Adult height in children with short stature and idiopathic delayed puberty after different management (original) (raw)
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Four-year Experience of Growth Hormone Treatment in Children with Non-endocrine Short Stature
Clinical Pediatric Endocrinology, 1996
Fifty-three children with non-endocrine short stature (NESS) were treated with recombinant human growth hormone (GH) for four years. GH treatment significantly increased height velocity, height SD score (SDS), and height velocity SDS for chronological age (CA) in NESS. The mean height velocity was increased by GH treatment from 4.4 cm/year to 7.2 cm/year in the first year, 6.3 cm/year in the second year, 5.7 cm/year in the third year and 5.4 cm/year in the fourth year; the mean height SDS from-3.15 SD to-2.70 SD in the first year,-2.49 SD in the second year,-2.40 SD in the third year and-2.34 SD in the fourth year. However, evaluated in terms of the height SDS for bone age, no significant improvement in the effect was observed. Twenty-seven children developed puberty during the four-year GH treatment. The height at the onset of puberty was shorter than that of normal children. The earlier GH treatment started, the younger age and the shorter height the patients entered puberty. Since it is known that the height at onset of puberty correlates well with the final height , it is probable that the patients who developed puberty at short stature in this study will remain short as adults. The effect of GH treatment in children with NESS should be carefully evaluated by conducting a long-term follow-up .
Adult Height in 24 Patients Treated for Growth Hormone Deficiency and Early Puberty 1
The Journal of Clinical Endocrinology & Metabolism, 1997
This study evaluates the capacity of treatment with the combination of growth hormone (GH) and gonadotropin releasing hormone (GnRH) analog to preserve the height potential of 24 patients (15 girls, 9 boys) with GH deficiency and early puberty (onset at 7.8 Ϯ 0.5 SE yr in girls and 9.0 Ϯ 0.7 yr in boys). All but 4 were given cranial irradiation. They (group 1) were compared with 17 patients of normal pubertal age treated with GH for cranial irradiation-induced GH deficiency (group 2) and with 19 girls treated with GnRH analog for idiopathic central precocious puberty (group 3). The adult heights in groups 1, 2 and 3 were -0.5 Ϯ 0.2, -1.3 Ϯ 0.2, and -0.2 Ϯ 0.2 SD, significantly lower (P Ͻ 0.01) in group 2. They were lower than the target heights in groups 1 and 2 (P Ͻ 0.001), and similar in group 3.
Clinical Endocrinology, 1998
OBJECTIVE Combined gonadotrophin-releasing hormone analogue and recombinant human growth hormone therapy has been used in an attempt to improve the final height of short non-GH deficient adolescents with normally timed puberty; its use, however, is still controversial as only short-term studies in a very limited number of patients have been undertaken, with either improvement in height prognosis or no beneficial effect on predicted growth. We have treated a group of extremely short healthy children with very low predicted adult heights entering into normally timed puberty with combined therapy, in order to determine whether we could improve their final height above their pretreatment predicted adult height. PATIENTS We treated 10 healthy adolescent short children (7 girls and 3 boys) simultaneously for 30.0 Ϯ 5.2 months with the GnRH analogue leuprolide acetate (0.3 mg/kg im every 28 days) and with rhGH (0.1 U/kg/day, sc, 6 days a week). The mean chronological age of our patients was 11.8 Ϯ 1.3 years, with a mean bone age of 11.2 Ϯ 0.9 years, height of 128.9 Ϯ 7.5 cm (¹ 2.4 Ϯ 0.4 SD below the mean) and a predicted adult height of 150.7 Ϯ 9.8 cm; they were all in Tanner stage II-III of puberty. Ten healthy short children (7 girls and 3 boys) in the early stages of puberty with a mean chronological age of 11.4 Ϯ 1.0 years, a mean bone age of 11.0 Ϯ 0.8 years, height of 128.9 Ϯ 7.8 cm(¹ 2.3 Ϯ 0.4 SD below the mean) and a mean adult predicted height of
Idiopathic short stature: Management and growth hormone treatment
Growth Hormone & IGF Research, 2008
In the management of ISS auxological, biochemical, psychosocial and ethical elements have to be considered. In boys with constitutional delay of growth and puberty androgens are effective in increasing height and sexual characteristics, but adult height is unchanged. GH therapy is efficacious in increasing height velocity and adult height, but the inter-individual variation is considerable. The effect on psychosocial status is uncertain. Factors affecting final height gain include GH dose, height deficit in comparison to midparental height, age and first year height velocity. In case of a low predicted adult height at the onset of puberty, addition of a GnRH analogue can be considered. Although GH therapy appears safe, long-term monitoring is recommended.
The Journal of Pediatrics, 1994
We report the effect of growth hormone (GH) treatment for 4 to 10 years in 15 prepubertal non-GH-deficient short children (10 boys, 5 girls, aged 7.4 to 13.2 years). In 7 patients, GH was administered at a dosage of 0.5 U/kg per week (group 1: 4 boys, 3 girls) and in 8 patients (group 2: 6 boys, 2 girls) at a dosage of 1.0 U/kg per week. After the first year, mean linear growth velocity had significantly increased in both groups. The increase in growth velocity was sustained during the first 4 years and then declined to pretreatment values in the majority of subjects. Treatment with GH did not induce an earlier onset of puberty, but there was a tendency toward faster skeletal maturation. The mean final height standard deviation score (SDS) was similar in the two groups and was significantly higher than the height SDS for chronologic age before treatment, but it did not differ from mean pretreatment predicted adult height SDS nor from mean target height SDS in both groups. Final height was significantly correlated with target height in both groups. These preliminary observations indicate that GH treatment does not generally increase final height over target height in short non-GH-deficient children.
The Journal of Clinical Endocrinology & Metabolism, 2007
Objective: Our objective was to assess final height (FH) and adverse effects of combined GH and GnRH agonist (GnRHa) treatment in short adolescents born small for gestational age or with normal birth size (idiopathic short stature). Design and Patients: Thirty-two adolescents with Tanner stage 2-3, age and bone age (BA) less than 12 yr for girls or less than 13 yr for boys, height SD score (SDS) less than Ϫ2.0 SDS or between Ϫ1.0 and Ϫ2.0 SDS plus a predicted adult height (PAH 0) less than Ϫ2.0 SDS were randomly allocated to receive GH plus GnRHa (n ϭ 17) or no treatment (n ϭ 15) for 3 yr. FH was assessed at the age of 18 yr or older in girls or 19 yr or older in boys. Results: FH was not different between treatment and control groups. Treated children had a larger height gain (FH Ϫ PAH 0) than controls: 4.4 (4.9) and Ϫ0.5 (6.4) cm, respectively (P Ͻ 0.05). FH was higher than PAH 0 in 76 and 60% of treated and control subjects, respectively. During follow-up, 50% of the predicted height gain at treatment withdrawal was lost, resulting in a mean gain of 4.9 cm (range, Ϫ4.0 to 12.3 cm) compared with controls. Treatment did not affect body mass index or hip bone mineral density. Mean lumbar spine bone mineral density and bone mineral apparent density tended to be lower in treated boys, albeit statistically not significant. Conclusion: Given the expensive and intensive treatment regimen, its modest height gain results, and the possible adverse effect on peak bone mineralization in males, GH plus GnRHa cannot be considered routine treatment for children with idiopathic short stature or persistent short stature after being born small for gestational age.
The Journal of Clinical Endocrinology & Metabolism, 2004
Background Short-term administration of growth hormone to children with idiopathic short stature results in increases in growth rate and standard-deviation scores for height. However, the effect of longterm growth hormone therapy on adult height in these children is unknown. Methods We studied 121 children with idiopathic short stature, all of whom had an initial height below the third percentile, low growth rates, and maximal stimulated serum concentrations of growth hormone of at least 10 µg per liter. The children were treated with growth hormone (0.3 mg per kilogram of body weight per week) for 2 to 10 years. Eighty of these children have reached adult height, with a bone age of at least 16 years in the boys and at least 14 years in the girls, and pubertal stage 4 or 5. The difference between the predicted adult height before treatment and achieved adult height was compared with the corresponding difference in three untreated normal or short-statured control groups. Results In the 80 children who have reached adult height, growth hormone treatment increased the mean standard-deviation score for height (number of standard deviations from the mean height for chronologic age) from ¡2.7 to ¡1.4. The mean (±SD) difference between predicted adult height before treatment and achieved adult height was +5.0±5.1 cm for boys and +5.9±5.2 cm for girls. The difference between predicted and achieved adult height among treated boys was 9.2 cm greater than the corresponding difference among untreated boys with initial standard-deviation scores of less than ¡2, and the difference among treated girls was 5.7 cm greater than the difference among untreated girls. Conclusions Long-term administration of growth hormone to children with idiopathic short stature can increase adult height to a level above the predicted adult height and above the adult height of untreated historical control children.