title: Vitamin A and iron supplementation is as efficient as hormonal therapy in constitutionally delayed children.
abstract: OBJECTIVE
  To assess the effect of nutritional supplementation on growth and puberty in constitutionally delayed children.
  
  
  METHODS
  One hundred and two boys, 13.6-15.5 years of age, who were referred because of short stature and delayed puberty.
  
  
  METHODS
  The boys were randomly allocated to one of the following treatment groups: oxandrolone therapy, 5 mg/day for 6 months (n = 15), testosterone depot, 100 mg monthly for 3 months (n = 15) or for 6 months (n = 20), nutritional programme (n = 17), oxandrolone and nutritional programme (n = 15) or passive observation (n = 20). Boys in the nutritional programmes received 12 mg/day iron and 6000 IU/week of vitamin A. Outcome measurements were of height, weight, pubertal signs, dietary intake, serum vitamin A, iron, GH and IGF-1.
  
  
  RESULTS
  Six months of vitamin A supplementation induced growth acceleration similar to that seen in the oxandrolone- and testosterone-treated children, and significantly greater than in the observation group (9.3 +/- 2.9 vs. 4.0 +/- 0.9 crn/yr, P < 0.001). Whereas in the vitamin A-supplemented group, puberty (increase in testicular volume >/= 12 ml) was induced within 12 months. In all testosterone-treated patients, pubic hair was noted within 3 months and a testicular volume of >/= 12 ml was observed 9-12 months after the initiation of therapy. No pubertal signs were noted in the observation group during this time.
  
  
  CONCLUSIONS
  Subnormal vitamin A intake is one of the aetiological factors in delayed pubertal maturation. Supplementation of both vitamin A and iron to normal constitutionally delayed children with subnormal vitamin A intake is as efficacious as hormonal therapy in the induction of growth and puberty.
authors.affiliation: Pediatric Endocrine Unit, Kaplan Medical Center, Rehovot, Israel. zvivadik@012.net.il
authors.forename: Z
authors.initials: Z
authors.lastname: Zadik
authors.forename: T
authors.initials: T
authors.lastname: Sinai
authors.forename: A
authors.initials: A
authors.lastname: Zung
authors.forename: R
authors.initials: R
authors.lastname: Reifen
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000728:Androgens / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D016014:Linear Models; D008297:Male; D010074:Oxandrolone / Q000627:therapeutic use; D011628:Puberty, Delayed / Q000188:drug therapy*; D013739:Testosterone / Q000627:therapeutic use; D014801:Vitamin A / Q000008:administration & dosage*
chemical_list: D000728:Androgens; D003692:Delayed-Action Preparations; D014801:Vitamin A; D013739:Testosterone; D010074:Oxandrolone; D007501:Iron