ESPE Abstracts

Introduction: Management of pediatric patients with short stature and poor adult height prognosis it’s challenging and effectiveness of treatment with growth-promoting agents is controversial when linear growth is ending. Aromatase inhibitors (AI) have become a therapeutic option as they promote slowdown of bone maturation and increase final height, but yet is a non-approved indication.

Aim: To conduct a survey about its current use in short children and adolescents to optimize final height.

Results: Two hundred and thirty-four endocrinologists from 23 countries answered the survey, and 71% used AI to preserve final height, with anastrozole being the most frequently AI used. A 26.4% of the clinicians used AI in prepubertal patients with short stature or significant advanced bone age with poor adult height prognosis, mostly combined with growth hormone (GH). The most common indication in this group of patients was in prepubertal boys with congenital adrenal hyperplasia. Ninety two percent of the endocrinologists use AI in male pubertal patients with short stature and poor adult height prognosis, and 66.5% used it in any boy with these features regardless of the cause. Eighty percent use was combined with GH. Regarding the duration of treatment, half of the clinicians (53.3%) used AI for an average of two years, 6.6% used it for 3 years and 21.4% used it for more years depending on the cause. Almost all endocrinologists (86.5%) requested safety tests every 3-6 months; with a great variability, being testosterone and liver function the most frequent labs requested. One fifth of the clinicians had to discontinue treatment due to adverse effects, being acne the most frequent cause of cessation of AI. Most clinicians felt confident about the effectiveness of AI in reducing bone age advancement and improving adult height prognosis in pubertal male patients. Nevertheless, the use of AI in girls was exceptional and most participants believed that AI had no role in improving adult height prognosis in female patients. The main reason for not using AI was the belief that there was lack of long-term data on effectiveness in improving final height.

Conclusion: Although these drugs remain off label in the pediatric population, its use has become a common practice in pediatric endocrinologists over the last years as more information about their use has been collected. We stimulate future trials to reassure the safety and effectiveness.