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Combined GH and LHRH analog treatment in short children
1Division of Endocrinology & Metabolism, National Children's Hospital, Tokyo, Japan.
Insights
Combining growth hormone (GH) and LHRH analog therapy in short boys starting puberty can improve final height. This treatment decelerates bone age maturation, allowing sustained growth and better height outcomes.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Pubertal Development
Background:
- Final height in short children is linked to pubertal onset height.
- Insufficient height at puberty onset often leads to short stature.
- Previous studies show gonadal suppression therapy improves final height in GH-deficient children.
Purpose of the Study:
- To evaluate the efficacy of combined growth hormone (GH) and gonadotropin-releasing hormone (GnRH) analog therapy in short boys.
- To assess the impact on bone age maturation and final height prediction.
Main Methods:
- Short boys with puberty onset height <130 cm received combined GH and GnRH analog treatment.
- Final height was predicted using height standard deviation score (SDS) for bone age.
- Bone age maturation rate and growth velocity were monitored.
Main Results:
- Pubertal growth spurt was not observed, but bone age maturation decelerated significantly.
- Growth velocity was maintained at 4 cm/year due to GH treatment.
- Height SDS for bone age improved due to slower maturation and extended treatment duration.
Conclusions:
- Combined GH and GnRH analog therapy is effective in improving final height in short children.
- Slower bone maturation allows for prolonged growth, enhancing height outcomes.
- Patient preference for taller stature often outweighs concerns about delayed puberty, though cultural factors play a role.
Abstract:
It has been reported that the final height in short children is strongly related to the height at the onset of pubertal development, and pubertal height gain in GH-treated children is not exceed the gain in normal children. Therefore, it is now the consensus that insufficient height at the onset of puberty leads to short final height. We have already demonstrated that the final height in GH-deficient children with spontaneous puberty with gonadal suppression therapy by medroxyprogesterone or cyproterone acetate was significantly taller than GHD with spontaneous puberty without gonadal suppression therapy. In this study, we treated short boys who started puberty at height shorter than 130 cm with combined GH and LHRH analog. Final height was predicted by the height SD score for bone age. Although pubertal growth spurt was not recognized in short children on combination treatment, bone age maturation over 11.5 years decelerated significantly to the rate of one year in three or four years. Even during this slow bone maturation period, growth velocity remained at 4 cm/year due to GH treatment. Therefore, height SDS for bone age was improved in combination with the elongation of treatment period by the slow bone maturation. Some investigators recommend not to delay induction if puberty much beyond the normal age to avoid psychological problems and ennuchoid proportion in these children. When we explained to our Japanese patients the chance of increasing the final height with gonadal suppression treatment and the risk of delaying the pubertal development, almost all children preferred taller final height to pubertal development and they did not experience much psychological trouble. The differences in social and cultural circumstances do, however, influence patients' preferences.