ESPE Abstracts

Background: GH treatment is effective in improving adult height (AH) in short children born Small for Gestational Age. If SGA children are short at the start of puberty, they could benefit from combined GH/GnRH Analogue (GnRHa) treatment.

Objective and hypotheses: To determine the timing and progression of pubertal development in short SGA children, comparing GH treatment with combined GH/GnRHa treatment.

Method: For the present study, 61 GH-treated SGA children were included. At the onset of puberty, 42 continued GH treatment (group A), while 19 started GnRHa treatment in addition to GH for 2 years (group B). Fifty-three children reached AH during follow-up. Pubertal onset was defined in girls as breast stage 2, in boys as a testicular volume ≥4 ml.

Results: Age at pubertal onset was similar for girls in groups A and B (P=0.42). Boys in group B started puberty at a significantly younger age than boys in group A (P=0.01). For girls in group B, the time between restart of puberty, after discontinuation of GnRHa treatment, and menarche was 1.2 years. This was significantly shorter than the time between pubertal onset and menarche in girls in group A (1.9 years; P=0.02). In addition, time between pubertal restart and AH for girls and boys in group B was shorter than the time between pubertal onset and AH for children in group A (P=0.004 and P=0.044 respectively).

Conclusion: The pace of pubertal progression in SGA children is different after treatment with combined GH/GnRHa treatment compared with GH treatment only. This may be explained by the fact that in children receiving combined treatment, puberty was already present before start of GnRHa treatment.