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Secondary hyperparathyroidism is not always an obstacle to improved growth during recombinant human growth hormone treatment.

Dr. Stefano Picca, Divisione di Nefrologia e Dialisi, Ospedale Pedíatrico ‘Bambino Gesù’, Istituto di Ricerca Scientifica, Piazza S. Onofri, 4, I-00165 Rome (Italy) Dear Sir, It is known that secondary hyperparathyroidism (HPT) is only a contributory cause of growth retardation in renal children [1] unless bone deformities occur altering skeletal morphology [2]. Nonetheless, the prevention of excessive parathyroid hormone (PTH) secretion by calcitriol administration has been generally considered essential to achieve linear growth [3]. Since recombinant human growth hormone (rhGH) treatment has been available for stunted children, no significant increase in PTH serum levels during rhGH treatment has been demonstrated [4, 5]. Recently, the induction of secondary HPT associated with poor response to rhGH treatment has been reported [6]. In order to verify if HPT could negatively affect response to rhGH treatment, we have retrospectively analyzed serum PTH levels together with growth rate during rhGH treatment in our children on chronic hemodialysis. Eleven children (7 boys, 4 girls), aged 6.7-14.2 years, were selected for rhGH treatment on the basis of the following criteria: chronological age > 3 years, height < 2 standard deviation score (SDS) for chronological age and/or height velocity < 2 5th centile during the year before the start of treatment, no evidence of systemic disease, malnutrition or radiological signs of osteodystrophy. All patients were prepubertal at the start of treatment. Dosage of rhGH was 4 IU/m2 of body surface area/day ( ± 10%). Intact PTH was measured by radioisotopic assay (Nichols Institute Diagnostics). Treatment duration ranged from 9 to 36 months: 1 patient was treated for 9 months, 1 for 12, 5 for 24, 3 for 36 and 1 for 48