Final Height of Patients with Pituitary Growth Failure and Changes in Growth Variables after Long Term Hormonal Therapy

Abstract

Summary: Eighteen patients with idiopathic growth hormone deficiency (GHD) were treated with human growth hormone (HGH) until cessation of growth. Half of these patients achieved a final height within 2 S.D. of the target height, the sex-corrected midparent height. Although growth data at the onset of therapy and during therapy were not different in the total and partial growth hormone deficient patients, the result of the latter was less favourable: eight of the 13 patients with total and only one of 5 with partial GHD reached a final height within parental target limits.

A longitudinal analysis of height and bone age in the males with total GHD showed a progressive improvement of the height standard deviation scores for chronologic age (SDS-CA) during 4 years of HGH therapy: from –5.6 to –3.8 standard deviation scores (SDS) with no influence on bone age SDS. After adding androgen therapy in order to induce puberty in the patients with additional gonadotropin deficiency, an increase of growth velocity from 4.7 to 6.3 cm/year was elicited. Height SDS-CA was improved by 1 SDS and bone age SDS advanced by 1.9 SDS.

Of the available methods for adult height prodiction calculated at onset of therapy, the Tanner method based on bone age best reflects the height that probably would be attained without therapy. HGH therapy initiated a clear increase in height prediction. Androgen therapy, in addition to HGH therapy, resulted in an additional small increase in the predicted height.

Final height achieved was significantly correlated with midparent height. Final height expressed in SDS of target height, accounting for the genetic background, was significantly correlated with the bone age deficit, with height SDS-bone age (BA) at onset of therapy, and with the increase in height velocity during the first year of HGH therapy. No correlations were found between final height expressed in SDS of target height and chronologic age, height SDS-CA at onset of therapy and pretreatment height velocity.

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