The Beneficial Effect of Combined GH/GnRHa Therapy in Increasing Adult Height Outcome in Children With ISS

Authors:
Publisher website
Google Scholar
Abstract
Context Management of GH-treated idiopathic short stature (ISS) children with early puberty and adolescents in mid-puberty at initiation of treatment is challenging. Objective To assess the effect of combined GH/GnRHa therapy during puberty on achieved adult height (AHt) in these ISS children and to determine whether outcome depended on sex and pubertal status at initiation of GH therapy. Design Retrospective, single-center, observational study from 2003 to 2018. Setting Tertiary endocrine center. Patients 192 GH treated ISS children; 58/192 were treated by GH/GnRHa during puberty; 31/58 were prepubertal (19 girls) and 27/58 - pubertal (19 girls) at initiation of GH. Main outcome measures AHt, gain-in-height SDS, AHt vs. predicted AHt (PAHt), AHt vs. target Ht (THt). Results Most boys and girls attained AHt SDS within the normal range (-0.73±0.60 and -0.85±0.65, respectively). Treatment modality, pubertal status and sex were tested for their joint effect on growth outcome measures. Combined GH/GnRHa therapy increased AHt vs. PAHt (PP=0.035). Prepubertal status at onset of GH treatment increased AHt (P=0.049), gain-in-height SDS (PPP=0.042). Female sex increased AHt vs. PAHt (P<0.001). Conclusions Our study demonstrated a beneficial effect of combined GH/GnRHa therapy in increasing AHt outcome in ISS children with early/normal puberty and in adolescents naïve to GH treatment who are in mid-puberty at initiation of therapy. This effect was more pronounced in the prepubertal group and in girls. Prospective randomized-controlled trials are needed to assess whether GnRHa can increase AHt in GH-treated ISS children.

This publication has 17 references indexed in Scilit: