The effect of anastrozole therapy on final height and sex hormone levels in pubertal boys receiving growth hormone therapy

ABSTRACT Objective: This research aimed to evaluate retrospectively the effect of anastrozole on height gain and sex hormone levels in pubertal boys receiving growth hormone (GH). Materials and methods: Pubertal boys who received both GH and anastrozole (GH+A) were one-to-one matched with boys who received only GH (GH-Only) for chronological and bone age, pubertal stage and height before the GH initiation, treatment duration and midparental height. Anthropometric measurements throughout treatment and adult heights were compared between the groups. Sex hormone levels were evaluated longitudinally in the GH+A group. Results: Forty-eight cases (24 in each group) were included. There was no statistical difference in adult height between the GH+A and GH-Only (p = 0.071). However, when the analysis was limited to those receiving anastrozole for at least 2 years, mean adult height was higher in the GH+A than in the GH-Only group (173.1 ± 6.2/169.8 ± 5.6 cm, p = 0.044). Despite similar growth rates between the two groups, bone age advancement was slower in the GH+A than in the GH-Only in a mean anastrozole treatment period of 1.59 years (1.37 ± 0.80/1.81 ± 0.98 years, p = 0.001). The greatest increase for FSH, LH, total and free testosterone and decrease for estradiol levels were observed in the third month after anastrozole was started, albeit remaining within the normal ranges according to the actual pubertal stages. Conclusions: Using anastrozole with GH for at least 2 years decelerates the bone age advancement resulting in adult height gain with no abnormality in sex hormone levels. These results suggest anastrozole can be used as an additional treatment to GH for further height gain in pubertal boys.

Near final height in Korean children referred for evaluation of short stature: clinical utility and analytical validity of height prediction methods

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.

Final height of Korean patients with early treated congenital hypothyroidism / 소아과

PURPOSE: Congenital hypothyroidism (CH) is the most common endocrine disorder in children. Thyroid hormone deprivation results not only in mental retardation but also growth retardation. This study investigates the final height (FH) in Korean patients with CH detected by newborn screening and examines factors that may affect the FH. METHODS: The medical records of Korean CH patients (n=45) were reviewed. The FH was examined and target height (TH) was calculated based on mid-parental height. The FH z score (FHZ) and TH z score (THZ) were computed using the 2007 Korean National Growth Chart. The FHZ and THZ were compared with a Student t test. The impact of the etiology of CH (athyreosis, dyshormonogenesis, ectopic thyoid, hypoplastic thyroid), initial serum thyroid stimulating hormone (TSH) level, initial free thyroxine (T4) level, and time of therapy initiation based on FH was assessed. RESULTS: The mean FHZ was 0.10±1.01 for male patients and −0.11±1.09 for female patients. There were no significant differences between FHZ and THZ for both female (P=0.356) and male patients (P=0.237). No significant relationship was found between FH and the etiology of CH, initial TSH level, initial free T4 level, and the time of therapy initiation. CONCLUSION: Early intervention and satisfactory management do not appear to impede growth in Korean patients with CH. Thus, early detection and proper management of patients with CH detected by newborn screening program are necessary.

Etiology and treatment of central precocious puberty

The timing of pubertal onset is occurring at younger ages. This phenomenon is associated with many environmental factors such as sufficient nutrition, stress, many kinds of endocrine-disrupting chemicals, and genetic background. The loss of transcriptional repression induces kisspeptin release, resulting in pulsatile gonadotropin-releasing hormone secretion, which trigger pubertal onset. According to many reports, gonadotropin-releasing hormone agonists therapy for patients with rapidly progressive central precocious puberty is effective for improving final adult height. However, those results were obtained from the treatment of relatively young patients at earlier stages of puberty. A large cohort study investigating the environmental causes of precocious puberty as well as genetic factors is needed.

Comparação entre métodos de avaliação de altura final em adolescentes com baixa estura variante do normal / Comparison of methods for final height assessment in adolescents with a normal variant short stature

INTRODUCTION: Patients with low stature normal variant growth have peculiar evolutionary patterns making it difficult to precisely define when final stature will be reached, since prediction methods are based on parameters of difficult quantification, such as bone age. OBJECTIVE: To assess the agreement between two methods for prediction of final height based on family target range regarding the final height reached by adolescents with a diagnosis of normal variant short stature. METHODS: Thirty-three subjects were evaluated using height of parents for the calculation of family target range and Bayley-Pinneau and Tanner-Whitehouse methods for prediction of final height. Spearman correlation coefficient was calculated to correlate final height with the mean of the family target range, and the St. Laurent concordance coefficient was used to assess concordance between final stature and predictive methods. RESULTS: 87.9% (29/33) subjects kept short stature at the end of growth and 90.9% (30/33) had a final height within family target range. A very strong positive correlation (Cs = 0.77; p < 0.01) was observed between parental mean and final height. Bayley-Pinneau method showed a 0.47 concordance coefficient with final height (95% CI: 0.34; 0.57), and Tanner-Whitehouse 3 method showed a concordance coefficient of 0.58 (95% CI: 0.41; 0.75. CONCLUSION: The strong positive correlation observed demonstrates the significant influence of parental height on final height. Neither method showed good concordance when used as a predictor of final height, with height values being overestimated.

INTRODUÇÃO: Pacientes com baixa estatura variante normal do crescimento têm padrões evolutivos peculiares dificultando definir com precisão quando a estatura final será atingida, visto que os métodos de previsão baseiam-se em parâmetros de difícil quantificação, como a idade óssea. OBJETIVO: Avaliar a concordância entre dois métodos de previsão da estatura final e do canal familiar com a altura final atingida (padrão ouro) por adolescentes com diagnóstico de variantes normais da baixa estatura atendidos em ambulatório de avaliação de problemas de crescimento. MÉTODO: Foram avaliados 33 sujeitos utilizando-se as estaturas dos pais para o cálculo do canal familiar e da média parental e os métodos Bayley-Pinneau e Tanner- Whitehouse 3 para as previsões de estatura final. Também foram calculados o coeficiente de correlação de Spearman para correlacionar a estatura final com a média do canal familiar, e o coeficiente de concordância de St. Laurent para avaliar a concordância entre a estatura final e os métodos de previsão. RESULTADOS: 87,9% (29/33) permaneceram com Baixa Estatura ao término do crescimento e 90,9% (30/33) apresentaram estatura final dentro do canal familiar. Observou-se correlação positiva muito forte (Cs = 0,77; p < 0,01) entre a média parental e a altura final. O método de Bayley-Pinneau apresentou coeficiente de concordância com a altura final de 0,47 (IC 95%: 0,34; 0,57), o de TW3, 0,58 (IC 95%: 0,41; 0,75). CONCLUSÃO: A correlação positiva forte demonstra a influência significativa da altura dos pais na estatura final. Nenhum dos dois métodos apresentou boa concordância ao serem utilizados como preditores de estatura final, pois os valores das alturas foram superestimados principalmente pelo método de Bayley-Pinneau.

Controversias en el manejo de la talla baja idiopática

La talla baja idiopática (TBI) es un diagnóstico de exclusión que abarca un amplio y heterogéneo grupo de niños aparentemente sanos pero con talla inferior a -2 desviaciones estándar. En los Estados Unidos está aprobado el uso de hormona de crecimiento (HC) en niños con TBI, a diferencia de la mayoría de países Europeos. La respuesta terapéutica de los niños con TBI tratados con HC es muy variable y dependiente de múltiples factores al inicio y durante el tratamiento, por lo cual el beneficio de su uso no ha podido establecerse de forma consensual. Esta revisión recoge información actualizada sobre los más recientes estudios publicados en pacientes con TBI tratados con HC hasta alcanzar talla final, los diferentes factores asociados a la respuesta terapéutica, los efectos metabólicos, psicosociales y efectos adversos de la HC, y sobre otras opciones terapéuticas a considerar tales como HC con análogos de la GnRH, inhibidores de aromatasa e IGF1 humana recombinante.

Idiopathic short stature (ISS) is an exclusion diagnostic which includes a broad and heterogeneous group of supposedly healthy children with height below -2 standard deviations. In the United States, treatment with growth hormone (GH) is approved for children with ISS, as opposed to the majority of European countries. The final height of children with ISS whom are treated with GH is highly variable and dependent on multiples factors at the beginning and during the treatment. For this reason, the indication of GH therapy in ISS children is not consensual. This revision contains actual data about the most recently published studies in patients with ISS treated with GH until final height, associated factors to height gaining, metabolic, psychosocial and adverse events, and finally, other therapeutic options such as GH combined with GnRH analogues, aromatase inhibitors and recombinant human IGF1.

Progress of diagnosis and clinical management of congenital adrenal hyperplasia / 中华实用儿科临床杂志

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders.Clinical manifestations can be hermaphroditism,pseudo-precocious puberty or acute infant adrenal crisis.The wide range of CAH symptom spectrums may lead to miss or misdiagnosis in those who had atypical clinical features.The common forms of CAH are caused by deficiency in 21-hydroxylase enzymes,11 β-hydroxylase,3β-steroid dehydrogenase,17α-hydroxylase and so on,while the most common form of CAH is 21-Hydroxylase deficiency (＞ 90％).The basic principal clinical management of CAH is lifelong therapy using corticosteroids.This paper review and summarize the recent progress on the diagnosis,principles of treatment and long-term prognosis of CAH.

Estatura final (EF) em síndrome de Turner (ST): experiência de 76 casos acompanhados na Unidade de Endocrinologia Pediátrica do Hospital de Clínicas da Universidade Federal do Paraná / Final height (FH) in Turner syndrome (TS): experience of 76 cases followed at the Pediatric Endocrinology Unit, Hospital de Clinicas, Federal University of Paraná

Objetivo: Relatar estatura final (EF) em 76 pacientes com síndrome de Turner (ST). Materiais e métodos: Revisão de prontuários e avaliação dos escores z: da estatura alvo (EA) e EF segundo o NCHS/CDC/2000 e da EF segundo Lyon e cols. Resultados: Pacientes foram classificados em três grupos: A (n = 16), tratamento com estrogênios e progestágenos; B (n = 21), tratamento com oxandrolona; C (n = 39), tratamento com hormônio de crescimento (GH) e oxandrolona. Não houve diferença no escore z da EA entre os grupos e no escore z da EF entre A e B. O escore z da EF do grupo C foi maior que o dos outros grupos, maior que 2 DP segundo Lyon e no percentil 3 da curva NCHS/CDC. Análise de regressão múltipla mostrou tipo de tratamento (p < 0,001) e estatura materna (p = 0,02) como fatores que mais influenciaram a EF. Conclusão: GH mais OX e estatura materna contribuíram significativamente para aumento da EF na ST.

Objective: To report the final height (FH) of 76 patients with Turner syndrome (TS). Materials and methods: Review of the files and calculation of z scores: of target height (TH), and FH according to NCHS/CDC/2000 and FH according to Lyon and cols. Results: Patients were classified in three groups: A (n = 16), treatment with estrogens and progestogens; B (n = 21), treatment with oxandrolone (OX); C (n = 39), growth hormone (GH) plus OX. The z score of TH was not different among the groups and z score of FH was not different between A e B. Z score of FH of group C was greater than the other groups, > 2SDS of Lyon's curve and fitted on the 3rd percentile of NCHS/CDC. Multiple regression analysis showed type of treatment (p < 0.001) and maternal height (p = 0.02) as most influencing factors on FH. Conclusion: GH plus OX and maternal height contributed significantly to enhance FH of TS patients.

Determinants of growth and final height outcome in congenital adrenal hyperplasia due to 21-hydroxylase deficiency / 国际儿科学杂志

Congenital adrenal hyperplasia(CAH)is a family of autosomal recessive disorders caused by the loss or severe decrense in activitv in one of the steroidogenie enzymes involved in cortisol biosynthesis.The cortisol synthetic block leads to corticotropin stimulation of the adrenal cortex.with accumulatiOn of cortisol precursors that are diverted to sex hormone biosynthesis.The most common CAH is 21-OHD due to deficiency of the enzyme 21-hydroxylase.It is distinguished in classical(C-CAH)and non-classical form(NC-CAH),and it is also one of the most eomnon autosomal recessive inherited disorders in human.The goal of therapy in CAH is to replace the missing glucocorticoids and mineralocorticoids,thereby suppressing eorticotropin concentrations and normalizing adrenal androgens, a8 well as to enable normal growth and skeletal maturation.Nonetheless.growth is a key problem in CAH because patients often fail to reach their target height,and the average heights are shorter than the general population,relating both to the underlying disease and its treatment.This paper review the literature on growth and final height outcome,considering the factors related tO diagnosis and treatment which are known to affect height outcome.Current strategies to optimize height outcome are indicated and future treatment strategies as well.

Talla final en pacientes transplantados renales bajo tratamiento con hormona de crecimiento / Final height in renal transplant patients after growth hormone treatment

El retardo de crecimiento es un importante problema clínico aun no resuelto ni correctamente manejado en niños con insuficiencia renal crónica (IRC). La optimización de todos los parámetros metabólicos y nutricionales no siempre lleva a una mejoría del crecimiento en estos pacientes. Desde hace aproximadamente 20 años se utiliza el tratamiento con rhGH para mejorar la talla en este grupo de niños. La bibliografía internacional muestra mejoría de la velocidad de crecimiento en estos pacientes sin embargo la experiencia publicada en la talla final (TF) alcanzada por los mismos es escasa. Los objetivos de este estudio fueron:1) evaluar la talla final alcanzada por pacientes transplantados renales(TxR) que recibieron tratamiento con rhGH (GrGH) comparándolos con un grupo control (GrC) con similares características clínicas, 2) evaluar los factores predictores de la TF, y 3) la repercusión de dicho tratamiento en la función renal. La TF en el GrGH fue significativamente mayor que la TF del GrC (-1.96 ± 1.13 vs -3.48 ± 1.19 SDS respectivamente, p <0.05). La talla (SDS) al inicio del tratamiento con rhGH fue la única variable significativa para predecir la respuesta al tratamiento (p= 0.001). Se observó una disminución significativa ClCr final en ambos grupos (GrGH: 76 ± 18 vs 66 ± 14 ml/min/m2 sup p<0.05; GrC: 72 ± 19 vs 56 ± 9 ml/min/m2 sup, p<0.05) lo que sugiere una caída similar del filtrado glomerular en ambos grupos independiente del tratamiento. Conclusión: Nuestros hallazgos permiten confirmar que el tratamiento con rhGH es efectivo para mejorar la talla final en pacientes TxR sin afectar la función renal (AU)

Growth retardation is a common and significant clinical problem that is not adequately managed in children with chronic renal disease. Despite optimization of metabolic parameters the growth of this patients not always amelioreted. About 20 years ago rhGH treatment became to be used for this group of children to optimization final height.The international experience show that rhGH treatment improve growth velocity but the results about final heigth are scarse. The aims of our trial were: 1) to evaluate final height in renal transplant patients treated with rhGH (n=23) comparing with a control group not treated with rhGH (n=14) with similar characteristics, 2) to evaluate the effect of rhGH on creatinine clearance,3) to establish predictive variables for final height. Final Heigth was significantly greater in treated group vs control group (-1.9±1.1 vs -3.5±1.2, p<0.05). Initial height was the only significant variable to predict final height (p=0.001). We described a significantly decrease of creatinine clearence in both groups during follow up (GH Group 76±9 vs 66±14 ml/min/m2 sup, p<0.05 and Control Group 72.5±19 vs 56±9 ml/min/m2 sup, p= p<0.05).This suggest a similar decrese of creatinine clearence in both groups. Conclution: Our data confirm that rhGH treatment was effective in improving final height in renal transplant patients and did not decline allograft function (AU)

Final height of patients with congenital heart disease / 소아과

PURPOSE: Growth impairment is usually observed in children with congenital heart disease (CHD). Studies on the final height and weight of this population are insufficient. Our aim was to evaluate the final height of children with CHD and to identify the relationship between CHD and growth. METHODS: We recorded the values of final height and weights of 105 CHD patients (age, <19 years) who visited Chonnam National University Hospital between November 2000 and March 2009, and we reviewed the medical records. RESULTS: The mean values of weight and height of male CHD patients were significantly lower than those of the normal subjects. Patients with severe growth impairment (below the third percentile of normal) included 5 males (8.6%) and 4 females (8.5%) with height less than normal and 9 males (15.5%) and 8 females (17.0%) with weight less than normal. The mean growth of the patients in the cyanotic heart disease group was lower than that of normal subjects, but a statistically significant difference was noted in the weights of males. In a comparative study based on the type of CHD, a significant difference was noted in weights of males. Patients with patent ductus arteriosus and those with tetralogy of Fallot had the highest and lowest mean values of weight, respectively. CONCLUSION: Growth impairment was more evident in children with CHD than normal children. Patients should be treated during an optimal time frame. Thus, CHD patients should be treated if follow-up studies indicate growth impairment.

Effects of gonadotropin-releasing hormone analogue on linear growth and final height in girls with central precocious puberty / 中华内分泌代谢杂志

The effect of gonadotropin-releasing hormone analogue(GnRHa) on lineafity growth and final height in 82 girls with central precocious puberty (CPP) was evaluated. The growth velocity in the second year was positively correlated with the difference value of bone age between the first year and the second year after treatment. The height standard deviation score for bone age and predicted aduh height increased after treatment. Twenty-six girls who had been followed to final height obtained better adult height than target height. GnRHa in combination with aerobic exercise increases linear growth and final height in girls with CPP.

A study and the growth and the development of microvascular complications in patients with type 1 diabetes mellitus / 소아과

PURPOSE: Reduced growth and microvascular complications have been recognized as consequences of type 1 diabetes mellitus (T1DM). We assessed the effect of T1DM on growth and factors associated with the development of microvascular complications. METHODS: We conducted a retrospective longitudinal evaluation of 154 patients above 16 years of age. We analyzed factors which affect final height standard deviation scores (SDS) and development of microvascular complications. RESULTS: Final height SDS was -0.11+/-1.15 (-0.26+/-1.33 in females, 0.04+/-0.91 in males). Final height SDS was significantly lower than midparental height SDS and height SDS at diagnosis. There was no difference in final height SDS according to age at onset, existence or nonexistence of complications, or average HbA1C. Height SDS at onset of puberty, midparental height SDS and pubertal growth gain affected final height SDS. The number of patients with complications was 37 (24 percent). Microvascular complications developed at a younger age and after longer duration of diabetes in patients with a prepubertal onset of T1DM compared to patients with pubertal onset. Patients with complications had a higher level of average HbA1C than patients without complications. Patients whose microalbuminuria regressed had lower levels of average HbA1C, systolic BP, second 24h urine microalbumin than patients with persistant or progressed microalbuminuria. CONCLUSION: The results suggest that degrees of glycemic control don't affect final height, but various factors associated with T1DM can impair growth potential. Additionally, the degrees of glycemic control and puberty affect the development of microvascular complications.

Update in the etiology and treatment of sexual precocity / 소아과

The pubertal activation of gonadotrophin releasing hormone(GnRH) requires coordinated changes in excitatory or inhibitory amino acids, growth factors, and a group of transcriptional regulators. The age of onset of puberty is progressing to younger age. Factors affecting early puberty include genetic traits, nutrition(body fat) and exposure to endocrine disrupting chemicals. In rapidly progressing central precocious puberty, gonadotrophin releasing hormone(GnRH) agonists(GnRHa) appear to increase final height if treated early stage. Further large scaled long-term follow-up study of the effects of GnRHa on final height is needed.

Evaluation of Effect of Renal Transplantation on Growth in Children with Chronic Renal Failure

PURPOSE: We aim to identify the clinical and demographic characteristics in children who underwent renal transplantation(RTx) and to evaluate the influence on growth of RTx in children. METHODS: We reviewed 17 medical records of chronic renal failure patients who underwent RTx from April 1992 and June 2004 at Busan Paik Hospital. Age and sex distribution, cause of disease, donor analysis, patient and graft survival rate, and the status of growth after RTx were analysed by retrospective study. RESULTS: Eighteen RTx were performed in 17 patients(8 boys, 9 girls). The mean age at the time of RTx was 15.8+/-3.5 years and the mean duration of dialysis therapy before RTx was 22.4+/-18.0 months. The 1 year and 5 year patient survival rate were each 100%, and the 1 year and 5 year graft survival rate were 88%, 36% respectively. The most common cause of graft failure was chronic rejection. The mean final height of male patients was 162.8+/-10.0 cm(143.0-172.5 cm) and of female patients was 154.5+/-12.1 cm(135.8-160.0 cm). The mean height standard deviation score(Ht SDS) increased after RTx from -1.95 to -1.53 but the increment rate was not statistically significant. Similar changes were noted in individual patient analysis. Also there was no significant difference between the living-related donors and cadaveric donors. CONCLUSION: Our data shows that even successful RTx rarely results in full growth rehabilitation. To overcome retarded growth in children with chronic renal failure, appropriate combined management of metabolic and nutritional problems, correction of anemia, proper use of recombinant growth hormone therapy, early renal transplantation and shortening of the duration of dialysis would be necessary.

Effect on Final Height of Gonadotropin-Releasing Hormone Agonist (GnRHa) in Children with Congenital Adrenal Hyperplasia / 대한소아내분비학회지

PURPOSE: Object of present study is to identify the effect of gonadotropin-releasing hormone agonis (GnRHa) treatment on final adult height in congenital adrenal hyperplasia (CAH) children with central precocious puberty. METHOD: A retrospective study was conducted of all CAH patients seen between 1977 and 2004, in pediatric endocrinology department, Seoul National University Hospital. All patients treated with glucocorticoid and mineralocorticoid toward to CAH. Treatment group (SW7, SV12) received GnRHa or associated with growth hormone (GH) when they had pubertal changes; breast development before 8 years in girls, testis enlargement (>4 mL) before 9 years in boys and pubertal response in GnRH stimulation test. GnRHa treatment was continued from 1 year to 7.5 years (mean=3.6 yr) while they continued glucocorticoid therapy. We evaluated them every 6 month or yearly until reached final adult height (FH). We compared FH SDS between treatment group and control group. Also final adult height in treatment group compared with pretreatment predicted adult height (By Bayley-Pinneau method). Each group was subdivided into salt wasting group (SW) and simple virilizing group (SV). RESULTS: Treatment group (SW 7, SV 12) was included 19 patients with CAH and control group (SW 6 SV 7) was belonged 13 patients. In treatment group, predicted adult heights are 148.5+/-8.8 cm (-2.8+/-0.8SDS) in SW, 149.8+/-6.7 cm (-2.8+/-1.1SDS) in SV and midparental heights are 165.9 7.7 cm (0.4+/-0.5SDS), 163.3+/-p9.0 cm (-1.40+/-0.8SDS), respectively. Final adult heights are 158.87.4 cm(-0.9+/-1.2SDS) in SW and 156.7+/-7.4 cm (-1.5+/-1.2SDS) in SV. In control group, pretreatment predicted adult height and midparental heights were 154.8+/-12.0 cm (-2.1+/-0.6SDS) in SW, 149.9+/-6.3 cm (-2.3+/-0.7SDS) in SV and 159.8+/-7.2 cm (-1.2+/-0.5SDS) in SW, 158.6+/-5.1 cm (-0.6+/-0.8SDS) in SV. Final heights are 154.4+/-5.3 cm (-2.1+/-0.6SDS) in SW and 153.6+/-4.1 cm (-1.5+/-0.8SDS) in SV. There was no significant difference in comparison of FH between control group and treatment group (By Mann-Whitney test, SW P=0.063, SV P=0.663). But it was significant in comparison predicted adult height and final adult height in treatment group (By Wilcoxon Signed Ranks test P=0.043 in SW, P=0.008 in SV). CONCLUSION: In CAH children with precocious puberty, treatment with GnRH agonist alone treatment is effective to improve final adult height. But the effectiveness is limited. So GH or GnRHa combined with GH therapy is more attempted.

Final Height in Growth Hormone Deficient Children Treated with Growth Hormone / 대한소아내분비학회지

PURPOSE:Improved adult final height(FH) is a major goal in the treatment of children with short stature due to growth hormone deficiency(GHD). The purpose of this study was to evaluate final height in idiopathic and organic GHD children after long-term growth hormone(GH) treatment. METHODS:Twenty five(16 males and 9 females) patients with GHD(14 idiopathic and 11 organic GHD) were included. GHD was diagnosed by two or more GH provocation tests(peak GH level <10 ng/mL). All subjects had multiple pituitary hormone deficiencies, and aged 10.7+/-.5(5.5-14) years at the start of GH treatment. The patients were treated with GH 0.45-0.7 IU/kg/week in 3-7 divided doses for 6.9+/-.8(5.2-10) years. Treatment was ended when growth velocity reached lower than 2 cm/year and/or bone age reached 16 years. Standard auxologic measurements were performed at the start of GH treatment and at every 6 month after initial GH treatment. RESULTS:FH was 166.9+/-.8 cm, which was not significantly lower than target height(167.1+/-.9 cm) and predicted adult height(169.1+/-5 cm). FH SDS was significantly improved to -0.8+/-.5 compared with -3.4+/-.0 of height SDS at the start of GH treatment. The largest height increment was observed in the first year of GH treatment, with a gradual decrease in the following years. There was no difference in FH and FH SDS between idiopathic and organic GHD. Unwanted serious adverse events were not observed in all patients during GH therapy. CONCLUSION: Early diagnosis and continuous treatment with optimal doses of GH to near adult height improve the outcome in children with short stature due to idiopathic and organic GHD.

Comparison of Validity of the Methods for Estimating Target Height / 中国医师杂志

18 years(n=160) were included. CMH method and FPH model were applied to analyse statistically final height of Shanghai children and their midparental height. Results There was a considerable disparity in stature between the Chinese and the Swedish study populations(P

Final Height in Idiopathic Growth Hormone(GH) Deficient Children Treated with GH

PURPOSE: Improved adult height is a major goal in the treatment of children with short stature due to GH deficiency(GHD). The purpose of this study was to evaluate final height in idiopathic GH deficient children after long-term GH treatment. METHODS: GHD was diagnosed in 9 male patients by at least two stimulation tests(maximum GH level< OR =5ng/ml). Other pituitary functions were evaluated by standard tests. All patients had multiple pituitary hormone deficiencies, aged 8.9-14(11.4+/-2.0)years at the start of GH treatment. GH, 0.45-0.7IU/kg/week in 3-7 divided doses, was given. Treatment ended when height velocity was less than 2cm/year and/or bone age of at least 16 years was reached. The mean length of treatment was 7.1+/-1.5(6-10)years. Predicted adult height(PAH) was determined by the method of Bayley-Pinneau. Target height(TH) was calculated by(father's height+mother's height+13)/2 and expressed as a standard deviation score(SDS) by Korean standard. Final height(FH) was determined at follow-up visits after GH treatment withdrawal and was defined as growth rate of less than 1cm/year and bone age of 18 years. Standard auxologic assessment was determined at the baseline and at every 6 months after initial GH therapy. RESULTS: Mean final height and height SDS of patients were 165.9+/-5.2cm and -0.4+/-0.3. Final height was not significantly lesser than their target height(168.2+/-3.3cm) and predicted adult height(170.0+/-3.6cm). Mean final height SDS was significantly improved to -0.4+/-0.3 as compared to -3.8+/-0.9 of mean height SDS at starting age of GH treatment. The highest height increment was observed in the first year of treatment, with a gradual decrease in the following years. Total pubertal growth was 17.4+/-4.3cm and mean age of onset of puberty was 15.6+/-1.2 years. Unwanted serious adverse events were not observed in all patients. CONCLUSION: Early diagnosis of GHD and continuous treatment with optimal doses of GH to near adult height should improve the outcome in children with short stature due to GHD.

Growth pattern and final height in congenital adrenal hyperplasia

Clinical characteristics and growth pattern were evaluated in 42 patients with classical congenital adrenal hyperplasia treated since diagnosis. And final height was evaluated in 16 patients who had reached final adult height with regard to clincal form, degree of hormonal control, and age of initial treatment. The results were as follows; 1) Among 42 patients with classical congenital adrenal hyperplasia, the male to female sex ratio was 1:1.8 (15 males and 27 females), and the frequency of the salt-wasting form (SW) and simple virilizing form (SV) was same (21 SW and 21 SV). 2) The length of time to initial treatment averated 4.2 months (range: 9 days-49 months) for salt-wasting form and 8.8 years (range: 1 month-21 years) for simple virilizing form. 3) In seven cases, precocious puberty developed during treatment and the average age on development was 6.8 years for salt-wasting form and 5.4 years for simple virilzing form. 4) The pattern of growth from birth throughout childhood in salt-wasting patients showed poor growth initially. The average height in simple virilizing patients was above the mean in the first years of life, declining steadily (falling below the mean by age 12), until the end of the growt period. 5) Bone ages were retarded initially in salt-wasting patients, thereafter accelerating by age 3, meanwhile in simple virilizing patients advanced initially. 6) In 16 patients who had reached final adult height, analysis of final height with regard to clinical form, degree of hormonal control, and age of initial treatment indicated that neither of them seem to after the height outcome. In conclusion, classical congenital adrenal hyperplasia patients seem to achieve final height consistently below the mean for the general population. Factors to affect the height outcome (clinical form, degree of hormonal control, age of initial treatment) may influence concomitently, and another factor may be present.