Growth Response to Growth-Hormone Administration during the Decelerating Phase of the Pubertal Growth Spurt in Short Normal Children

Abstract

In order to investigate the value of growth hormone (GH) treatment during late puberty, we studied the effect of human GH (hGH) administration (0.85 ± 0.30 IU/kg/week; range: 0.44–1.28) on height velocity (HV) after the peak of the pubertal growth spurt in a group of 10 (4 girls and 6 boys) short normal children (GH peak after pharmacological stimulation: 15.5 ± 2.3 ng/ml) with growth retardation (height: 2.6 ± 0.3 SD) and puberty Tanner stage 4. A group of 10 untreated children, observed prior to the study, served as controls. The children were regularly measured during their pubertal growth spurt, and HV (cm/year) was calculated every 6 months. The pretreatment evaluation consisted of 2 consecutive 6-month periods characterized by a decrease in HV of at least 25%. In the group of selected children, hGH administration was then initiated and growth variables were evaluated after 6 and 12 months of therapy. Skeletal maturation was evaluated at the beginning as well as after 6 months and 12 months of hGH therapy. In the controls, HV (mean ± SD) had decreased from 8.8 ± 1.8 to 4.9 ± 1.4 cm/year during the pretreatment period (in girls from 7.9 ± 1.4 to 4.1 ± 0.6 cm/year and in boys from 9.6 ± 1.6 to 5.8 ± 1.2 cm/year). During the following semester, HV was 3.3 ± 0.8 cm/year (girls: 3.4 ± 1.0 and boys: 3.2 ± 0.2 cm/year). In the group of children treated with hGH, HV had decreased from 8.3 ± 1.3 to 5.3 ± 0.8 cm/year (from 7.5 ± 0.8 to 5.0 ± 0.2 cm/year in girls and from 8.9 ± 1.0 to 5.5 ± 0.8 cm/year in boys). During the first 6 months of hGH, HV was 7.7 ± 2.0 cm/year (7.5 ± 1.6 cm/year in girls and 7.8 ± 2.0 cm/year in boys). During the second 6-month period of treatment, a waning effect of GH was observed since HV decreased to 4.5 ± 1.4 cm/year (4.3 ± 1.4 cm/year in girls and 4.6 ± 1.5 cm/year in boys). We conclude that in this group of short normal children hGH (mean dose of 0.85 ± 0.30 IU/kg/week) increased HV after the peak of the pubertal growth spurt; complementary trials are indicated to determine if final adult height is enhanced when this therapy is administered during late puberty.

Combined treatment with growth hormone and luteinizing hormone releasing hormone-analogue (LHRHa) of pubertal children with familial short stature

“…Moreover GH seems to be more effective in promoting growth of short children than other neuroactive substances such as clonidine and L-Dopa (4). The vast majority of these experiences however have been carried out on prepubertal children and the results of GH treatment during puberty are still preliminary (5) . On the other hand , it is known that the height achieved at the beginning of puberty is positively correlated with final height so that it could be useful in short children to combine GH with LHRH analogue (LHRHa) therapy in order to delay puberty and to prolong the prepubertal growth period .…”