ESPE Abstracts

Short children who are not GH deficient, often necessitate a different strategy, especially those with acceleration of bone age, which greatly limits height poten¬tial and the time available for growth. In this setting the use of agents to delay bone maturation has been explored to improve adult height. Estrogen principally modulates epiphyseal fusion in females and males through ERα. Aromatase inhibitors (AIs) block androgen to estrogen conversion, slowing down growth plate fusion, while allowing normal virilization in males and stimulating longitudinal bone growth via androgen receptor effects on the growth plate. During prepubertal years these are the only agents allowing pharmacological manipulation of bone maturation. Efficacy and safety in different conditions will be reviewed. During puberty GH production rates and growth velocity more than double, and high-dose GH use has shown dose-dependent increases in linear growth, but also can raise insulin-like growth factor I concentrations supraphysiologically and increase treatment costs. Gonadotropin-releasing hormone analogs (GnRHa) suppress physiologic puberty, and when used in combination with GH can meaningfully increase height potential in males and females while rendering adolescents temporarily hypogonadal at a critical time in development. The use of potent oral AIs, has shown that limited use of AIs is a viable alternative to promote growth in pubertal males, particularly combined with GH with an excellent safety profile. Ultimately the best approach for children with growth re¬tardation is early referral to pediatric endocrinology, well be¬fore the onset of puberty, so proper diagnoses are made, and tailored interventions started. Careful discussion of these treatments and realistic expectations needs to be discussed with families.