ESPE Abstracts (2019) 92 P2-156

Growth Hormone Monotherapy Versus Combined GH and LHRH Analog in 2 Sisters with Short Stature, Early Pubertal Development, and Advanced Bone Age (BA)

Sohair Elsiddig, Ashraf Soliman, Nada Alaaraj, Ahmed Khalil


Hamad General Hospital, Doha, Qatar


Introduction: There is still a debate on the effect of combined treatment with growth hormone (GH) and a luteinizing hormone-releasing hormone (LHRH) analog versus GH alone on final adult height in children with idiopathic short stature (ISS) and those who have early pubertal development at a short height.

Case Report: We studied two sisters with a history of familial short stature, early puberty and advanced bone age at presentation. Both of them presented to the endocrine clinic with the same presentation at the same age, in two different times.(R) presented with breasts Tanner 3 and was menstruating for 9 months. She was treated with GH monotherapy (0.05 mg/kg/day) for 2 years until her final adult height (FAHt). (D) presented at the same age with breast Tanner 3 and menstruated once. She received combined GH and LHRH-a therapy and still on treatment. (Table)

Age at Presentation(R)10.5 years old(D)10.5 years old
Breast developmentT3T3
Menarche9 months1 month
HtSDS 10.34−1.5
MPHtSDS−1.5−1.5
BMISDS11.470.85
BA11.512
HormonesFSH: 3.39 IU/L
LH: 4.87 IU/L
Estradiol: 182 pmol/L
FSH: 4.70 IU/L
LH: 3 IU/L
Estradiol: 277 pmol/L
InterventionGH therapycombined
Age 211.511.5
HtSDS20.06−0.54
BMISDS21.720.79
GV/y 1 GVSDS5cm −0.76.9 0.9
BA13.5 y12
Age 312.5---
HtSDS3−0.77----
BMISDS31.5----
GV/y 22.4cm/y----
BA15y---
End adult Ht* (cm) HtSDS152 −1.68157.8 (predicted) −0.89

At presentation, pubertal stage and BA were equal in both sisters. However, (D) was significantly shorter (difference 1.84 SDS). After a year of follow up on different therapies (D) showed significant improvement in HtSDS, GV and GVSDS (LHRH-a + GH effect) in comparison to her sister (R) who received GH monotherapy, with a change in HtSDS = +1 in (D) versus −0.28 in (R). The combined therapy resulted in a deceleration of bone aging that increased the potential of FAHt. (R) Received GH for 2years stopped therapy when she achieved final adult height (152cm, SDS −0.73) in comparison to her MPHSDS −1.5. The predicted FAHt for D, who was shorter at presentation, proved that she will be taller than her sister (157.8 cm, −0.89)

Conclusion: In these sisters with advanced BA and early puberty, the combined LHRH-a + GH therapy proved to be more beneficial for height growth compared to GH monotherapy.

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