ADULT HEIGHT IN SHORT NORMAL ADOLESCENT GIRLS TREATED WITH GONADOTROPIN-RELEASING-HORMONE ANALOG AND GROWTH-HORMONE

GnRH analog associated with GH therapy has potential importance for tr eatment of short stature in subjects without GH deficiency and with a normal onset of puberty. We treated 10 girls with familial short statu re with the GnRH analog leuprolide (3.75 mg, im, every 25 days) and GH (0.1 IU/kg . day, sc, 6 days/week). The combined therapies were start ed simultaneously, and the patients were treated for 28.1 +/- 5.4 (ran ge, 24-36) months. At the onset of treatment, chronological age was 11 .6 +/- 1.4 yr, bone age was 10.6 +/- 0.9 yr, height was -2.7 +/- 0.7 S D, predicted height (PH; Bayley-Pinneau score) was 143.2 +/- 3 cm. Tar get height was 147.6 +/- 5.6 cm. Tanner stage was II-III for breast an d genitalia. During treatment, puberty was completely suppressed in al l patients. Statistical analysis was performed using Student's t test for paired data. After 12 months of treatment, we observed a significa nt (P < 0.02) improvement of predicted height (146.2 +/- 3.4 cm). This improvement remained significant (147.6 +/- 3.5; P < 0.001) when trea tment was withdrawn. At that time, chronological age was 13.9 +/- 1.2 yr, and bone age was 12.4 +/- 0.7 yr. At the present time (3 +/- 0.97 yr after discontinuation), all of the girls have reached a final heigh t of 144.6 +/- 3 cm (range, 140-149.3 cm). The final height is not sig nificantly different compared with the PH at the beginning of treatmen t or with target height. These data show that in our patients, combine d treatment with GnRH analog-and GH, despite a significant improvement in PH during therapy and upon its withdrawal, does not result in a si gnificant increase in adult stature. Larger and perhaps more prolonged studies in patients of both sexes are required to reach definitive co nclusions. Nevertheless, the cost of this treatment in terms of both s ubject compliance and economic cost should be weighed against the smal l height gain, if any, that may be achieved.