Is the severity of obesity associated with poor prediction of adult height and height gain?

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.

The Comparison of Clinical Factors according to Growth Velocity during Gonadotropin-Releasing Hormone Agonist Treatment in Central Precocious Puberty Girls

BACKGROUND: The aim of this study was to investigate the favorable factors for gonadotropin-releasing hormone (GnRH) agonist treatment with regard to the growth velocity and the predicted adult height (PAH) in central precocious puberty (CPP) girls. METHODS: We reviewed the clinical and auxological parameters in 46 CPP girls who were treated with GnRH agonist at the pediatric endocrinology clinic of Korea University Hospital from January 2001 to August 2007. We divided the two groups according to the growth velocity of 5 cm/yr and we assessed the related factors associated with growth velocity. We also assessed the changes in PAH for two years. RESULTS: The pretreatment chronological age and bone age were significantly younger in the high growth velocity group (> 5 cm/yr) compared to that of the low growth velocity group (7.8 +/- 0.9 year vs. 8.4 +/- 0.5 year, 9.4 +/- 1.2 year vs. 10.1 +/- 0.9 year, respectively) (P 5 cm/yr)(P < 0.05). Growth velocity during treatment had negative correlation with the pretreatment chronological age and positive correlation with the PAH after one and two years of treatment (r = -0.45, P < 0.05 and r = 0.51, P < 0.01). PAH had positive correlation with the treatment duration (r = 0.31, P < 0.05). CONCLUSION: In our study, the growth velocity during GnRH agonist treatment was negatively related to age at the initiation of treatment. Therefore, earlier treatment is important to improve the outcomes and to maintain appropriate growth velocity in CPP girls.

Comparison of predicted adult heights measured by Bayley-Pinneau and Tanner-Whitehouse 3 methods in normal children, those with precocious puberty and with constitutional growth delay / 소아과

PURPOSE: This study compared bone ages measured by the Greulich-Pyle (GP) and Tanner-Whitehouse 3 (TW3 ) methods and investigated the differences in predicted adult heights measured by Bayley-Pinneau (BP) and TW3 methods. METHODS: Bone ages were assessed from left-wrist radiographs by two investigators, one for each GP and TW3 methods in 85 normal children, 30 precocious puberty girls, and 30 constitutional growth delay boys. The differences between the measured predicted adult heights using the BP and TW3 methods were compared in each group. RESULTS: The bone age measured by the TW3 method was less than that by the GP method in normal children. The predicted adult heights measured by the two methods showed no significant difference in normal boys, while the predicted adult height measured by the TW3 method was higher than that by the BP method for normal girls (156.4+/-4.7 cm vs. 158.9+/-3.8 cm, P<0.01) and for precocious puberty girls (156.3+/-4.0 cm vs. 159.3+/-4.2 cm, P<0.01). In contrast, the predicted adult height was higher from the BP method than from the TW3 method in constitutional growth delay boys (173.3+/-4.4 cm vs. 169.7+/-3.2 cm, P<0.01). CONCLUSION: There were significant differences in predicted adult heights between the BP and TW3 method in normal girls, precocious puberty girls, or constitutional growth delay boys. In precocious puberty and constitutional growth delay, the BP method might be preferred to predict adult height, but further studies on final adult height are needed.

The Effect of Gonadotropin Releasing Hormone Agonist with or without Growth Hormone Treatment on Predicted Adult Height in Girls with Early Puberty / 대한소아내분비학회지

PURPOSE: Many recent studies have been performed to improve adult height in short normal girls with early puberty by arresting rapid pubertal progression. We evaluated the effect of combined therapy with growth hormone (GH) and gonadotropin releasing hormone agonist (GnRHa) on predicted adult height in girls with early puberty, comparing them with a group treated with GnRHa alone. METHODS: Twenty eight girls with early puberty were classified into two groups and treated for an average 18 months. Group I of 18 girls was treated with GnRHa alone (leuprolide acetate; dosage: 30-90 mcg/kg, s.c. every 28 days) and group II of 10 girls was treated in combination with GH (dosage: 0.1 IU/kg, s.c. 5-7 days/week). Two groups were compared in terms of bone age, height, sexual maturity, and predicted adult height at the start and after the treatment. RESULTS: Two groups were not significantly different from each other in chronologic age, bone age, weight, target height, and sexual maturity before and after treatment. After treatment, group I showed predicted adult height (157.1+/-6.2 cm) which was comparable to target height (157.1+/-3.7 cm) and was not significantly higher than predicted adult height before treatment (156.0+/-6.5). On the contrary, group II showed predicted adult height (158.5+/-4.6 cm) which was comparable to target height (156.2+/-3.6 cm), but significantly higher than predicted adult height before treatment (154.2+/-7.4 cm) (P<0.05). CONCLUSIONS: GH and GnRHa combination treatment is more effective than GnRHa treatment alone to improve predicted adult height in girls with early puberty.

Growth promoting effect of short-term gonadotropin releasing hormone agonist with or without growth hormone in girls with early puberty / 소아과

PURPOSE: The hope that arresting pubertal developement might increase final adult height has led to an attempt to use GnRH agonist (GnRHa) in children with early puberty and poor growth prognosis. We investigated the growth-promoting effect of GnRH agonists with or without growth hormone (GH) in girls with early puberty and decreased predicted adult height (PAH). METHODS: Thirty five girls with advanced bone age and early pubertal signs were randomized for treatment for about 1 year with monthly GnRHa in group 1 (n=18), or with a combination of GH and GnRHa in group 2 (n=17). The following growth parameters were compared between groups, and the difference (delta) before and after treatment:chronological age (CA), bone age (BA), delta(BA-CA), height (HT), target height (TH), predicted adult height (PAH), delta (TH-PAH), serum insulin-like growth factor (IGF-1) and insulin-like growth factor binding protein (IGFBP-3). RESULTS: Before treatment, BA, TH, PAH Standard deviation scores (SDS), delta(TH-PAH) were not different between the two groups, but CA was higher in group 2 and delta(BA-CA) were higher in group 1 (P<0.05). After 1.06+/-0.93 year of treatment, delta (BA-CA) decreased and there were significant changes in PAH and delta (TH-PAH), especially in group 2 (P<0.05 in group 1, and P<0.001 in group 2). In both groups, IGF-1 and IGFBP-3 were not different before and after treatment, but after treatment, IGF-1 level in group 2 was marginally higher than IGF-1 in group 1 (P<0.1). CONCLUSION: Compromised predicted adult height in girls with early puberty and advanced bone age was significantly improved with GnRH with/without GH treatment in the short-term period. The addition of GH to GnRHa results in a significant increase in PAH compared to GnRHa alone because GnRHa suppressed growth hormone-IGF-1 axis. For comparison of final adult height, further longitudinal follow-up will be needed.

Gonadotropin releasing hormone analogues in treating idiopathic central precocious puberty in girls / 中国医师进修杂志

Objective To observe the clinical effect of gonadotropin releasing hormone analogues in treatment of the girls with idiopathic central precocious puberty(ICPP). Methods Twelve girls with ICPP received therapy with GnRH-A.Before and after the end of treatment for 6 months,secondary sexual characteristics and growth velocity were observed,pelvic ultrasonic examination,X-ray bone age(BA),serum level of E_2 and LHRH stimulating test were detected,and the predicted adult height(PAH) was analysed. Results After treatment,the size of breasts,uterus and ovaries were significantly reduced.The basic and peak levels of serum LH and FSH by LHRH stimulation were also significantly reduced.The ratio of BA/CA(chronology age)was decreased.The PAH was increased. Conclusions GnRH-A can effectively depress the sexual characteristics,reduce the maturation of BA,and also improve the PAH in girls with ICPP.

Effect of Potent Aromatase Inhibitor (Letrozole) on Bone Maturation and Predicted Adult Height in Boys with Early Puberty / 대한소아내분비학회지

PURPOSE: We evaluated the effect of potent aromatase inhibitor (Letrozole) on the rate of bone maturation and an increase in predicted adult height (PAH) in boys with early puberty. METHODS: Nine boys, aged 10.9-12.9 years, with early puberty were studied. The boys were treated with the aromatase inhibitor, letrozole, 2.5 mg/day for 1 year. The main outcome parameters were the change in bone age and predicted adult height. Also, serum LH, FSH, testosterone and estradiol concentrations were measured and sexual maturation before and after 12 months of treatment were evaluated. RESULTS: PAH significantly increased by 3.3 cm (P<0.05) and PAH standard deviation score significantly increased by 0.6 (P<0.05). Bone age before therapy advanced by 0.72+/-0.93 year, but bone age after therapy decreased by 0.07+/-0.90 year compared to chronological age (P<0.01). Whereas, sexual maturation of the subjects progressed normally. CONCLUSION: These results suggest that treatment with the potent aromatase inhibitor, letrozole, delays bone maturation and improves PAH in boys with early puberty.

Effect of GnRH analogue on predicted adult height in girls with early puberty / 소아과

PURPOSE: The recent results observed in precocious puberty and the hope that interrupting puberty might increase adult height have led to an attempt to use GnRH agonist(GnRHa) in children with premature puberty and a poor growth prognosis. We aimed to analyze the growth promoting effect of GnRHa in girls with early puberty and low predicted adult height(PAH). METHODS: Thirty six girls were recruited. They were grouped according to the GnRHa treatment period(group 1>6 mo, n=18; group 2<6 mo, n=18). The following variables were analyzed before and after GnRHa treatment:chronological age(CA), bone age(BA), delta age(CA-BA), height, target height (TH), PAH, serum IGF-1, IGFBP-3. RESULTS: Duration of the GnRHa treatment was 0.89+/-0.81 yr(1.37+/-0.92 yr in group 1, and 0.41+/-0.08 yr in group 2). Before treatment, none of the variables were different between the two groups. There were no differences in the following variables the between two groups at the end of treatment:CA, BA, delta age, PAH, serum IGF-1, IGFBP-3. But, growth velocity(GV) and PAH increment during treatment were significantly reduced in group 1. Compared with initial PAH, PAH at the end of treatment was significantly increased(3.7+/-3.2 cm). The last serum levels of IGF-1 and IGFBP-3 were lower than those before treatment. CONCLUSION: Even though last PAH didn't approach TH, short term GnRHa administration in early puberty with low predicted PAH was somewhat effective. But, GnRHa administration suppressed the growth hormone-IGF-1 axis. Therefore, it is recommended that growth hormone(GH) should be used in combination with GnRHa.

Growth and Growth-determining Factors in Girls with Idiopathic Central Precocious Puberty Treated with Long-acting Luteinizing Hormone-Releasing Hormone Analogue / 대한소아내분비학회지

PURPOSE:In idiopathic central precocious puberty(CPP), characterized by premature but otherwise normal puberty, the early onset of the pubertal growth spurt with increased height velocity results in premature epiphyseal closure with reduced final height. We examined the growth and growth-determining factors in female patients with CPP treated with a long-acting luteinizing hormone-releasing hormone analogue(Tryptorelin). METHODS:Ten female patients who were diagnosed as idiopathic precocious puberty were treated with Tryptorelin(0.06mg/kg, IM every 4 weeks) for 2 years. We evaluated the patients into two groups(Group A, 4 cases, predicted adult height before treatment were less than 150cm; Group B, 6 cases, predicted adult height before treatment were 150cm or greater), and analysed the growth and its determing factors. RESULTS:In total patients, the growth velocity during the second year were decreased to 4.1+/-1.9 from 5.7+/-2.2/yr during the first year(p>0.05) and no significant difference was found in predicted adult height(PAH) before and after 2 years of treatment(152.3+/-6.7 vs. 1453.9+/-6.8cm). The difference between the PAH before and after 2 years of treatment was not correlated with age, bone age, PAH, height standard deviation score(Ht SDS) before treatment, but correlated with difference between the PAH before and after 1 year of treatment(r=0.89310, P=0.0005). The mean Ht SDS for bone age in group A were significantly lower than those in group B(P<0.05). In group A, the mean PAH increased from 147.0+/-1.9 to 153.7+/-3.7cm during two years of treatment, but no difference in PAH was found in group B. So PAH were similar in two groups(154.1+/-8.7 vs. 153.7+/-3.7cm) after second year. The mean difference between bone age and chronological age decreased from 4.5+/-1.3 to 3.0+/-1.3 years in group A(P<0.05). CONCLUSION: Long-term Tryptorelin treatment is more effective in girls with idiopathic central precocious puberty, whose PAH before treatment were below 150cm. If PAH before treatment is 150 cm or greater or increase in PAH during the first year of treatment is poor, this treatment modality might be useless in terms of improved growth.