help button home button Endocrine Society JCEM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pasquino, A. M.
Right arrow Articles by Segni, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pasquino, A. M.
Right arrow Articles by Segni, M.
Right arrowPubmed/NCBI databases
*Compound via MeSH
*Substance via MeSH
Medline Plus Health Information
*Growth Disorders
The Journal of Clinical Endocrinology & Metabolism Vol. 85, No. 2 619-622
Copyright © 2000 by The Endocrine Society

Original Studies

Adult Height in Short Normal Girls Treated with Gonadotropin-Releasing Hormone Analogs and Growth Hormone

Anna Maria Pasquino, Ida Pucarelli, Mario Roggini and Maria Segni

Pediatric Endocrinology Unit, Pediatric Radiology Unit (M.R.), Pediatric Department, University La Sapienza, 00161 Rome, Italy

Address all correspondence and requests for reprints to: Anna Maria Pasquino, M.D., Pediatric Endocrinology Unit, Pediatric Department, University La Sapienza, Viale Regina Elena 324, 00161 Rome, Italy.


   Abstract
Top
 Abstract
Introduction
 Subjects and Methods
 Results
 Discussion
 References
 
Combined treatment with GH and GnRH analogs (GnRHa) has been proposed to improve final adult height in true precocious puberty, GH deficiency, and short normal subjects with early or normal timing of puberty with still controversial results. We treated 12 girls with idiopathic short stature and normal or early puberty with GH and GnRHa and followed them to adult height; 12 girls comparable for auxological and laboratory characteristics treated with GH alone served to better evaluate the efficacy of addition of GnRHa. At the start of combined treatment, the chronological age of the girls (CA; mean ± SD) was 10.2 ± 0.9 yr, bone age (BA) was 10.6 ± 1.9 yr, height SD score for BA was -1.81 ± 0.8, PAH was 146.3 ± 5.0 cm. PAH was significantly lower than target height (TH 152.7 ± 3.6 cm; P < 0.005). GH was given at a dose of 0.3 mg/kg·week, sc, 6 days weekly, and GnRHa (depot-triptorelin) was given at a dose of 100 µg/kg every 21 days, im. The 12 girls were treated with GH alone at the same dose; at the start of therapy their CA was 10.7 ± 1.0, BA was 10.1 ± 1.4 yr, height SD score for BA was -1.65 ± 0.8, PAH was 145.6 ± 4.4 cm, and TH was 155.8 ± 4.6 cm. Pubertal Tanner stage in both groups was B2P2 or B3P3. LHRH test and pelvic ultrasound showed the beginning of puberty. The GH response to standard provocative tests was 10 g/L or more. The mean period of treatment was 4.6 ± 1.7 yr in the group treated with GH plus GnRHa and 4.9 ± 1.4 yr in the group treated with GH alone; both groups discontinued treatment at comparable CA and BA. Adult height was considered to be attained when growth during the preceding year was less than 1 cm, with a BA of over 15 yr. Patients in the group treated with GH plus GnRHa showed an adult height significantly higher (P < 0.001) than the pretreatment PAH (156.3 ± 5.9 vs. 146.3 ± 5 cm); the gain in centimeters calculated between pretreatment PAH and adult height was 10 ± 2.9 cm, and 7 of 12 girls had a gain over 10 cm. Target height was significantly exceeded. Height SD score for BA increased from -1.81 ± 0.8 to -0.85 ± 1.0. The GH alone group reached an adult height higher than the pretreatment PAH (151.7 ± 2.7 vs. 145.6 ± 4.4 cm); the gain in final height vs. pretreatment PAH was 6.1 ± 4.4 cm, and 5 of 12 girls did not gain more than 4 cm. TH was even not reached. The height SD score did not significantly change. No adverse effects were observed in either group. All of the girls showed good compliance and were satisfied with the results. Our experience suggests that the combination of GH and GnRHa is significantly more effective in improving adult height than GH alone in girls with idiopathic short stature, early or normal onset of puberty, and low PAH well below the third percentile and TH. As the cost-benefit of such invasive treatment must be seriously considered, further studies are needed due to the small sample of our patients as well as in other studies reported to date.


   Introduction
Top
 Abstract
 Introduction
Subjects and Methods
 Results
 Discussion
 References
 
IN SUBJECTS with short stature and normal GH secretion, so-called short normal or idiopathic short stature, the poor final growth is often the result a poor velocity during the prepubertal age (in the low range of normality) and a reduced spurt during the pubertal age either with a normal tempo or with an early onset of puberty.

In idiopathic short stature, GH alone has been used in many trials, with controversial results at least as reported to date (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11). GnRH analogs (GnRHa) alone have been used in the same condition at pubertal age to induce a delay in epiphyseal fusion and consequent prolongation of the duration of linear growth with still controversial results (12, 13, 14, 15).

We evaluated the effect of combined therapy with GH and GnRHa in 12 girls with idiopathic short stature and normal or early puberty, comparing them with a group treated with GH alone. Adult heights are available for all of the girls in each treatment group.


   Subjects and Methods
Top
 Abstract
 Introduction
 Subjects and Methods
Results
 Discussion
 References
 
Twelve girls (group 1) with chronological age (CA; mean ± SD) of 10.2 ± 0.9 and bone age (BA) of 10.6 ± 1.9 yr, height SD score for BA of -1.81 ± 0.8, predicted adult height (PAH) of 146.3 ± 5.0 cm, and target height (TH) of 152.7 ± 3.6 cm were enrolled for combined treatment (GH and GnRHa) on the basis of the low PAH (lower than the TH). Auxological data at start of GnRHa plus GH therapy are shown in Table 1Go.


View this table:
[in this window]
[in a new window]
  		Table 1. Auxological data of 12 short normal patients treated with GnRHa plus GH

 
Twelve girls (group 2) with comparable auxological and laboratory criteria were treated with GH alone at the same dose (CA, 10.7 ± 1.0; BA, 10.1 ± 1.4 yr; height SD score for BA, -1.65 ± 0.8; PAHm 145.6 ± 4.4 cm; TH, 155.8 ± 4.6 cm). Their auxological data at the start of treatment are shown in Table 2Go.


View this table:
[in this window]
[in a new window]
  		Table 2. Auxological data of 12 short normal patients treated with GH alone

 
In all of the girls in both groups, genetic, skeletal, systemic, and thyroid diseases were excluded. GH secretion was normal, with a GH peak above 10 g/L at two stimulation tests (clonidine, arginine, or insulin), as were insulin-like growth factor I levels and biochemical and hematological parameters. A LHRH test was performed in all patients to assess the beginning of puberty. GH was given at a dose of 0.3 mg/kg·week, sc, 6 day/week, in all of the patients in both groups. Depot-triptorelin was given at a dose of 100 µg/kg every 21 days, im, in the girls treated with combined therapy.

The study was approved by the ethical committee of our institution; written consent was obtained from parents. Both groups of patients were evaluated at start of treatment and every 6 months either during the course of treatment or after the withdrawal. At each evaluation, height was measured three times with a Harpenden stadiometer. BA was determined according to the method of Greulich and Pyle (16) by the same observer, who was unaware of the treatment condition along the whole study, and adult height was predicted according to the Bayley and Pinneau method (17). Pubertal stage was evaluated using the method of Tanner and ranged between B2P2 and B3P3 in all of the girls (18).

Pelvic ultrasound was performed at the beginning of the study in both groups to verify initial puberty and during therapy with GnRHa to verify the suppression of gonadotropin activity. Midparental TH was calculated from the mean height of the parents adjusted for sex, as described by Tanner et al. (19).

Every 6 months in both groups metabolic and hematochemical analyses were assessed; a LHRH test was performed in both groups at the beginning of treatment to confirm the initial puberty and in the GH- and GnRHa-treated group every 6 months to verify the suppression of gonadotropins. An oral glucose tolerance test was performed in all the girls once a year.

The duration of treatment was (mean ± SD) was 4.6 ± 1.7 yr in group 1 (GnRHa plus GH) and 4.9 ± 1.4 in group 2 (GH alone), CA at the discontinuation of treatment was 14.8 ± 1.6 and BA was 13.8 ± 0.8 in group 1, and CA was 15.0 ± 1.2 and BA was 14.4 ± 1.0 in group 2. Discontinuation of treatment was decided according to classical criteria (i.e. growth velocity <2 cm/yr and BA >=14 yr), although several girls either growing less than 2 cm/yr or satisfied with their height discontinued therapy some months before 14 yr of BA. GnRHa was discontinued at the same time as GH in group 1. Adult height was considered to be attained when growth velocity during the last year was less than 1 cm and BA was over 15 yr or more; in two girls in group 1 no growth was observed in the last year at a BA of less than 15 yr.

Hormone assay

Plasma LH and FSH were measured in duplicate by immmunoradiometric assay (Maiaclone, Serono Biodata, Milan, Italy). Estradiol was measured by RIA (Diagnostic Products, Los Angeles, CA; Bio-Rad Laboratories, Inc., Hercules, CA). GH was measured in duplicate by polyclonal RIA (Sorin Biomedica, Vercelli, Italy). Insulin was measured in duplicate by RIA (Diagnostic Products).

Statistical analysis

Data are expressed as the mean ± SD unless otherwise stated. Statistical analysis was performed using paired and unpaired Student’s t test. P < 0.05 was considered significant.


   Results
Top
 Abstract
 Introduction
 Subjects and Methods
 Results
Discussion
 References
 
The group treated with combination treatment (GnRHa and GH; group 1) showed an increment in height SD score for BA from -1.81 ± 0.8 to -0.85 ± 1.0 (P < 0.001; {Delta}SD score for BA, +0.96 ± 0.73); the mean PAH at the start of treatment was 146.3 ± 5 cm and reached a mean of 156.8 ± 5.7 cm at discontinuation of treatment (P < 0.001). Adult height, reached during the following year or more, was 156.3 ± 5.9 cm (SD score for BA, -0.91 ± 1.0); TH was 152.7 ± 3.6 cm. The gain in centimeters calculated as the difference between pretreatment PAH and final adult height was 10.0 ± 2.9. Pretreatment height in SD score for BA increased significantly from -1.81 ± 0.8 to -0.91 ± 1.0 (P < 0.001; {Delta}SD score for BA, +0.90 ± 0.7). GnRHa treatment decelerated bone age and arrested sexual development; pelvic ultrasound showed reduced ovarian and uterine volumes. After withdrawal of therapy, ovarian and uterine volume increased regularly in 12 months. No ovarian cysts were observed (20). No negative metabolic side-effects were observed, especially regarding the oral glucose tolerance test and lipid metabolism. LH and FSH were suppressed during treatment and resumed completely after discontinuation, followed by regular menses in all of the girls after 6–15 months.

In girls treated with GH alone (group 2), the height SD score for BA changed from -1.65 ± 0.8 to -1.46 ± 0.4 (P = NS; {Delta}SD score for BA, +0.19 ± 0.7) at discontinuation of treatment. PAH at the beginning of treatment was 145.6 ± 4.4 cm and increased to 153.5 ± 2.1 cm at the discontinuation of therapy (P < 0.001). Adult height was 151.7 ± 2.7 cm, with a gain vs. pretreatment PAH of 6.08 ± 4.4 cm. TH was 155.8 ± 4.6 cm. Pretreatment height in SD score for BA did not significantly change from -1.65 ± 0.8 to -1.72 ± 0.45 ({Delta}SD score for BA, -0.26 ± 0.3). No negative metabolic side-effects were observed. The girls treated with GH alone showed a normal pattern of puberty and no ovarian cysts.


   Discussion
Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
References
 
Combined treatment with GnRHa and GH has been proposed and performed to improve adult height in true precocious puberty by several researchers (21, 22, 23, 24, 25); recently, we reported data on adult height in our trial (26). GH-deficient adolescents have also been treated with GH combined with GnRHa to increase final height (27, 28). For idiopathic short stature with normal or simply early puberty, combined treatment of GnRHa and GH has been performed, leading to conflicting results for adult height (29, 30, 31, 32, 33).

A loss of gain in adult height in 10 girls treated for 2–3 yr with GH and GnRHa has been reported (31). Adult height was reached 3 yr after the discontinuation of therapy; the researchers themselves state that their results could have been negatively influenced by the low dose of GH (0.6 IU/kg·weekly) and the discontinuation before completion of growth. On the other hand, a significant improvement in adult height has been reported in 14 girls treated with GnRHa combined with GH and with GH alone for 2 yr more after discontinuation of GnRHa (32).

In another study, 10 subjects (7 females and 3 males) were treated for 30 months with combined therapy (leuprolide acetate, 300 µg/kg every 28 days; GH, 0.6 IU/kg weekly) (33). Although PAH in the first year of therapy showed a significant improvement, adult height remained significantly lower than TH. The low dose of GH, the short period of therapy, and the evaluation of results, calculated by using mean value PAH for males and females limits in some ways the usefulness of this study. Our study was performed in both groups using the same criteria, such as GH dose (0.3 mg/kg·week), auxological characteristics of the girls, and time of discontinuation of treatment.

In group 1, GnRHa was given at a suppressive dose (at least 100 µg/kg in 21 days, im). Furthermore, we were very careful in adjusting the dose according to weight either for GH in both groups or for GnRHa in group 1, and we treated girls for longer period than in other studies (31, 33).

Girls treated with combined therapy obtained a mean gain in adult height of 10.0 ± 2.9 cm compared with pretreatment PAH (156.3 ± 5.9 vs. 146.3 ± 5 cm) and similar to PAH at the discontinuation of therapy (156.3 vs. 156.8 cm). In this group the variability of the response (range, 5.7–15 cm) was less striking than that in group 2; 7 of 12 subjects had a gain over 10 cm. TH was significantly exceeded (156.3 ± 5.9 vs. 152.7 ± 3.6 cm; P < 0.05 Table 3Go). If we consider height in SD score for BA at the beginning of treatment and at final adult height, the increment is about 0.9 SD score for BA.


View this table:
[in this window]
[in a new window]
  		Table 3. Predicted adult height, final height, and TH of 12 short normal patients treated with GnRHa plus GH

 
Girls treated with GH alone obtained a mean gain in adult height vs. pretreatment PAH (151.7 ± 2.7 vs. 145.6 ± 4.4 cm) of 6.1 ± 4.4 cm, with a great variability (range, 0.1–14.1 cm). Five of 12 patients did not gain more than 4 cm, comparing adult height with pretreatment PAH. TH was not exceed by adult height (155.8 ± 4.6 vs. 151.7 ± 2.7 cm; P < 0.05; Table 4Go). If we consider height SD score for BA at the beginning of treatment and at adult height, no significant change was obtained. All girls had good compliance, and most of them were satisfied ith the results.


View this table:
[in this window]
[in a new window]
  		Table 4. Predicted adult height, final height, and TH of 12 short normal subjects treated with GH

 
In conclusion, our experience shows that the addition of GnRHa to GH improves adult height significantly compared with PAH in girls with idiopathic short stature and normal or early puberty. The advantage obtained with the combination is more significant and may be due to the deceleration of both BA and progression of puberty compared with those obtained in the GH alone group as to the amount of gain in adult height (10 vs. 6 cm). The benefit of treatment remains significant but less striking in group 1 (GH plus GnRHa) and not significant in the GH alone group, if we compare heights in SD score for BA as reported previously (31, 33). However, if we consider their economical and ethical costs, these therapies should be limited to very short subjects who have a very low PAH well below the third percentile and parental TH, in whom even a gain of 6 cm could be considered worthwhile. As the cost-benefit of such invasive treatment must be seriously considered, further studies are needed.

Received June 16, 1999.

Revised October 8, 1999.

Accepted October 22, 1999.


   References
Top
 Abstract
 Introduction
 Subjects and Methods
 Results
 Discussion
 References
 

  1. Bierich JR, Nolte K, Drews K, Brugmann G. 1992 Constitutional delay of growth and adolescence. Results of short-term and long-term treatment with GH. Acta Endocrinol (Copenh). 127:392–396.[Abstract/Free Full Text]
  2. Albertsson-Wikland K on behalf of the International Board of the Kabi Pharmacia International Growth Study. 1993 Characteristics of children with idiopathic short stature in the Kabi Pharmacia International Growth Study and their response to growth hormone treatment. Acta Paediatr. 391(Suppl):75–78.
  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 Pediatr. 125:196–200.[CrossRef][Medline]
  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 growth rate and normal growth hormone response to secretagogues. Clin Endocrinol (Oxf). 42:365–372.[Medline]
  5. Hindmarsh PC, Brook CGD. 1996 Final height of short normal children treated with growth hormone. Lancet. 348:13–16.[CrossRef][Medline]
  6. Rakers-Mombarg LTM, Massa GG, Wit JM. 1996 Final height of short normal children treated with growth hormone. Lancet. 348:681.
  7. Bernasconi S, Street ME, Volta C, Mazzardo G, Italian Multicentre Study Group. 1997 Final height in non-growth hormone deficient children treated with growth hormone. Clin Endocrinol (Oxf). 47:261–266.[CrossRef][Medline]
  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 treated with growth hormone. Eur J Pediatr. 156:680–683.[CrossRef][Medline]
  9. Buclis JC, Irizarry L, Crotzer BC, Shine BJ, Allen L, MacGillivray MH. 1998 Comparison of final heights of growth hormone-treated vs. untreated children with idiopathic growth failure. J Clin Endocrinol Metab. 83:1075–1079.[Abstract/Free Full Text]
  10. McCaughey ES, Mulligan J, Voss LD, Betts PR. 1998 Randomised trial of growth hormone in short normal girls. Lancet. 351:940–944.[Medline]
  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 with idiopathic short stature. N Engl J Med. 340:502–507.[Abstract/Free Full Text]
  12. Lindner D, Job JC, Chaussain JL. 1993 Failure to improve height prediction in short-stature pubertal adolescents by inhibiting puberty with luteinizing hormone-releasing hormone analogue. Eur J Pediatr. 152:393–396.[CrossRef][Medline]
  13. Municchi G, Rose SR, Pescovitz OH, Barnes KM, Cassorla FG, Cutler GB. 1993 Effect of deslorelin-induced pubertal delay on the growth of adolescents with short stature and normally timed puberty: preliminary results. J Clin Endocrinol Metab. 77:1334–1339.[Abstract]
  14. Carel JC, Hay F, Coutant R, Rodrigue D, Chaussain JL. 1996 Gonadotropin-releasing hormone agonist treatment of girls with constitutional short stature and normal pubertal development. J Clin Endocrinol Metab. 81:3318–3322.[Abstract]
  15. Cutler GB, Yanovski JA, Rose SR, et al. 1997 Luteinizing hormone-releasing hormone agonist (LHRHa)-induced delay of epiphyseal fusion increases adult height of adolescents with short stature. Horm Res. 48(Suppl 2):28.
  16. Greulich WW, Pyle SI. 1959 Radiographic atlas of skeletal development of the hand and wrist, 2nd Ed. Stanford: Stanford University Press.
  17. Bayley N, Pinneau SR. 1952 Tables for predicting adult height from skeletal age: revised for use with the Greulich and Pyle hand standards. J Pediatr. 40:423–441.[CrossRef][Medline]
  18. Marshall WA, Tanner JM. 1969 Variations in pattern of pubertal changes in girls. Arch Dis Child. 44:291–303.
  19. Tanner JM, Goldstein H, Whitehouse RH. 1970 Standards for children’s height at ages 2–9 allowing for height of parents. Arch Dis Child. 45:755–762.
  20. Bridges NA, Cooke A, Healy MJR, Hindmarsh PC, Brook CGD. 1995 Ovaries in sexual precocity. Clin Endocrinol (Oxf). 42:135–140.[Medline]
  21. Oostdijik W, Drop SLS, Odink RJH, Hummelink R, Partsch CJ, Sipell WG. 1991 Long-term results with a slow-release gonadotrophin-release hormone agonist in central precocious puberty. Acta Paediatr Scand. 372(Suppl):39–45.
  22. Di Martino-Nardi J, Wu R, Fishman K, Saenger P. 1991 The effect of long-acting analog of luteinizing hormone-releasing hormone on growth hormone secretory dynamics in children with precocious puberty. J Clin Endocrinol Metab. 73:902–906.[Abstract/Free Full Text]
  23. Saggese G, Pasquino AM, Bertelloni S et al. 1995 Effect of combined treatment with gonadotropin releasing hormone analogue and growth hormone in patients with central precocious puberty who had subnormal growth velocity and impaired height prognosis. Acta Paediatr. 84:299–304.[Medline]
  24. Tatò L, Saggese G, Cavallo L et al. 1995 Use of combined Gn-RH agonist and hGH therapy for better attaining the goals in precocious puberty treatment. Horm Res. 44(Suppl 3):49–54.
  25. Pasquino AM, Municchi G, Pucarelli I et al. 1996 Combined treatment with gonadotropin-releasing hormone analog and growth hormone in central precocious puberty. J Clin Endocrinol Metab. 81:948–951.[Abstract]
  26. Pasquino AM, Pucarelli I, Segni M, Matrunola M, Cerrone F. 1999 Adult height in girls with central precocious puberty treated with gonadotropin-releasing hormone analogues and growth hormone. J Clin Endocrinol Metab. 84:449–452.[Abstract/Free Full Text]
  27. Adan L, Souberbielle JC, Zucker JM, Pierre-Kahn A, Kalifa C, Brauner R. 1997 Adult height in 24 patients treated for growth hormone deficiency and early puberty. J Clin Endocrinol Metab. 82:229–233.[Abstract/Free Full Text]
  28. Tanaka T, Satoh M, Yasunaga T, et al. 1999 When and how to combine growth hormone with a luteinizing hormone-releasing hormone analogue, Acta Paediatr. 428(Suppl):85–88.
  29. Job JC, Toublanc JE, Landier F. 1994 Growth of short normal children in puberty treated for 3 years with growth hormone alone or in association with gonadotropin-releasing hormone agonist. Horm Res. 41:177–184.[Medline]
  30. Saggese G, Cesaretti G, Barsanti S, Rossi A. 1995 Combination treatment with growth hormone and gonadotropin-releasing hormone analogs in short normal girls. J Pediatr. 126:468–473.[CrossRef][Medline]
  31. Balducci R, Toscano V, Mangiantini A et al. 1995 Adult height in short normal adolescent girls treated with gonadotropin-releasing hormone analog and growth hormone. J Clin Endocrinol Metab. 80:3596–3600.[Abstract]
  32. Barsanti S. Federico G, Saggese G. 1997 Final height in short-normal girls treated with growth hormone plus GnRH-analogs. Further data on new cases and comparison with an untreated control group. Horm Res. 48 (Suppl 2):5.
  33. Lanes R, Gunczler P. 1998 Final height after combined growth hormone and gonadotrophin-releasing hormone analogue therapy in short healthy children entering into normally timed puberty. Clin Endocrinol (Oxf). 49:197–202.[CrossRef][Medline]



This article has been cited by other articles:


Home page
 PediatricsHome page
J.-C. Carel, E. A. Eugster, A. Rogol, L. Ghizzoni, M. R. Palmert, and on behalf of the members of the ESPE-LWPES GnRH An
Consensus Statement on the Use of Gonadotropin-Releasing Hormone Analogs in Children
Pediatrics, April 1, 2009; 123(4): e752 - e762.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
D. I. Shulman, G. L. Francis, M. R. Palmert, E. A. Eugster, and for the Lawson Wilkins Pediatric Endocrine Society
Use of Aromatase Inhibitors in Children and Adolescents With Disorders of Growth and Adolescent Development
Pediatrics, April 1, 2008; 121(4): e975 - e983.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
N. Mauras, L. Gonzalez de Pijem, H. Y. Hsiang, P. Desrosiers, R. Rapaport, I. D. Schwartz, K. O. Klein, R. J. Singh, A. Miyamoto, and K. Bishop
Anastrozole Increases Predicted Adult Height of Short Adolescent Males Treated with Growth Hormone: A Randomized, Placebo-Controlled, Multicenter Trial for One to Three Years
J. Clin. Endocrinol. Metab., March 1, 2008; 93(3): 823 - 831.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
S. A. van Gool, G. A. Kamp, H. Visser-van Balen, D. Mul, J. J. J. Waelkens, M. Jansen, L. Verhoeven-Wind, H. A. Delemarre-van de Waal, S. M. P. F. de Muinck Keizer-Schrama, G. Leusink, et al.
Final Height Outcome after Three Years of Growth Hormone and Gonadotropin-Releasing Hormone Agonist Treatment in Short Adolescents with Relatively Early Puberty
J. Clin. Endocrinol. Metab., April 1, 2007; 92(4): 1402 - 1408.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
J.-C. Carel, P. Chatelain, P. Rochiccioli, and J.-L. Chaussain
Improvement in Adult Height after Growth Hormone Treatment in Adolescents with Short Stature Born Small for Gestational Age: Results of a Randomized Controlled Study
J. Clin. Endocrinol. Metab., April 1, 2003; 88(4): 1587 - 1593.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
J. A. Yanovski, S. R. Rose, G. Municchi, O. H. Pescovitz, S. C. Hill, F. G. Cassorla, and G. B. Cutler Jr.
Treatment with a Luteinizing Hormone-Releasing Hormone Agonist in Adolescents with Short Stature
N. Engl. J. Med., March 6, 2003; 348(10): 908 - 917.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
M. Maniati-Christidi, S. Livadas, A. Voutetakis, G. Tolis, and C. Dacou-Voutetakis
Human Growth Hormone and Gonadotropin Releasing Hormone Analog Combination Therapy Increases Predicted Height in Short Normal Girls
Clinical Pediatrics, January 1, 2003; 42(1): 59 - 65.
[Abstract] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
B. S. Finkelstein, T. F. Imperiale, T. Speroff, U. Marrero, D. J. Radcliffe, and L. Cuttler
Effect of Growth Hormone Therapy on Height in Children With Idiopathic Short Stature: A Meta-analysis
Arch Pediatr Adolesc Med, March 1, 2002; 156(3): 230 - 240.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
D. Mul, J .M. Wit, W. Oostdijk, and J. Van den Broeck
The Effect of Pubertal Delay by GnRH Agonist in GH-Deficient Children on Final Height
J. Clin. Endocrinol. Metab., October 1, 2001; 86(10): 4655 - 4656.
[Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
P. B. Kaplowitz
If Gonadotropin-Releasing Hormone Plus Growth Hormone (GH) Really Improves Growth Outcomes in Short Non-GH-Deficient Children, Then What?
J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 2965 - 2968.
[Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
G. A. Kamp, D. Mul, J. J. J. Waelkens, M. Jansen, H. A. Delemarre-van de Waal, L. Verhoeven-Wind, M. Frolich, W. Oostdijk, and J. M. Wit
A Randomized Controlled Trial of Three Years Growth Hormone and Gonadotropin-Releasing Hormone Agonist Treatment in Children with Idiopathic Short Stature and Intrauterine Growth Retardation
J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 2969 - 2975.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
R. Lanes and P. Gunczler
Final Adult Height in Short Healthy Children Treated with Growth Hormone and Gonadotropin-Releasing Hormone Analogs
J. Clin. Endocrinol. Metab., January 1, 2001; 86(1): 458 - 458.
[Full Text]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pasquino, A. M.
Right arrow Articles by Segni, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pasquino, A. M.
Right arrow Articles by Segni, M.
Right arrowPubmed/NCBI databases
*Compound via MeSH
*Substance via MeSH
Medline Plus Health Information
*Growth Disorders

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Endocrinology Endocrine Reviews J. Clin. End. & Metab.
Molecular Endocrinology Recent Prog. Horm. Res. All Endocrine Journals