Can the TW3 Bone Age Determination Method Provide Additional Criteria for Growth Hormone Treatment in Adopted Girls with Early Puberty?

Abstract

Background/Aims: Gonadotropin-releasing hormone analogues (GnRHa) are the accepted treatment of idiopathic central precocious puberty. As it has been found that growth velocity may be decreased with GnRHa treatment, clinical trials with GnRHa combined with growth hormone (GH) have been carried out. In a recent study 46 adopted girls with early or precocious puberty were randomly assigned to treatment with either GnRHa or GnRHa combined with GH, and followed to final height (FH). It was found that FH was significantly higher in the combined treatment group, 158.9 compared with 155.8 cm in the GnRHa treated group. In order to select the patients who could benefit from added GH, predictions of FH at the start of treatment according to the methods of bone age determination of Greulich-Pyle (GP) and Tanner-Whitehouse 2 (TW2) were compared. It was found that the GP method was the most useful method for patient selection. Recently, a revision of the Tanner-Whitehouse method, named Tanner-Whitehouse 3 (TW3), has been developed. The present study examined the usefulness of the TW3 method in selecting suitable patients for combined treatment. Method: The TW3 method bone age determinations of the 46 girls were compared to the GP and TW2 method determinations, using the differences between actual FH and predicted adult height (PAH). Beside accuracy of prediction of FH, the criteria of efficiency of selection and replicability were applied in the comparison. Results: We found that the GP method, also when compared to the TW3 method, gave the most accurate prediction of the FH on only GnRHa treatment. This gives the best ground for selection of patients who can benefit from combined treatment. The GP method was also the most efficient in selecting patients, i.e., it could select the least number of patients that needed the combined treatment. The only drawback of the GP method was that it requires an experienced pediatric radiologist. Automated methods are being developed and may soon facilitate the use of the GP method for those less experienced. The FH after combined treatment could be predicted with an equation including PAH GP as well as PAH TW3 as variables. Conclusion: The GP method remains the most useful method for selection of those patients who will benefit most from the addition of GH to GnRHa in the treatment of idiopathic central precocious or early puberty. FH prediction after combined treatment requires PAH GP as well as PAH TW3.

Is a Combination of a GnRH Agonist and Recombinant Growth Hormone an Effective Treatment to Increase the Final Adult Height of Girls with Precocious or Early Puberty?

“…Tuvemo et al [19], Tuvemo et al [9], and Proos et al [23, 24] report data from the same study, as do Kamp et al [20], van Gool et al [13], Mul et al [8, 22], and van der Steen et al [26, 27]. The studies of Mul et al [22], van Gool et al [13], Proos et al [24], and van der Steen et al [27], which followed the subjects through to adulthood, were analyzed. The studies of Pasquino et al [7], Mul et al [22], Proos et al [24], and Liang et al [25] were of ICPP, and the interventions compared were a GnRHa and rhGH combination and GnRHa alone.…”

“…The studies of Mul et al [22], van Gool et al [13], Proos et al [24], and van der Steen et al [27], which followed the subjects through to adulthood, were analyzed. The studies of Pasquino et al [7], Mul et al [22], Proos et al [24], and Liang et al [25] were of ICPP, and the interventions compared were a GnRHa and rhGH combination and GnRHa alone. The studies of Job et al [11], Saggese et al [18], Lanes and Gunczler [12], van Gool et al [13], and van der Steen et al [27] were of early puberty.…”

“…There was significant heterogeneity in the pooled data from the four studies of ICPP (heterogeneity test: Q = 136.24, df = 1, P < 0.00001, I 2 = 98%) (Pasquino et al [7], Mul et al [22], Proos et al [24], Liang et al [25]) (Figure 3). Therefore, a sensitivity analysis was conducted.…”

“…Many factors can affect height, especially parental height. Participants in the studies of Proos et al [24] and Mul et al [22] were girls adopted from developing countries, in which the onset of puberty is often considerably later than in the countries the children had migrated to, resulting in lower adult height. When they were adopted, HSDS was 2 SDS less than for children of the same age in a developed country.…”

Bone age estimation by cervical vertebral dimensions in lateral cephalometry

“…[21][22][23][24] We evaluated individuals 8-years-old and above, because orthodontists believe that growth modification treatments should begin before completion of adolescent growth spurt and supposedly, the treatment can be done at any time before that point. 20 On the other hand, Hellsing showed that there are some differences between 15-years-old boys and "adult" boys, concerning body height and cervical vertebral dimensions.…”