Height outcomes in children with growth hormone deficiency and idiopathic short stature treated concomitantly with growth hormone and aromatase inhibitor therapy: data from the ANSWER program

Background Short stature is one of the main causes of children referral to pediatric endocrinologists. Common etiologies include idiopathic growth hormone deficiency (IGHD), small for gestational age (SGA), and idiopathic short stature (ISS). Objectives The aim of this study was to assess and compare the response of children with IGHD, ISS, and SGA to growth hormone (GH) therapy. Methods This was a mixed cohort study that included 40 children with short stature (classified into IGHD, ISS, and SGA) following up at Diabetes, Endocrine, and Metabolism Pediatric Unit (DEMPU), Cairo University Children’s Hospital. Ages ranged between 3 and 18 years. Recruited cases were evaluated for their 1-year response to GH therapy. In addition to history taking, physical examination, and anthropometric measurements, serum levels of IGF-1 were assayed at recruitment. Results Among the 3 groups, height gain (cm/year) was significantly higher in the IGHD group (6.59 cm/year), followed by the ISS (4.63 cm/year) and SGA groups (4.46 cm/year) (p = 0.039). Using the Bang criterion for first-year responsiveness to GH therapy, most cases (30/40, 75%) were considered poor responders. Conclusion There is a male predominance in children seeking medical advice for short stature. Starting GH therapy at an older age was associated with poor response. Children with IGHD respond better to GH therapy than those with ISS and SGA.

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“…The majority of cases (55%) in our study were prepubertal (Tanner stage 1), which is similar to the study of Miller et al [ 17 ].…”

Section: Discussionsupporting

confidence: 91%

Growth hormone therapy response in children with short stature

Gad

Shamma

Elmonem

et al. 2023

Egypt Pediatric Association Gaz

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“…This knowledge corroborates the literature, as demonstrated in the clinical trial by Mauraset al, 2016 4 and in the retrospective cohort by Miller et al, 2020. 13 In our study, it is also noteworthy that in all the years of follow-up, those who used GH concomitantly with AI showed greater adherence to treatment. Our hypothesis for such adherence was based on the fact that obtaining GH was only possible by periodically updating the reports performed by an endocrinologist, probably causing greater motivation to maintain regular specialized follow-ups.…”

Section: Discussionsupporting

confidence: 56%

Impact of anastrozole use on the prediction of final height in male adolescents: a retrospective cohort

2022

IJDR

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Introduction: The objective of this study was to evaluate the impact of the use of anastrozole (ANZ) in monotherapy or associated with growth hormone (GH) in the predicted of final height (PFH) and nearfinal height (NFH) of male adolescents with PEF below target familiar height (TH). Methods: This is a retrospective cohort. Data were obtained from medical records in a pediatric endocrinology service. Results: 75 patients between 11 and 14 years old participated in this cohort. Treatment with ANZ occurred for 1 year in 38.7%, 2 years in 40.0%, and 3 years in 21.3%. 76.0% used GH+ANZ, and 24.0% ANZ alone. TH and PFH at different treatment times showed a statistically significant difference, regardless of the use or not of GH. The ANZ group alone showed a mean increase of 5.73cm, 7.60cm, and 7.15cm in predicted height after 1, 2, and 3 years of ANZ. In the GH+ANZ group, this increase was 6.82cm, 10.27cm, and 7.44cm. Twenty-seven patients reached NFH, and in these, we observed a statistically significant increase concerning baseline PFH of 4.68 cm in the total group and 5.55 cm in the GH+ANZ group. Conclusions: The use of ANZ effectively increased PFH and NFH in adolescents with PFH below TH. However, the subgroup with concomitant use of GH had better outcomes.

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“…The limited number of studies on the efficacy of AIs on height gain have conflicting results, as previously stated ( 6 – 10 ). Furthermore, in numerous comparative studies, a concomitant treatment with GH showed to increase adult height ( 1 , 19 , 20 ). In Mauras and cols.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the late initiation of the AI, the study demonstrated a significant difference between adult heights in favor of the group that received anastrozole and GH treatment (168.4 ± 2.6 cm vs. 164.2 ± 5.6 cm, and height increments during treatment were 12.7 ± 5.6 cm vs. 7.8 ± 5 cm). Lastly, a longitudinal cohort study concluded that adding an AI improved height SDS in pubertal boys with idiopathic short stature or GH deficiency receiving GH therapy ( 20 ). At the initiation of AI therapy, height SDSs were −0.92 ± 0.89 in the boys with GHD (n = 70) and −0.87 ± 0.86 in the boys with ISS (n = 19).…”

Section: Discussionmentioning

confidence: 99%

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

Tarçın,

Koç,

Turan

et al. 2024

Archives of Endocrinology and Metabolism

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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.

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Height outcomes in children with growth hormone deficiency and idiopathic short stature treated concomitantly with growth hormone and aromatase inhibitor therapy: data from the ANSWER program

Cited by 11 publications

References 31 publications

Growth hormone therapy response in children with short stature

Growth hormone therapy response in children with short stature

Impact of anastrozole use on the prediction of final height in male adolescents: a retrospective cohort

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

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