Objective: To explore the therapeutic effects and adverse reactions of a combination of letrozole or Gonadotropin releasing hormone analog (GnRHa) and recombinant human growth hormone (rhGH), compared with rhGH alone, in pubertal short boys.
Methods: Sixty-four pubertal short boys were divided into three groups, one group were treated with rhGH (rhGH group, n=21), one group were treated with the combination of GnRHa and rhGH (GnRHa group, n=19) and another group were treated with the combination of letrozole and rhGH (letrozole group, n=24). All boys had completed one or two years of treatments. The advancement of grow velocity, bone age (BA), height standard deviation score by bone age (Ht SDSBA), while the body mass index (BMI), glucose and lipid metabolism, adverse reactions were measured.
Results: The ages of three groups were (12.79±0.98), (12.14±1.01) and (12.81±0.93) years (P>0.05), BA were (11.66±1.14), (12.97±0.90) and (13.27±0.75) years (P<0.05). The growth velocities of the first year were (10.75±1.56), (8.01±1.69), (10.11±2.19) cm/year (P<0.05), there were (9.44±1.53), (6.06±1.53) and (7.39±2.08) cm/year in the second year (P<0.05). The increasing of BA of the first year were (1.67±1.01), (0.71±0.36 ) and (0.58±0.30)year/year(P<0.05), there were (1.13±0.43 ), (0.61±0.37) and (0.47±0.22)year/year(P<0.05), there were no significant difference in BA after treatment for two years. Increase of HtSDSBA in the first year were (0.05±0.88), (0.50±0.28) and (0.94±0.47), (P<0.05), there were (0.35±0.37), (0.26±0.29) and (0.81±0.46) (P<0.05) in the second year. There were no statistically significant difference of BMI, glucose and lipid metabolism between the three groups. During the treatment of combination group 3 boys suffered fractures, ultrasound bone density scan showed serious shortage of bone mineral density, after supplemental calcium and calcitriol, bone density increased within 3 to 6 months, no recurrence of fracture. There were no other adverse reactions in three groups.
Conclusion: Combination of letrozole and rhGH in pubertal short boys could inhibit BA progression, reduce growth slowdown, ameliorate Ht SDSBA compare to the combination of GnRHa and rhGH, but bone density may be affected, and long-term follow-up is needed.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology