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GH y Triptorelina Tbi Niñas
GH y Triptorelina Tbi Niñas
2
The Journal of Clinical Endocrinology & Metabolism Printed in U.S.A.
Copyright © 2000 by The Endocrine Society
619
620 PASQUINO ET AL. JCE & M • 2000
Vol 85 • No 2
TABLE 1. Auxological data of 12 short normal patients treated TABLE 2. Auxological data of 12 short normal patients treated
with GnRHa plus GH with GH alone
TABLE 3. Predicted adult height, final height, and TH of 12 TABLE 4. Predicted adult height, final height, and TH of 12
short normal patients treated with GnRHa plus GH short normal subjects treated with GH
acetate, 300 g/kg every 28 days; GH, 0.6 IU/kg weekly) adult height (10 vs. 6 cm). The benefit of treatment remains
(33). Although PAH in the first year of therapy showed a significant but less striking in group 1 (GH plus GnRHa) and
significant improvement, adult height remained signifi- not significant in the GH alone group, if we compare heights
cantly lower than TH. The low dose of GH, the short period in sd score for BA as reported previously (31, 33). However,
of therapy, and the evaluation of results, calculated by using if we consider their economical and ethical costs, these ther-
mean value PAH for males and females limits in some ways apies should be limited to very short subjects who have a
the usefulness of this study. Our study was performed in very low PAH well below the third percentile and parental
both groups using the same criteria, such as GH dose (0.3 TH, in whom even a gain of 6 cm could be considered
mg/kg䡠week), auxological characteristics of the girls, and worthwhile. As the cost-benefit of such invasive treatment
time of discontinuation of treatment. must be seriously considered, further studies are needed.
In group 1, GnRHa was given at a suppressive dose (at
least 100 g/kg in 21 days, im). Furthermore, we were very References
careful in adjusting the dose according to weight either for
1. Bierich JR, Nolte K, Drews K, Brugmann G. 1992 Constitutional delay of
GH in both groups or for GnRHa in group 1, and we treated growth and adolescence. Results of short-term and long-term treatment with
girls for longer period than in other studies (31, 33). GH. Acta Endocrinol (Copenh). 127:392–396.
Girls treated with combined therapy obtained a mean gain 2. Albertsson-Wikland K on behalf of the International Board of the Kabi
Pharmacia International Growth Study. 1993 Characteristics of children with
in adult height of 10.0 ⫾ 2.9 cm compared with pretreatment idiopathic short stature in the Kabi Pharmacia International Growth Study and
PAH (156.3 ⫾ 5.9 vs. 146.3 ⫾ 5 cm) and similar to PAH at the their response to growth hormone treatment. Acta Paediatr. 391(Suppl):75–78.
discontinuation of therapy (156.3 vs. 156.8 cm). In this group 3. Loche S, Cambiaso P, Setzu S, et al. 1994 Final height after growth hormone
therapy in non-growth-hormone-deficient children with short stature. J Pe-
the variability of the response (range, 5.7–15 cm) was less diatr. 125:196 –200.
striking than that in group 2; 7 of 12 subjects had a gain over 4. Wit JM, Boersma B, de Muinck Keizer-Schrama SMPF, et al. 1995 Long-term
results of growth hormone therapy in children with short stature, subnormal
10 cm. TH was significantly exceeded (156.3 ⫾ 5.9 vs. 152.7 ⫾ growth rate and normal growth hormone response to secretagogues. Clin
3.6 cm; P ⬍ 0.05 Table 3). If we consider height in sd score Endocrinol (Oxf). 42:365–372.
for BA at the beginning of treatment and at final adult height, 5. Hindmarsh PC, Brook CGD. 1996 Final height of short normal children treated
with growth hormone. Lancet. 348:13–16.
the increment is about 0.9 sd score for BA. 6. Rakers-Mombarg LTM, Massa GG, Wit JM. 1996 Final height of short normal
Girls treated with GH alone obtained a mean gain in adult children treated with growth hormone. Lancet. 348:681.
height vs. pretreatment PAH (151.7 ⫾ 2.7 vs. 145.6 ⫾ 4.4 cm) 7. Bernasconi S, Street ME, Volta C, Mazzardo G, Italian Multicentre Study
Group. 1997 Final height in non-growth hormone deficient children treated
of 6.1 ⫾ 4.4 cm, with a great variability (range, 0.1–14.1 cm). with growth hormone. Clin Endocrinol (Oxf). 47:261–266.
Five of 12 patients did not gain more than 4 cm, comparing 8. Schmitt K, Blumel P, Waldhor T, Lassi M, Tulzer G, Frisch H. 1997 Short- and
long-term (final height) data in children with normal variant short stature
adult height with pretreatment PAH. TH was not exceed by treated with growth hormone. Eur J Pediatr. 156:680 – 683.
adult height (155.8 ⫾ 4.6 vs. 151.7 ⫾ 2.7 cm; P ⬍ 0.05; Table 9. Buclis JC, Irizarry L, Crotzer BC, Shine BJ, Allen L, MacGillivray MH. 1998
4). If we consider height sd score for BA at the beginning of Comparison of final heights of growth hormone-treated vs. untreated children
with idiopathic growth failure. J Clin Endocrinol Metab. 83:1075–1079.
treatment and at adult height, no significant change was 10. McCaughey ES, Mulligan J, Voss LD, Betts PR. 1998 Randomised trial of
obtained. All girls had good compliance, and most of them growth hormone in short normal girls. Lancet. 351:940 –944.
were satisfied ith the results. 11. Hintz RL, Attie KM, Baptista J, Roche A, for the Genentech Collaborative
Group. 1999 Effect of growth hormone treatment on adult height of children
In conclusion, our experience shows that the addition of with idiopathic short stature. N Engl J Med. 340:502–507.
GnRHa to GH improves adult height significantly compared 12. Lindner D, Job JC, Chaussain JL. 1993 Failure to improve height prediction
in short-stature pubertal adolescents by inhibiting puberty with luteinizing
with PAH in girls with idiopathic short stature and normal hormone-releasing hormone analogue. Eur J Pediatr. 152:393–396.
or early puberty. The advantage obtained with the combi- 13. Municchi G, Rose SR, Pescovitz OH, Barnes KM, Cassorla FG, Cutler GB.
nation is more significant and may be due to the deceleration 1993 Effect of deslorelin-induced pubertal delay on the growth of adolescents
with short stature and normally timed puberty: preliminary results. J Clin
of both BA and progression of puberty compared with those Endocrinol Metab. 77:1334 –1339.
obtained in the GH alone group as to the amount of gain in 14. Carel JC, Hay F, Coutant R, Rodrigue D, Chaussain JL. 1996 Gonadotropin-
622 PASQUINO ET AL. JCE & M • 2000
Vol 85 • No 2
releasing hormone agonist treatment of girls with constitutional short stature 25. Pasquino AM, Municchi G, Pucarelli I et al. 1996 Combined treatment with
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hormone agonist (LHRHa)-induced delay of epiphyseal fusion increases adult 26. Pasquino AM, Pucarelli I, Segni M, Matrunola M, Cerrone F. 1999 Adult
height of adolescents with short stature. Horm Res. 48(Suppl 2):28. height in girls with central precocious puberty treated with gonadotropin-
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