High-dose GH treatment limited to the prepubertal period in young children with idiopathic short stature does not increase adult height.
OBJECTIVE
To assess the long-term effect of prepubertal high-dose GH treatment on growth in children with idiopathic short stature (ISS).


METHODS
Forty children with no signs of puberty, age at start 4-8 years (girls) or 4-10 years (boys), height SDS <-2.0 SDS, and birth length >-2.0 SDS, were randomly allocated to receive GH at a dose of 2 mg/m(2) per day (equivalent to 75 microg/kg per day at start and 64 microg/kg per day at stop) until the onset of puberty for at least 2 years (preceded by two 3-month periods of treatment with low or intermediate doses of GH separated by two washout periods of 3 months) or no treatment. In 28 cases, adult height (AH) was assessed at a mean (S.D.) age of 20.4 (2.3) years.


RESULTS
GH-treated children (mean treatment period on high-dose GH 2.3 years (range 1.2-5.0 years)) showed an increased mean height SDS at discontinuation of the treatment compared with the controls (-1.3 (0.8) SDS versus -2.6 (0.8) SDS respectively). However, bone maturation was significantly accelerated in the GH-treated group compared with the controls (1.6 (0.4) versus 1.0 (0.2) years per year, respectively), and pubertal onset tended to advance. After an untreated interval of 3-12 years, AH was -2.1 (0.7) and -1.9 (0.6) in the GH-treated and control groups respectively. Age was a positive predictor of adult height gain.


CONCLUSIONS
High-dose GH treatment restricted to the prepubertal period in young ISS children augments height gain during treatment, but accelerates bone maturation, resulting in a similar adult height compared with the untreated controls.
van Gool
S A
SA
Department of Pediatrics, Leiden University Medical Center, Postal Zone J6-S, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Kamp
G A
GA
Odink
R J
RJ
de Muinck Keizer-Schrama
S M P F
SM
Delemarre-van de Waal
H A
HA
Oostdijk
W
W
Wit
J M
JM
D001827:Body Height / Q000187:drug effects*; D015992:Body Mass Index; D001846:Bone Development / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D016014:Linear Models; D008297:Male; D009426:Netherlands; D011627:Puberty; D055815:Young Adult
D019382:Human Growth Hormone