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Appropriate size selection of double?lumen tubes (DLTs) for one?lung ventilation (OLV) in adults is still a humongous task. Several important factors are to be considered like patient height, gender, tracheal diameter, left main bronchial diameter, and cricoid cartilage transverse diameter. In addition to radiological assessment of the airway diameters, the manufacturing details of the particular DLT being used also play a significant role in size selection. Optimal positioning of the appropriately sized DLT is indispensable to avoid complications like airway trauma, cuff rupture, hypoxemia, and tube displacement. It is imperative to know whether the one?size?fits?all dictum holds for DLT size selection as claimed by certain studies. Further randomized studies are required for crystallizing standard protocols ascertaining the correct DLT size. This systematic review article highlights the various parameters employed for DLT size selection and explores the newer DLTs used for adult OLV.
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Objectives To validate adult height predictions (BX) using automated and Greulich–Pyle bone age determinations in children with chronic endocrine diseases. Methods Heights and near-adult heights were measured in 82 patients (48 females) with chronic endocrinopathies at the age of 10.45±2.12 y and at time of transition to adult care (17.98±3.02 y). Further, bone age (BA) was assessed using the conventional Greulich–Pyle (GP) method by three experts, and by BoneXpert™. PAH were calculated using conventional BP tables and BoneXpert™. Results The conventional and the automated BA determinations revealed a mean diference of 0.25±0.72 y (p=0.0027). The automated PAH by BoneXpert™ were 156.26 ± 0.86 cm (SDS ? 2.01 ± 1.07) in females and 171.75 ± 1.6 cm (SDS ? 1.29 ± 1.06) in males, compared to 153.95 ± 1.12 cm (SDS ? 2.56 ± 1.5) in females and 169.31 ± 1.6 cm (SDS?1.66±1.56) in males by conventional BP, respectively and in comparison to near-adult heights 156.38±5.84 cm (SDS?1.91±1.15) in females and 168.94±8.18 cm (SDS?1.72±1.22) in males, respectively. Conclusion BA ratings and adult height predictions by BoneXpert™ in children with chronic endocrinopathies abolish rater-dependent variability and enhance reproducibility of estimates thereby refning care in growth disorders. Conventional methods may outperform automated analyses in specifc cases.
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Objective:To evaluate the effect of oral acitretin on the height and bone development of children.Methods:Clinical and imaging data were collected from 106 children receiving oral acitretin for at least 1 month in Department of Dermatology, Beijing Children′s Hospital from March 2007 to January 2021, and retrospectively analyzed. The main outcome measures were height and near-adult height. Multivariate logistic regression analysis was carried out to investigate relevant factors for short stature in children, and non-inferiority test was used to analyze the proximity of the actual height to target height of children who had reached near-adult height. The secondary outcome measures were bone age and epiphyseal closure. Wilcoxon signed-rank test was used to analyze differences in the value of bone age minus chronological age between the baseline and last follow-up, and the premature closure of epiphysis was also evaluated.Results:Among the 106 children, 62 were males and 44 were females; 84 were diagnosed with pustular psoriasis, 10 with psoriasis vulgaris, 11 with pityriasis rubra pilaris, and 1 with lupus miliaris disseminatus faciei. These children received oral acitretin at doses of <1 mg·kg -1·d -1 for 1 - 90 months. Among the 96 children aged under 18 years, 91 (94.8%) were of normal stature, and 5 (5.2%) were short in stature; among the 83 children receiving acitretin monotherapy, 81 (97.6%) were of normal stature, and 2 (2.4%) of short stature. Binary logistic regression analysis showed that the risk of short stature caused by acitretin combined with glucocorticoid therapy was 76.57 times higher than that of acitretin monotherapy ( OR = 77.57, 95% CI: 2.20 - 2 738.82, P = 0.017) , while the type of disease, gender, age at onset, age at initial treatment with acitretin, course of treatment, and average daily dose of acitretin did not significantly affect the stature of children ( P = 0.988, 0.214, 0.087, 0.078, 0.066, 0.350, respectively) . At the last follow-up visit, 13 children who had reached near-adult height were of normal stature, and the non-inferiority test showed that their near-adult height was not inferior to the target height (Satterthwaite = 0.23, P = 0.030) . Bone age was evaluated in 45 children at baseline and last follow-up visit, there was no significant difference in the value of bone age minus chronological age between the baseline and last follow-up ( Z = -0.85, P = 0.250) , and no patients experienced premature closure of epiphysis before and after the treatment. Conclusion:This study preliminarily revealed that oral acitretin at doses of <1 mg·kg -1·d -1 for less than 90 months might not significantly affect the height and bone development of children.
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Resumen Los inhibidores de la aromatasa son fármacos disponibles por vía oral que inhiben la conversión de la testosterona en estradiol. Los estrógenos desempeñan un papel esencial en la maduración del cartílago de crecimiento y del cierre epifisario, evento que marca el final del proceso de crecimiento esquelético. Por este motivo, los inhibidores de la aromatasa se han probado como una intervención para mejorar la talla en niños y adolescentes de sexo masculino mediante el retraso en la maduración esquelética al disminuir la concentración de estradiol en la placa de crecimiento. Se resumen los resultados de una revisión sistemática Cochrane en la cual se evaluaron la eficacia y la seguridad de los inhibidores de la aromatasa para el tratamiento de la estatura baja en niños.
Abstract Aromatase inhibitors are orally administered drugs that inhibit the conversion of testosterone to estradiol. Estrogens have an important role in growth plate maturation and epiphyseal closure. Thus, aromatase inhibitors have been used to improve final height in male children and adolescents by delaying skeletal maturation through a decrease in estradiol concentration. The results of a Cochrane systematic review evaluating the efficacy and safety of aromatase inhibitors for the treatment of short stature in children are summarized below.
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OBJECTIVES@#To systematically evaluate the effect of gonadotropin-releasing hormone analogue (GnRHa) treatment on the final adult height of children over 6 years of age with central precocious puberty (CPP) or early and fast puberty (EFP).@*METHODS@#PubMed, MEDLINE, Embase, Cochrane Library, CNKI, and Wanfang Data were searched for related articles on GnRHa treatment for children with CPP or EFP. Stata 12.0 software was used to perform a Meta analysis of related data.@*RESULTS@#A total of 10 studies were included, and the total sample size was 720 children, with 475 children in the GnRHa treatment group and 245 children in the control group. The Meta analysis showed that compared with the control group, the GnRHa treatment group had significantly better final adult height (@*CONCLUSIONS@#GnRHa treatment is safe and effective in improving the final adult height of children over 6 years of age with CPP or EFP.
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Adult , Child , Humans , Body Height , Gonadotropin-Releasing Hormone , Puberty , Puberty, Precocious/drug therapyABSTRACT
El porcentaje de estatura adulta (PEA) es un indicador del estado de maduración, que refleja la variación en la tasa y progreso de crecimiento. Existen diversos métodos para estimar la estatura adulta, sin haberse documentado en la literatura de manera concreta sus similitudes o diferencias. Los objetivos del presente trabajo fueron comparar tres métodos de estimación del PEA, identificar cambios seculares en niños y adolescentes y establecer valores de referencia del PEA para población portuguesa. Se midieron en 799 niños y 736 niñas, de 7,0 a 16,49 años, la edad ósea, el peso y la estatura, para estimar el porcentaje de estatura adulta por las metodologías TW3, KR y RWT. Los valores del método TW3 del presente estudio, fueron comparados con los reportados en décadas atrás para identificar cambios seculares. Se utilizó un ANOVA de medidas repetidas para estimar las diferencias entre los métodos en el presente estudio, así como gráficas de Bland y Altman. Se utilizó la prueba de Kruskal-Wallis para analizar las diferencias entre los valores encontrados en la presente investigación y los presentados en décadas atrás en otros estudios. No se encontraron diferencias entre los métodos TW3 y KR en los diferentes grupos de edad cuando se clasificaron los sujetos por edad cronológica, en ambos sexos (P>0,05). Así mismo, no se observaron cambios seculares en el PEA (P>0.05). Los métodos TW3 y KR pueden ser intercambiables entre sí, debido a que no presentan diferencias en la estimación a diferentes edades y en ambos sexos. Además, no existió cambio secular en la estimación de PEA por estas metodologías, lo que las hace útiles en la actualidad.
The adult height percentage (AHP) is an indicator of maturity state, which reflects variation in growth rate. Several methods estimates adult height; however, its similarities or differences have not been documented in a concrete way in literature. The aims of the present work were to compare three common methods of AHP estimation, to identify children and adolescents secular changes and to develop AHP reference values in Portuguese population. Skeletal age, weight and height were measure in 799 children and 736 girls from 7.0 to 16.5 years; in addition, parents height was self-reported by them to estimate the AHP by TW3, RWT and KR methods. ANOVA was used to estimate differences between TW3, KR and RWT methods, as well as Bland-Altman graphs. Also, Kruskal-Wallis test was applied. No differences were found between TW3 and KR methods in all age groups, in both sexes, when subjects were classified by chronological age (P> 0.05). Likewise, no secular changes were observed in AHP (P> 0.05). Not only TW3 and KR protocols can be interchangeable each other because they did not present differences in the AHP estimation at different ages and in both sexes. However, secular changes were not observed in AHP estimation by these methods.
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Humans , Male , Female , Child , Adolescent , Body Height , Anthropometry/methods , Growth , Probability , Age FactorsABSTRACT
Abstract Objectives: To discuss the etiology and growth consequences of small size at birth and the indications, effects, and safety of biosynthetic growth hormone therapy in children born small for gestational age. Source of data: A comprehensive and non-systematic search was carried out in the PubMed, LILACS, and SciELO databases from 1980 to the present day, using the terms "small for gestational age," "intrauterine growth restriction," and "growth hormone". The publications were critically selected by the authors. Data synthesis: Although the majority of children born small for gestational age show spontaneous catch-up growth during the first two years of life, some of them remain with short stature during childhood, with high risk of short stature in adult life. Treatment with growth hormone might be indicated, preferably after 2-4 years of age, in those small for gestational age children who remain short, without catch-up growth. Treatment aims to increase growth velocity and to reach a normal height during childhood and an adult height within target height. Response to growth hormone treatment is variable, with better growth response during the pre-pubertal period. Conclusions: Treatment with growth hormone in short children born small for gestational age is safe and effective to improve adult height. Efforts should be done to identify the etiology of small size at birth before treatment.
Resumo Objetivos: Discutir a etiologia e as consequências para o crescimento e as indicações, os efeitos e a segurança da terapia com hormônio de crescimento biossintético em crianças pequenas para idade gestacional. Fonte dos dados: Uma busca abrangente e não sistemática foi feita nas bases de dados PubMed, LILACS e SciELO de 1980 até a presente data, com os termos "small for gestational age" (pequeno para a idade gestacional), "intrauterine growth restriction" (restrição de crescimento intrauterino) e "growth hormone" (hormônio do crescimento). As publicações foram selecionadas criticamente pelos autores. Síntese dos dados: Embora a maioria das crianças nascidas pequenas para idade gestacional apresente recuperação espontânea do crescimento durante os dois primeiros anos de vida, algumas delas permanecem com baixa estatura durante a infância, com alto risco de baixa estatura na vida adulta. O tratamento com hormônio de crescimento pode ser indicado, preferencialmente após os dois aos quatro anos, naquelas crianças sem recuperação espontânea do crescimento e com baixa estatura. Seus objetivos são aumentar a velocidade de crescimento e atingir uma altura normal durante a infância e uma altura adulta dentro da altura-alvo. A resposta ao tratamento com hormônio de crescimento é variável, com melhor resultado se iniciado durante o período pré-puberal. Conclusões: O tratamento com hormônio de crescimento em crianças baixas nascidas pequenas para idade gestacional é seguro e eficaz para melhorar a estatura adulta. Esforços devem ser feitos para identificar a etiologia do nascimento pequenas para idade gestacional antes do tratamento.
Subject(s)
Humans , Female , Infant, Newborn , Infant, Small for Gestational Age/growth & development , Growth Hormone/therapeutic use , Child Development/drug effects , Growth Disorders/drug therapyABSTRACT
OBJECTIVES: Unfavorable predicted adult height and psychosocial inadequacy represent parameters used to guide therapeutic intervention in girls with central precocious puberty. Gonadotropin-releasing hormone analog is the first-line treatment. The aim of this study was to compare two methods used to predict adult height and assess a validated tool for predicting the age at menarche in girls with central precocious puberty. METHODS: The predicted adult height of 48 girls with central precocious puberty was calculated at diagnosis using the Bayley-Pinneau method based on average and advanced bone age tables and compared with the predicted adult height calculated using a mathematical model. In addition, the age at spontaneous menarche was predicted using the new formulae. After Gonadotropin-releasing hormone analog treatment, the predicted adult height was calculated using only the Bayley-Pinneau tables. RESULTS: The achieved adult height was within the target height range in all treated girls with central precocious puberty. At diagnosis, the predicted adult height using the Bayley-Pinneau tables was lower than that using the mathematical model. After the Gonadotropin-releasing hormone analog treatment, the predicted adult height using the Bayley-Pinneau method with the average bone age tables was the closest to the achieved adult height. Using the formulae, the predicted age at spontaneous menarche was 10.1±0.5 yr. The Gonadotropin-releasing hormone analog treatment significantly postponed this event until 11.9±0.7 yr in these "idiopathic" central precocious puberty girls, highlighting the beneficial effect of this treatment. CONCLUSION: Both initial adult height prediction methods are limited and must be used with caution. The prediction of the age at spontaneous menarche represents an innovative tool that can help in clinical decisions regarding pubertal suppression.
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Humans , Female , Child, Preschool , Child , Puberty, Precocious/drug therapy , Body Height/physiology , Menarche/physiology , Models, Statistical , Reference Values , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Gonadotropin-Releasing Hormone/analogs & derivatives , Age Factors , Statistics, NonparametricABSTRACT
PURPOSE: Predicted adult height (PAH) is often crucial to decision-making about treatment with human growth hormone (GH) or gonadotropin-releasing hormone agonist in children with short stature. This study compares final adult height (FAH) with different methods used to determine PAH and assesses the clinical utility and analytical validity of height prediction for children not treated with GH. METHODS: Clinical findings were retrospectively analyzed, and the heights of 44 children (22 males and 22 females) who visited our clinic between August 2006 and June 2017 and reached near final adult height (NFAH) were evaluated. Children treated with GH were excluded. We compared measured NFAH to PAH using the Bayley-Pinneau (BP), Tanner-Whitehouse Mark 2, and Roche-Wainer-Thissen (RWT) methods. RESULTS: Pearson correlation between all 3 prediction methods and NFAH showed high positive correlations in males and females (P < 0.05). The average difference between PAH and NFAH for the BP method (0.4±3.9 cm) was significantly lower than those for the RWT and TW 2 methods in females (P=0.000, analysis of variance). Furthermore, only PAH by the BP method in females was very close to measured NFAH (paired t-test). A Bland-Altman plot verified that 95% of the differences between the PAH and NFAH exist between limits of agreement (mean±1.96 standard deviation). CONCLUSIONS: The BP method is more useful to predict NFAH in females than other methods. Careful attention is still required when using such tools because PAH can be inaccurate. Therefore, a more accurate FAH prediction model for Korean children is needed.
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Adult , Child , Female , Humans , Male , Gonadotropin-Releasing Hormone , Human Growth Hormone , Methods , Retrospective StudiesABSTRACT
Bone development is influenced by a number of factors,including nutrition,hormonal secretions,and genetics.Skeletal age assessment(SAA) is a clinical procedure,which is used in determining the skeletal age(SA) of children and adolescents.The selection of evaluation methods,the difference of evaluation techniques,and the influence of disease can affect the accuracy of SAA.Currently,the main clinical methods for SAA are the Greulich-Pyle(GP) and Tanner-Whitehouse(TW)methods.The GP method has the advantage of being quick and easy to use.The method of TW,however,seems to be more reliable than the GP method.In China,the CHN method is also used.With the development of technology,the computer automatic SAA and ultrasonic SAA are gradually applied in clinical practice.The SAA plays an important role in the diagnosis and treatment of endocrine diseases,such as short stature and precocious puberty,and also in the children's growth and development.In order to improve the accuracy of SAA,this article reviews the related methods,techniques and clinical applications.
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Objective To observe the gonadotropin analogue ( GnRHa) Triptorelin of idiopathic central pre-cocious puberty(ICPP) girls′body mass index(BMI) and final adult height(FAH).Methods 120 patients with idi-opathic central precocious puberty cases were summarized and track the return visit ,which.of 62 cases with ICPP girls Triptorelin treatment,6,12,18,24,36 months of observation and treatment of bone age (BA),the growth rate(GV), BMI,predicted height ( PAH) ,and life-long high and up to lifelong high BMI .The untreated group was also observed the relevant indicators such as BMI ,and lifelong.Results After treatment,the increase in BA was less than that in age.The PAH has improved with the growth of the treatment regimens .After treatment PAH 12,18,24,36 months PAH respectively[(153.4 ±7.1)cm,(154.6 ±6.2)cm,(155.7 ±4.7)cm,(156.9 ±5.9) cm], both were statisti-cally significant(t=2.23,2.67,3.01,2.88,all P0.05).Lifelong treatment and control groups,respectively[(158.2 ±3.9)cm,(153.7 ±2.8) cm],and between the two there is a statistically significant (t=3.04,P0.05). Conclusion Triptorelin can effectively suppress idiopathic central precocious sexual characteristics and bone age growth and improve adult height .There is no significant effect on the BMI .
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Objective To assess the efficacy and impact factors of treatment with Gonadotropin-releasing hormone analogs (GnRHa) in central precocious puberty (CPP) or early and fast puberty (EFP) girls in a retrospective unicenter study.Methods One hundred and two girls (75 CPP and 27 EFP) were treated with GnRHa alone and were followed up to their final adult hight (FAH).Results FAH was (158.0 ± 4.8) cm,being significantly higher than pretreatment predicted adult height [(151.1 ±5.1) cm,P＜0.01].There was no significant difference between CPP [(7.3 ± 4.4) cm] and EFP [(5.5 ± 4.5) cm] in net height gain.There was no significant improvement in FAH and pretreatment PAH for the patients who had menarche before treatment or whose growth velocity was less than 4 cm during the first year.Conclusion GnRHa treatment improves FAH efficiently for both CPP and EFP girls.Nevertheless,those who had menarche before treatment or whose growth velocity was less than 4 cm during the first year can hardly improve FAH by GnRHa treatment alone.
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Forty girls with Turner's syndrome (TS),aged (12.6 ± 1.9) years,were treated with daily subcutaneous injection of recombinant human growth hormone (rhGH,1.0 ～ 1.1 IU · kg-1 · w-1) and oral stanozolol (0.02 ～ 0.04 mg · kg-1 · d-1) for 1 ～ 5 years.Growth velocity (GV),height standard deviation score (SDS) by reference of healthy Chinese girls (HtSDSNor) and height SDS by reference of untreated Chinese TS girls (HtSDSTs)were evaluated regularly.Of the forty girls studied,thirteen had discontinued the treatment after a mean duration of (2.9 ± 1.2)years when GV was less than 2 cm/year or when patients were satisfied with the achieved height.Final adult height (FAH) or near-final height,which was defined as the most recent available height after discontinuation of treatment,and the height gained in the thirteen girls were evaluated.Estrogen therapy was started at the age of(16.0 ± 1.1) years.HtSDSNor increased from-4.2 ± 1.0 to-3.4 ± 1.0 in the first year,and-2.8 ± 1.0,-2.4 ± 0.8,-2.5 ± 0.5,-2.3 ±0.3 respectively in the 2nd,3rd,4th,and 5th year.The change in HtSDSTs was similar to HtSDSNor.It was increased from 0.1 ± 0.9 to 1.0 ± 0.9 in the first year,and to 1.5 ± 0.8,1.9 ± 0.6,1.7 ± 0.4,1.7 ± 0.2 in the subsequent 4 years.The predicted adult height (PAH) in 13 girls was (142.8 ± 4.2) cm before treatment.FAH was (151.7 ± 4.1) cm,which was significantly higher than PAH (P＜0.01),and the mean height gain was (8.9 ± 2.8) cm (5.1 ～ 12 cm).FAHSDSNor was increased to-1.6 ± 0.8 from-3.8 ± 0.8.For girls with TS around 9 years of age,combined therapy with rhGH and low dosage of stanazolol may significantly increase growth velocity and improve final adult height.
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Objective To observe the final adult height of 20 boys with idiopathic central precocious puberty (ICPP) treated with slow-releasing gonadotropin-releasing hormone analogue(GnRHa).Methods Twenty boys with ICPP were treated with GnRHa for( 20.0 ± 6.1 ) months.At the beginning of therapy,mean chronological age and bone age was( 11.4 ± 1.0 ) years and ( 13.0 ± 0.4 ) years,respectively,GnRHa was discontinued when the boys reached the chronological age and bone age of( 13.2 ± 1.1 ) years and ( 13.7 ± 0.6 ) years,respectively.After the end of treatment,all the boys had been followed up for( 3.3 ± 1.5 ) years and had achieved adult height.Comparisons were made among their predicted adult height ( PAH ),final adult height ( FAH ),and target height ( THt ).The long-term outcome of final adult height in boys with ICPP was investigated after GnRHa treatment.Results All the boys reached target height range.Final height was similar to the target height [ ( 169.8 ± 5.8 vs 167.8 ± 4.6 ) cm,P＞0.05 ].The height gain,defined as the difference between predicted adult height at the start of treatment using the height SDS for bone age and actual adult height was( 3.62 ± 3.57 ) cm with the residual growth capacity of ( 11.82 ±3.99)cm,PAH significantly improved after GnRHa treatment compared with before treatment [ ( 169.0 ± 5.0 vs166.2 ± 4.2 ) cm,P＜0.01 ].There were no differences among PAH,FAH,and THt.Conclusion GnRHa treatment improves final height within the range of target height in boys with central precocious puberty.
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BACKGROUND: Multiple factors affect the growth response to recombinant human growth hormone (rhGH) in children with idiopathic short stature (ISS). AIM: To evaluate the growth responses of children with ISS treated with rhGH, aiming to identify the predictors of growth response. MATERIALS AND METHODS: We studied 120 cases, 90 males (75%), with a mean age of 13.8±2.7 years and 30 females (25%), with a mean age of 12.3±2.5 years. All patients received rhGH with a standard dose of 20 IU/m2/week. The calculated dose per week was divided into six days and given subcutaneous at night. RESULTS: A significant positive trend was detected in the delta changes of all anthropometric data. For the first year, the growth response was positively correlated to CA and BA delay and negatively correlated to height, weight and IGF-1 SDSs. For the second year, the growth response was correlated positively to first year growth velocity, BA, triceps skin fold thickness SDS and deviation from target height, and negatively correlated to weight, IGFBP3 SDS and target height SDS. For the third year, the growth response was positively correlated to five variables namely target height, 2nd year growth velocity, IGF-1 SDS, weight SDS and triceps skin fold thickness SDS. For the fourth year, growth response was positively correlated to 2nd and 3rd year growth velocity, BA, deviation from target height and weight/ height SDS. CONCLUSION: Our study showed multiplicity of predictors that is responsible for response in ISS children treated with rhGH, and BA was an important predictor.
Subject(s)
Adolescent , Age Determination by Skeleton , Body Height/drug effects , Female , Child , Dwarfism/drug therapy , Dwarfism/metabolism , Growth Disorders/drug therapy , Human Growth Hormone/administration & dosage , Human Growth Hormone/pharmacology , Humans , Male , Puberty/drug effects , Skin/cytologyABSTRACT
Objective To evaluate the long-term final adult height outcome of combined treatment with gonadotropin-releasing hormone analogue(GnRHa)and recombinant human growth hormone(rhGH)in girls with idiopathic central precocious puberty(ICPP).Methods Out of 49 sirls with ICPP[treated with GnRHa at a dose of 60-80 μg/kg every 4 weeks for at least 6 months,whose height velocity fell below 4 cm/year and showed no improvement of predicted adult height(PAH)in 6 months],26 received(rhGH-combined group),in addition to chronological age,and duration of GnRHa treatment,who showed the same growth pattern but refused rhGH treatment,served to evaluate the efficacy of rhGH in addition.At the conclusion of the smdy,all the girls had been followed up for(3.3±1.9)years,and(3.2±0.9)years in rhGH-combined group and control group,respectively;and had achieved adult heisht.To compare the PAH with the final adult height(FAH)before and after treatment in the two groups.Results During rhGH treatment, height velocity of the rhGH-combined girls increased significantly[(6.7±2.0 vs <4)cm/year baseline],RhGH-combined gids showed an adult height far higher than pretreatment PAH [(157.5±4.5 vs 148.1±4.6)cm,P<0.01],and target height[(154.4±4.6)cm] was,significantly excceded.The control group reached an adult heisht also significandy higher than pretreatment PAH[(154.7±5.5vs 150.3±6.0)cm,P<0.01],while target height[(155.6±4.3)cm]was just reached but not significantlyexcceded.The gain in height obtained,calculated between pretreatment PAH and final heisat,(9.4±4.9)cm in rhGH-combined group was much more than that(4.3±4.2)cm in the control group(P<0.01).Conclusion RhGH may accelerate the linear growth and improve adult height of GnRHa-treated ICPP girls.
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It is well known that a decline secular trend evaluated in the age of puberty onset.Sexual characteristics and linear growth spurt are two major events for puberty.The growth pattern of puberty characterized as acceleration-deceleration-cessation in growth velocity is specific for human being.It is modulated symphonically by both gonadal and somatotropic axes.This article reviews the advances in the modulming mechanisms of pubertal growth,particularly in the local sites of growth plate,and the concept of keeping positive balance between skeletal lineal growth and maturation.Finally,various therapeutic strategies for improving the final adult height in individuals with growth disorders during adolescence are discussed.
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Objective To observe the final adult height (FAH) outcome and influencing factors in Turner′s Syndrome(TS) children treated with recombinant human growth hormone ( rhGH ).Methods Thirty TS children treated with rhGH were compared with 16 TS children without rhGH treatment and were followed up to achieve their FAH.Comparisons were made regarding predicted adult height (PAH),height standard deviation score for chronological age( HtSDScA ),height SDS for BA( HtSDSRA ),and growth velocity ( GV ) between rhGH treatment and without treatment groups and between the onset and by the end of rhGH treatment group.The factors determining FAH were also evaluated.Results FAH in rhGH treatment group was obviously improved as compared with untreatment group[ ( 149.5±6.3 vs 142.4±5.2) cm,P＜0.01 ].FAH in treatment group was positively correlated with height standard deviation score for chronological age ( Ht0 SDSCA ),Hto SDS for BA ( Hto SDSBA ),height age ( HA0 ) at preliminary diagnosis,and correlated with duration of rhGH therapy,duration of estrogen-free rhGH therapy,and PAH0SDS at preliminary diagnosis.Stepwise regression analysis indicated that duration of estrogen-free rhGH therapy and PAH0 SDS were the variables with the greatest identified influence on FAH (F =11.56 and F =86.91,P＜ 0.01 ).FAH in the 45,XO group was significantly different from the mosaicism group (45,XO/46,XX ) [ ( 147.2 ± 6.3 vs 153.3±6.4) cm,P =0.038].Conclusion rhGH treatment is efficacious in improving FAH of TS children,but a variability in the magnitude of the response to rhGH is recognized.Duration of estrogen-free rhGH therapy and PAH0SDS are the variables with the greatest identified influence on FAH,and karyotype may be one of the influence factors.rhGH treatment should be initiated as early as possible and sufficient course of estrogen-free rhGH therapy is needed to yield a satisfactory FAH.
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Objective In order to understand whether recombinant human growth hormone(r-hGH) can improve the idiopathic short stature(ISS) boys' final adult height(FAH).Methods We measured 16 cases diagnosed as ISS boys FAH, divided into 2 groups, of which 9 cases were not given r-hGH treatment, treatment group ,7 patients received r-hGH treatment, a dose of 0.1 ～ 0.13 U· kg-1·d-1, before going to sleep subcutaneous injection, duration of treatment was 6 ～ 20 months ( 11.9 ± 5.2 months).Results The treatment group compared with the average FAH FAH observation group had significantly improved the average(t =2.219,P<0.05).Conclusion r-hGH can improve the ISS boys FAH, but early treatment, the longer the course the more obvious effects.
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Background: Obese children may attain skeletal maturation earlier than normal weight children, but the relation between body fat and physical maturation including adult height has not been clarified. Objective: To identify impact of obesity on predicted adult height and height gain. Materials and methods: Sixty two obese children (38 males and 24 females) aged 5-17 years old at the Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok, were recruited. Height, weight, mid-parental height, pubertal staging, bone age, predicted adult height, and height gain were recorded. Results: Severity of obesity was positively associated with bone age advancement that had a substantial negative correlation to predicted adult height and height gain. Poor predicted adult height was demonstrated in obese girls who have a low height standard deviation score and high bone age advancement. Conclusion: Obese children may have suboptimal final adult height due to their advanced bone age. They also have poor predicted adult height and height gain.