Indian J. Pediatr. 44 : 315, 1977
G R O W T H H O R M O N E SECRETION IN G R O W H R E T A R D E D ASTHMATIC CHILDREN* PRANEStt NIGAM, S. LAUNGIA, B.I~,'[. GOYAL AND BRAHMA DUTT Jhansi
Various factors produce disturbance in growth e.g., malnutrition, tissue anoxia, diminished peripheral blood flow, hypermetabolic state, chronic cardiac decompensation, genetic and endocrine factors and frequency of upper and lower respiratory tract infections (Friedman and Braunweld 1974). Asthmatic children in whom the onset is in the growing age period, tend to show retarded growth (FaUiers et al. 1963, N o r m a n 1965). It has been observed that the use of cortlcosteroid might have affected the growth hormone level. Now the possibilities are, asthma disease compiex affects growth either by influencing growth hormone levels or its mobilisation or that the growth hormone mechanism is normal but tissues do not get enough oxygen saturation as might be expected from the diseased respiratory mechanism in asthmatic attacks, or a combination of the foregoing. By the use of the Bovril test the growth hormone secretion can be estimated and evaluation can be done in asthmatic children. The present study looked at growth hormone responses to Bovril in growth retarted asthmatic children. *From the Departments of Medicine, Paediatrics, Tuberculosis and Chest Diseases, and Physiology, M.L.B. Medical College, Jhansl-284001, U.P. Paper read in the InterasrnaCongress VIII, Vllssingen, The Netherlands, October, 6-10, 1975. Received on April 20, 1977.
M a t e r i a l and M e t h o d s Fifteen growth retarted asthmatic children were included in this study. They had paroxysms o f expiratory dyspnoea and wheezing, overinflation of the lungs, cough and audible rhonchi ( N o r m a n 1974). T h e y were interrogated for manifestations of allergic disorders and symptoms pertaining to the dlsease and treatment was taken. Their height and weight were m e a s u r e d (expressed as percentile for the purpose of comparison) and a thorough clinical examination was done. The routine investigations were p e r f o r m e d in all the aforesaid subjects. The Bovril Test was carried out on all of them as described by Jackson et al. (1968). Bovril, the ingredients of which are hydrolysed beef protein, beef stock, yeast extract, extract of beef, salt, caramel, starch and spices, was administered in the dose of 20 gin. per 1.5 sq. m. body surface in 160 ml. of hot water. During the test the children r e m a i n e d on the bed and were not allowed any activity. Blood specimens were taken by venepuncture before the Bovril was given and thereafter at 30 minutes interval, for two and half hours. Blood samples were left over night at 4~ and the serum was separated and stored at -- 15~ until assayed. H u m a n growth hormone levels were d e t e r m i n e d by the double antibody technique based on that described by Morgan and Lazason (1963) and modified by Grant 1967.
316
I N D I A N
J O U R N A L
O F
Observations
Vet.. 44, No. 357
P E D I A T R I C S
and
ing from 2 years 4 mondls to 7 years 2 months (mean duration 4 years 2 months), and when tested for human growth hormone all of them had a height which fell on or below the third percentile. The remaining 5, who were not receiving corticosteroids, showed severe growth retardation. All of the asthmatic children showed human growth hormone response to Bovril (Table 2). Nevertheless, the quantitative human growth hormone results could not be correlated with the patient's growth status.
Results
Amongst 15 growth retarted asthmatic children, there were 3 girls and 12 boys with their age ranging between 7 years 7 months to 16 years (mean 11 years 1 month) (Table 1). All of them were severely asthmatic. Ten of them showed eczema and six hayfever. At the time of human growth hormone assay the height o f t e n was below the third percentile and that of one on the fifth percentile. Retardation of skeletal maturation was observed in all of the patients. Corticosteroids, as prednisolone and prednisone, dose ranging from 5 to 20 mg per day, had been given to 10 of the children and they got the same doses at the time of testing. In two of them the height was known before corticosteroid therapy was started, while of the remaining 8, five already showed severe growth retardation (Fig. I). i.e., were on the third percentile for height and three showed moderate growth retardation. The height percentile of all the I0 had shown a downward trend after they had been receiving corticosteroids for a period rang-
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Discussion
Physical underdevelopment and a delayed onset of adolescence are common feature of many types of cyanotic and to a lesser extent acyanotic congenital heart diseases and chronic obstructive puhnonary diseases. The frequent and prolonged attacks of asthma result in a low oxygen saturation of the arterial blood with the retetation of carbon dioxide resulting in tissue anoxia etc. which in turn may cause interference with growth. It cannot be said that growth retardation, following
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G R O W T H H O R M O N E SECRETION IN G R O W H R E T A R D E D ASTHMATIC CHILDREN* PRANEStt NIGAM, S. LAUNGIA, B.I~,'[. GOYAL AND BRAHMA DUTT Jhansi
Various factors produce disturbance in growth e.g., malnutrition, tissue anoxia, diminished peripheral blood flow, hypermetabolic state, chronic cardiac decompensation, genetic and endocrine factors and frequency of upper and lower respiratory tract infections (Friedman and Braunweld 1974). Asthmatic children in whom the onset is in the growing age period, tend to show retarded growth (FaUiers et al. 1963, N o r m a n 1965). It has been observed that the use of cortlcosteroid might have affected the growth hormone level. Now the possibilities are, asthma disease compiex affects growth either by influencing growth hormone levels or its mobilisation or that the growth hormone mechanism is normal but tissues do not get enough oxygen saturation as might be expected from the diseased respiratory mechanism in asthmatic attacks, or a combination of the foregoing. By the use of the Bovril test the growth hormone secretion can be estimated and evaluation can be done in asthmatic children. The present study looked at growth hormone responses to Bovril in growth retarted asthmatic children. *From the Departments of Medicine, Paediatrics, Tuberculosis and Chest Diseases, and Physiology, M.L.B. Medical College, Jhansl-284001, U.P. Paper read in the InterasrnaCongress VIII, Vllssingen, The Netherlands, October, 6-10, 1975. Received on April 20, 1977.
M a t e r i a l and M e t h o d s Fifteen growth retarted asthmatic children were included in this study. They had paroxysms o f expiratory dyspnoea and wheezing, overinflation of the lungs, cough and audible rhonchi ( N o r m a n 1974). T h e y were interrogated for manifestations of allergic disorders and symptoms pertaining to the dlsease and treatment was taken. Their height and weight were m e a s u r e d (expressed as percentile for the purpose of comparison) and a thorough clinical examination was done. The routine investigations were p e r f o r m e d in all the aforesaid subjects. The Bovril Test was carried out on all of them as described by Jackson et al. (1968). Bovril, the ingredients of which are hydrolysed beef protein, beef stock, yeast extract, extract of beef, salt, caramel, starch and spices, was administered in the dose of 20 gin. per 1.5 sq. m. body surface in 160 ml. of hot water. During the test the children r e m a i n e d on the bed and were not allowed any activity. Blood specimens were taken by venepuncture before the Bovril was given and thereafter at 30 minutes interval, for two and half hours. Blood samples were left over night at 4~ and the serum was separated and stored at -- 15~ until assayed. H u m a n growth hormone levels were d e t e r m i n e d by the double antibody technique based on that described by Morgan and Lazason (1963) and modified by Grant 1967.
316
I N D I A N
J O U R N A L
O F
Observations
Vet.. 44, No. 357
P E D I A T R I C S
and
ing from 2 years 4 mondls to 7 years 2 months (mean duration 4 years 2 months), and when tested for human growth hormone all of them had a height which fell on or below the third percentile. The remaining 5, who were not receiving corticosteroids, showed severe growth retardation. All of the asthmatic children showed human growth hormone response to Bovril (Table 2). Nevertheless, the quantitative human growth hormone results could not be correlated with the patient's growth status.
Results
Amongst 15 growth retarted asthmatic children, there were 3 girls and 12 boys with their age ranging between 7 years 7 months to 16 years (mean 11 years 1 month) (Table 1). All of them were severely asthmatic. Ten of them showed eczema and six hayfever. At the time of human growth hormone assay the height o f t e n was below the third percentile and that of one on the fifth percentile. Retardation of skeletal maturation was observed in all of the patients. Corticosteroids, as prednisolone and prednisone, dose ranging from 5 to 20 mg per day, had been given to 10 of the children and they got the same doses at the time of testing. In two of them the height was known before corticosteroid therapy was started, while of the remaining 8, five already showed severe growth retardation (Fig. I). i.e., were on the third percentile for height and three showed moderate growth retardation. The height percentile of all the I0 had shown a downward trend after they had been receiving corticosteroids for a period rang-
.
.
.
9 ~'
..
Discussion
Physical underdevelopment and a delayed onset of adolescence are common feature of many types of cyanotic and to a lesser extent acyanotic congenital heart diseases and chronic obstructive puhnonary diseases. The frequent and prolonged attacks of asthma result in a low oxygen saturation of the arterial blood with the retetation of carbon dioxide resulting in tissue anoxia etc. which in turn may cause interference with growth. It cannot be said that growth retardation, following
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