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He M, Zhang Y, Zhao Q, He D, Li Y, Zhang M, Ban B. Letrozole combined with rhGH treatment increases the adult height of short pubertal boys. J Pediatr Endocrinol Metab 2024; 37:74-79. [PMID: 38018388 DOI: 10.1515/jpem-2023-0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES This study was performed to investigate the effectiveness of the combination of letrozole and recombinant human growth hormone (rhGH) to improve the predicted adult height (PAH) and final adult height (FAH) of Chinese short pubertal boys. METHODS In total, 171 Chinese short pubertal boys were recruited for this study. 96 of them received letrozole (2.5 mg/d) combined with rhGH (33.3-66.6 μg/kg.d), and the others received rhGH alone. Follow-up visits were conducted at 1, 3, 6, 9, and 12 months or regularly after the first treatment. During each visit, plasma samples were collected for clinical tests and biomedical analyses, all of which were performed according to standard protocols. This study was registered at www.chictr.org.cn under ID number ChiCTR1900026142. RESULTS After receiving treatment for at least 3 months, 68 boys (91 %) in the rhGH therapy group and 90 (94 %) in the letrozole combined with rhGH (letrozole+rhGH) therapy group achieved an increase in PAH, with the latter treatment leading to a more effective slowing of bone age (BA) advancement. Moreover, the increased PAH showed a significant positive correlation with treatment time in both groups, and letrozole+rhGH increased the PAH to a greater degree than rhGH alone (p=0.0023). And letrozole+rhGH not only slowed the increase in BA more efficiently than rhGH therapy alone (p=0.0025), but also achieved a higher FAH (p=0.0078). CONCLUSIONS Letrozole combined with rhGH treatment is a promising therapy to increase the PAH and FAH of Chinese short pubertal boys.
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Affiliation(s)
- Mingming He
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Yanhong Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Qianqian Zhao
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Dongye He
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Yanying Li
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Mei Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
| | - Bo Ban
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, P.R. China
- Chinese Research Center for Behavior Medicine in Growth and Development, Jining, Shandong, P.R. China
- National Human Genetic Resources Sharing Service Platform, Jining, Shandong, P.R. China
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Saroufim R, Eugster EA. Non-GH Agents and Novel Therapeutics in the Management of Short Stature. Indian J Pediatr 2021; 88:1209-1213. [PMID: 34196930 DOI: 10.1007/s12098-021-03824-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
Short stature is one of the most common reasons for referral to pediatric endocrinologists. The vast majority of short children do not have growth hormone (GH) deficiency or another pathologic process that is interfering with normal growth. While GH has been approved in the US for several etiologies of non-GH deficient short stature, its high cost and need for daily injections represent barriers for many families. Alternative agents for the management of short stature include the use of gonadotropin releasing hormone analogs (GnRHas) to delay puberty, and aromatase inhibitors (AIs) in boys to postpone epiphyseal fusion. The results of studies employing GnRHas as either monotherapy or combined with GH are mixed, and there is a dearth of rigorously designed clinical trials that have followed patients to adult height. While AIs have been found to result in modest increases in adult height in some studies, important questions about their long-term safety exist. The C-type natriuretic peptide analog vosoritide is an experimental agent that is emerging as a potential treatment for a few specific conditions including achondroplasia, although its efficacy in attenuating disproportionality is as yet unproven. While each of these therapeutic strategies holds promise, none are currently considered standard of care and several important questions remain. These include the impact of these interventions on quality of life as well as long-term outcomes.
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Affiliation(s)
- Rita Saroufim
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Erica A Eugster
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN, USA
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