Abstract
Extract: The effect of human growth hormone (GH) administration (5 mg daily) was studied in 12 children with short stature, in an attempt to elucidate the cause of the hypercalcuria which so commonly occurs at the initiation of GH therapy. Complete metabolic balances were determined for Ca, P, N, Na, K, and Cl; and urine was analyzed for hydroxyproline, stable Sr, Pb, Mg, 137Cs, F, and creatinine. Some subjects had determinations of basal metabolic rate (BMR) and of ultrafiltrable serum Ca. In keeping with the reports of others, levels of N, P, K, Na, and Cl in urine all declined, as did that of 137Cs; Mg excretion fell slightly.
Ten of the 12 children with short stature (6 of whom had subnormal plasma GH responses to a variety of stimuli) had hypercalcuria; 3 of these had an increase in urine Ca in the face of a low Ca diet (170 mg/24 hr). Fecal Ca declined in some subjects and rose in others. Ultrafiltrable serum Ca did not change.
A majority of the subjects showed an increase in the urinary excretion of F, Sr, Pb, and hydroxyproline.
The effect of the hormone was also studied in three patients with idiopathic hypo-parathyroidism; two of these responded with an increase in urine Ca.
The magnitude of the rise in urine Ca could not be correlated with changes in BMR, changes in creatinine clearance, or changes in Na excretion; it was positively correlated with the increases in Sr and Pb in urine.
Speculation: We have evidence that the hypercalcuria accompanying GH administration is not due to increased gastrointestinal absorption, alterations in serum Ca, or changes in metabolic rate or renal function; nor is it mediated via parathyroid activity. These considations, plus the fact that the hypercalcuria is accompanied by hydroxyprolinuria and an increase in the urinary excreation of three “bone seekers” (Sr, Pb, and F), lead us to postulate that the hormone enhances bone resorpation, either per se or via “sulfation factor.”
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Bryson, M., Forbes, G., Amirhakimi, G. et al. Metabolic Response to Growth Hormone Administration, with Particular Reference to the Occurrence of Hypercalcuria. Pediatr Res 6, 743–751 (1972). https://doi.org/10.1203/00006450-197210000-00001
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DOI: https://doi.org/10.1203/00006450-197210000-00001
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