Height prognosis of children with true precocious puberty and growth hormone deficiency: Effect of combination therapy with gonadotropin releasing hormone agonist and growth hormone

• Published in: The Journal of pediatrics Vol. 120; no. 5; pp. 709 - 715
• Main Authors: Cara, José F., Kreiter, Mary L., Rosenfield, Robert L.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.1992; Elsevier
• Subjects: Age Determination by Skeleton; Biological and medical sciences; Body Height - drug effects; Child; Drug Therapy, Combination; Female; Gonadotropin-Releasing Hormone - analogs & derivatives; Gonadotropin-Releasing Hormone - therapeutic use; Growth Disorders - complications; Growth Disorders - drug therapy; Growth Hormone - deficiency; Growth Hormone - therapeutic use; Hormones. Endocrine system; Humans; Leuprolide - therapeutic use; Male; Medical sciences; Nafarelin; Pharmacology. Drug treatments; Prognosis; Puberty, Precocious - complications; Puberty, Precocious - drug therapy; Time Factors; Endocrinopathy; Human; Prognosis; Deficiency; STH; Growth retardation; Genital diseases; Precocious puberty; Protein hormone; Concomitant disease; Treatment; Adenohypophyseal hormone; Pituitary diseases; Pubertal disorders; Child
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(05)80232-X

We evaluated height prognosis and therapeutic efficacy of long-term, combination therapy with gonadotropin releasing-hormone agonist and growth hormone (GH) in five children (three girls) with coexistent precocious puberty and GH deficiency. Their clinical characteristics and growth response were compared with those of 12 girls with idiopathic true precocious puberty and eight prepubertal GH-deficient children (one girl). Precocious GH-deficient subjects were older than the precocious GH-sufficient children (9.5±1.8 years vs 6.5±1.3 years; mean±SD), but bone ages were comparable (12±3.7 years vs 10±0.9 years); their chronologic age was similar to that of the prepubertal GH-deficient children (9.6±2.1 years), but bone age was significantly more advanced (6.9±2.3 years). The mean height velocity of the prepubertal GH-deficient children (3.8±1.5 cm/yr) was lower than that of the precocious GH-deficient subjects (6.7±1.6 cm/yr) and the precocious GH-sufficient children (9.5±2.9 cm/yr). Baseline adult height prediction z scores were significantly lower in the precocious GH-deficient children (−3.7±1.0) than in either the precocious GH-sufficient children (−2.2±1.0) or the prepubertal GH-deficient subjects (−1.5±0.8). During therapy with gonadotropin releasing-hormone agonist, growth rates slowed to an average of 3.7 cm/yr in the precocious GH-deficient children but increased after the addition of GH to 7.4 cm during the first year of combination therapy. After 2 to 3 years of combination therapy, height predictions increased an average of 10 cm, compared with an increase of 2.8 cm in the precocious GH-sufficient group treated with gonadotropin releasing-hormone agonist alone. We conclude that combination treatment with gonadotropin releasing-hormone agonist and GH improves the height prognosis of children with coexistent true precocious puberty and GH deficiency, but falls short of achieving normal adult height potential.