Background: A combination of GH and a gonadotropin releasing hormone analogue (GnRH a) is hypothesized to improve adult height in children with a poor adult height prediction.
Study design: In this multicenter study, 24 girls in early puberty (bone age ≤12.0 y),with a predicted adult height ≤151.0 cm and normal body proportions were treated with GH (Zomacton) 50 μg/kg per day and triptorelin (Gonapeptyl) 3.75 mg/month SC or IM (for 4 years. Adult height was defined as the height attained at a bone age of at least 16 years. Bone age was determined yearly by the Greulich and Pyle method and height predictions were made using the Bayley-Pinneau tables. Height SDS were calculated using Flemish growth curves (Roelants 2009).
Results: Sixteen girls completed the study per protocol (PP). Reasons to drop out during the treatment phase were: doping concerns in sports (1), no wish to postpone puberty any further after 2.5 or 3 years (3), poor compliance (1), premature stop of GH injections (1). Two participants did not return for their adult height visit after stop of treatment. Mean height SDS was −2.25±0.73 at the start of treatment, rose to −1.36±0.81 at the end of treatment and further increased to −1.10±0.76 at adult height. Height (mean±S.D.) increased from 131.3±4.1 cm to 155.3±4.7 cm at the end of the treatment period and to an adult height of 159.8±4.8 cm. Adult height was attained at a median age of 18.5 years and surpassed the predicted height at the start of treatment by 12.0±2.6 cm (range 4.719.7 cm). Serious adverse events in the total group were: depression (2 years after treatment), pyelonephritis and a fracture of forefoot bones in a ballet dancer (possibly related to the treatment). Other adverse events were restricted to injection site reactions (pain, bruising, scarring) and common health problems for this age group.
Conclusion: A 4 year combination treatment of GH and triptorelin, started in early puberty, was safe and resulted in an adult height significantly above predicted adult height. This outcome must be weighed against the marked financial and psychological burden of the treatment.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology