Final height outcome after three years of growth hormone and gonadotropin-releasing hormone agonist treatment in short adolescents with relatively early puberty.
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).


METHODS
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 -2.0 SDS or between -1.0 and -2.0 SDS plus a predicted adult height (PAH0) less than -2.0 SDS were randomly allocated to receive GH plus GnRHa (n=17) or no treatment (n=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-PAH0) than controls: 4.4 (4.9) and -0.5 (6.4) cm, respectively (P<0.05). FH was higher than PAH0 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, -4.0 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.


CONCLUSIONS
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.
van Gool
Sandy A
SA
Leiden University Medical Center, Department of Pediatrics, and Tergooi Hospital, Blaricum, The Netherlands. s.van_gool@lumc.nl
Kamp
Gerdine A
GA
Visser-van Balen
Hanneke
H
Mul
Dick
D
Waelkens
Johan J J
JJ
Jansen
Maarten
M
Verhoeven-Wind
Liesbeth
L
Delemarre-van de Waal
Henriëtte A
HA
de Muinck Keizer-Schrama
Sabine M P F
SM
Leusink
Geraline
G
Roos
Jan C
JC
Wit
Jan M
JM
D000293:Adolescent; D001827:Body Height / Q000187:drug effects; D002648:Child; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D019382:Human Growth Hormone / Q000819:agonists*; D006801:Humans; D008297:Male; D011629:Puberty, Precocious / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D012044:Regression Analysis; D015203:Reproducibility of Results; D016896:Treatment Outcome
D019382:Human Growth Hormone; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone