline and 6 months in both groups and change in bone age for chronological age was also similar in the two groups. In the rhGH group, fasting insulin increased from 4Æ0 (2Æ0, 11Æ0) to 7Æ0 mU/l (2Æ0, 16Æ0) (P =0Æ02), whereas in the Ctrl group, it was 3Æ0 (1Æ2, 12Æ7) and 3Æ8 mU/l (2Æ1, 7Æ0) (P =0Æ72), respectively. Conclusions Although this pilot trial shows that rhGH can improve short-term linear growth in children with CD, the clin- ical efficacy of this therapy needs to be further studied in longer-term studies of growth, glucose homeostasis and disease status. (Received 19 October 2010; returned for revision 2 November 2010; finally revised 29 December 2010; accepted 29 December 2010) Introduction Growth retardation in conditions such as inflammatory bowel disease (IBD) is multifactorial in origin and particularly affects those with Crohn’s disease (CD). 1 In children with IBD, sys- temic markers of the GH/IGF-1 axis are altered suggesting that many may have a variable extent of functional growth hormone (GH) insufficiency and resistance. 2 Improving the disease and nutritional status of children with CD has been shown to be associated with beneficial changes in growth and markers of the systemic GH/IGF-1 axis. 3 However, despite optimizing therapy, approximately a third of affected children may continue to grow poorly. 4,5 It is possible that some of the inhibitory effects of disease are mediated by cytokines and glucocorticoids at the level of the growth plate 6,7 and exposure to IGF-1 at this local level may rescue some of these effects. 8 It is, therefore, possible that treatment with recombinant human GH (rhGH) may exert a beneficial effect on growth in children who grow poorly despite optimization of their IBD therapy. This ratio- nale is further strengthened by the improved growth that has been observed following rhGH therapy in children with juvenile idio- pathic arthritis (JIA) 9,10 and cystic fibrosis. 11 In addition, prelimin- ary reports of rhGH therapy in IBD have suggested a beneficial Correspondence: Professor S. Faisal Ahmed, Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK. Tel.: 00 44 141 201 0571; Fax: 00 44 141 201 0837; E-mail: faisal.ahmed@glasgow.ac.uk Clinical Endocrinology (2011) 74, 599–607 doi: 10.1111/j.1365-2265.2011.03977.x Ó 2011 Blackwell Publishing Ltd 599