Historical Tidbit – Then and Now: This Month in Pediatric Endocrinology
Submitted by Evan Graber, DO
In the age of pituitary-derived human GH treatment (phGH), GH was administered intramuscularly (IM). Prior reports of subcutaneous (SQ) use had shown lipoatrophy as a side effect. There also seemed to be more development of GH antibodies, rendering treatment ineffective. However, different purification methods were used to isolate phGH and by the 1980’s, purer preparations were becoming available. In 1985, Wilson et al, studied the IGF-I and IGF-II responses to daily SQ phGH as well as effects on growth rate, GH antibody formation, and patient satisfaction. There was no significant difference in the growth factor levels or growth rates between the SQ and IM groups. Several patients in each group developed GH antibodies but continued to have increased growth rates. Of 9 subjects switched from IM to SQ administration, only 1 preferred the IM method.
Ironically, 1985 was also the year recombinant human GH (rhGH, somatrem) became available (available for children in 1987). At first, this preparation was given either IM or SQ. However, studies such as Wilson’s demonstrated that SQ was equally as effective as IM, preferred by patients, and did not cause any additional adverse effects. Now rhGH is exclusively given by the SQ route and daily administration has evolved to a weekly option.