ADULT HEIGHT IN CHILDREN WITH GROWTH-HORMONE DEFICIENCY WHO ARE TREATED WITH BIOSYNTHETIC GROWTH-HORMONE - THE NATIONAL COOPERATIVE GROWTH STUDY EXPERIENCE

Objective. To determine whether the height gain during puberty in chil dren with growth hormone deficiency (GHD) who are treated with biosynt hetic growth hormone (GH) is similar to that in otherwise healthy chil dren with delayed bone ages and whether the height standard deviation score (SDS), which began to increase before puberty, continues to incr ease during puberty. Methods. The inclusion criteria included a diagno sis of idiopathic GHD, prepubertal on enrollment in the National Coope rative Growth Study, and spontaneous onset of puberty, as defined by T anner stage 2 breast development in girls and a testicular volume of a t least 3 mt in boys. Near-adult height was judged to have been attain ed in the subjects who had reached a chronologic age of at least 18 ye ars (females) or 20 years (males) or had reached at least pubertal sta ge 4 and a chronologic age of at least 14 years (females) or 16 years (males). These subjects constituted group 1. Group 2 was a subgroup of these subjects who met a more stringent criterion for near-adult heig ht; in addition to meeting the above criteria, they had to have attain ed a bone age of at least 14 years (females) or 16 years (males). Resu lts. Group 1 consisted of 480 males and 194 females. Group 2 consisted of 153 males and 105 females. In the subjects in group 1, the Tanner pubertal stage 2 was 14.1 +/- 1.5 years in males and 12.6 +/- 1.6 year s in females; the bone age at this stage was 11.9 +/- 1.5 years in mal es and 10.6 +/- 1.5 years in females; and the height SDS was -2.1 +/- 0.9 in males and -2.4 +/- 0.9 in females. The total height gained duri ng puberty was 22.4 +/- 7.9 cm in males and 17.4 +/- 6.3 cm in females ; the percentage of adult height gained during puberty was 13.3% +/- 4 .6% in males and 11.3% +/- 4.0% in females; the near-adult height SDS was -1.3 +/- 1.0 in males and -1.6 +/- 0.9 in females; and the target adult height SDS was -0.4 +/- 0.8 in males and -0.5 +/- 0.7 in females . The growth characteristics in the subjects in group 2 were of simila r magnitude. In both groups, there was a significant negative correlat ion between age at the onset of Tanner stage 2 and both the total heig ht gained during puberty and the percentage of adult height gained. Co nclusions. The growth characteristics of these subjects were similar t o those reported in normal children and in previous reports of the pub ertal growth in smaller populations of children with GHD. The height S DS increased in these subjects during puberty, but the target adult he ight SDS was not attained. This is a strong argument for early diagnos is and treatment in children with GHD to optimize prepubertal growth.