In the Czech Republic is born to 5 % of SGA / IUGR children, about 5, 000 children a year, and their incidence is increasing. In 10 - 15 % does not occur postnatal compensation growth acceleration and growth retardation is then further deepens. Since 2003, these children can be treated by recombinant growth hormone in supraphysiological doses. Master thesis brings informations about SGA / IUGR children and their growth parameters during the first 2 years from the beginning of treatment when the monitoring was carried out at three - month intervals. The results are compared with the group of patients treated with growth hormone for growth hormone deficiency. Growth data was processed by a group of 57 SGA / IUGR children, which was compared with data of 34 children with growth hormone deficiency treated between 2003-2015 with growth hormone. Treatment of both groups of patients was carried out by a suitable therapeutic protocol, with the dose of GH by the respective diagnosis. These parameters were monitored: body height and weight, growth rate, BMI and weight - height ratio of patients. SGA / IUGR and GHD patients showed different growth profile in the initial phase of treatment when GHD patients had higher acceleration peak after 3 months of starting treatment and steeper increase in growth rate....

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Idiopathic Short Stature is a heterogeneous set of conditions without obvious hormonal changes or defined etiologies. It may include the partial insensitivity to GH (PGHI) and the moderate GH deficiency (MGHD), both of them with low concentrations of growth factor like insulin type I (IGF-I) and hyper or sub-answer of GH on tests of stimulation, respectively. The objective of this study is to assess the response to treatment with GH in PGHI and MGHD, comparing them twith the results obtained in a group with severe GH deficiency (SGHD). It was studied in PGHI (GH peak ≥18 ng/ml) 20 individuals (14 boys), 12.07 (2.57-year-old); in MGHD (GH peak between 5 and 10 ng/ml) 12 (7 boys), 10.73 (1.79-year-old); and in SGHD (GH peak lower than 5 ng/ml) 19 (10 boys), 10.90-(3.51) yearold, treated with GH for one to ten years. The initial and present GH doses were, respectively, 43.33(10.00) and 49.61 (12.90) μg/kg/day in SGHD, 50.27 (11.76) and 57.27 (15.83) μg/kg/day in MGHD; and50.18 (6.99) and 55.66 (9.61) μg/kg/day in PGHI. The standard deviation score (SDS) of initial height of the SGHD group was lower than MGHD group (p< 0.01) and PGHI group (p <0.001).The SDS of initial IGF-I of SGHD was similar to MGHD and lower than PGHI group (p<0.0001).The initial bone age (BA) in SGHD group was similar to MGHD and lower than PGHI group GH (p < 0.01). GH treatment has brought about a lower increase in the height SSD and in the IGF-I SSD (both, p < 0.05) and in the bone age (p< 0.01) in the PGHI group than in the SGHD group, probably due to the more accentuated height deficit in the SGHD group and lower IGF-I increase in the PGHI group. Treatment response was similar in MGHD and SGHD groups. The lowest height gain in the PGHI suggests that the partial GH insensitivity needs higher GH doses to be effective. / A baixa estatura idiopática é um conjunto heterogêneo de condições sem evidentes alterações hormonais ou etiologias definidas. Pode incluir a insensibilidade parcial ao GH (IPGH) e a deficiência moderada de GH (DMGH), ambas com concentrações baixas de fator de crescimento semelhante à insulina tipo I (IGF-I) e hiper ou sub-resposta do GH aos testes de estímulo, respectivamente. O objetivo do presente trabalho é avaliar a resposta ao tratamento com GH na IPGH e DMGH, comparando-as com os resultados obtidos na deficiência grave de GH (DGGH). Foram estudados no grupo IPGH (pico de GH ≥18 ng/ml), 20 indivíduos (14 meninos), com 12,0 (2,57) anos de idade; no grupo DMGH (pico de GH entre 5 e 10 ng/ml), 12 (sete meninos), com 10,73 (1,79) anos; e no DGGH (pico de GH < 5 ng/ml), 19 (10 meninos), com 10,90 (3,51) anos, tratados com GH por um a dez anos. As doses de GH iniciais e atuais foram, respectivamente, 43,33 (10,00) e 49,61 (12,90) μg/kg/dia no DGGH; 50,27 (11,76) e 57,27 (15,83) μg/kg/dia no DMGH; e 50,18 (6,99) e 55,66 (9,61) μg/kg/dia no IPGH. O escore de desvio-padrão (EDP) da altura inicial do grupo DGGH foi menor do que no DMGH (p< 0,01) e no IPGH (p <0, 001). O EDP do IGF-I inicial do grupo DGGH foi similar ao DMGH e menor do que o do IPGH (p< 0, 0001). A idade óssea inicial no grupo DGGH foi similar ao DMGH e menor do que a do grupo IPGH (p < 0,01). O tratamento com GH propiciou um menor incremento no EDP da altura e no EDP do IGF-I (ambos, p < 0,05) e na IO (p< 0,01) no grupo IPGH do que no DGGH, provavelmente refletindo o maior déficit estatural no grupo com DGGH e menor aumento do IGF-I no grupo IPGH. A resposta ao tratamento nos grupos DMGH e DGGH foi semelhante. O ganho estatural menor no grupo IPGH sugere que a insensibilidade parcial ao GH necessitaria de doses mais altas de GH para ser vencida.