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Likki SR, Allen HF, Knee A, Tonyushkina KN. Use of letrozole to augment height outcome in pubertal boys: a retrospective chart review. J Pediatr Endocrinol Metab 2022; 35:1232-1239. [PMID: 36169241 DOI: 10.1515/jpem-2022-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We describe growth patterns and predicted adult height (PAH) in pubertal boys treated with letrozole and evaluate the potential predictors of growth responses. METHODS We performed a retrospective analysis of data from 2002 to 2020. All subjects were treated for ≥6 months and had at least 3 height measurements to calculate the growth velocity (GV) before and during treatment. We evaluated growth measurements, bone age, and biochemical parameters before, during and after treatment. RESULTS A total of 59 subjects aged 12.7 (± 1.7) years old were included. At treatment initiation, bone age was 13.1 (± 1.5) years and predicted adult height (PAH) was 163.8 (± 9.9) cm compared to mid-parental height of 172.4 (± 5.8) cm. Growth velocity decreased during letrozole therapy and rebounded after completion. Sub-analysis of 26 subjects with bone age data available at baseline and at least 1 year later showed a trend to modest increase in PAH. In boys simultaneously receiving growth hormone (rhGH), the change in PAH was significantly more (3.2 cm, p<0.05) compared to those treated with letrozole alone. CONCLUSIONS We show that letrozole appropriately slows down skeletal maturation and GV responses are variable. Possible negative predictors include lower baseline GV and advanced bone age. A small positive trend in PAH with letrozole therapy is augmented by simultaneous use of rhGH. Future randomized controlled trials are needed to better understand which group of patients will benefit from treatment.
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Affiliation(s)
- Snigdha R Likki
- Division of Pediatric Endocrinology and Diabetes, Baystate Children's Hospital, Springfield, MA, USA
| | - Holley F Allen
- Division of Pediatric Endocrinology and Diabetes, Baystate Children's Hospital, Springfield, MA, USA
| | - Alexander Knee
- Epidemiology/Biostatistics Research Core, Office of Research, Baystate Medical Center, Springfield, MA, USA
| | - Ksenia N Tonyushkina
- Division of Pediatric Endocrinology and Diabetes, Baystate Children's Hospital, Springfield, MA, USA
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Varimo T, Miettinen PJ, Vaaralahti K, Toppari J, Huopio H, Voutilainen R, Tenhola S, Hero M, Raivio T. Circulating Liver-Enriched Antimicrobial Peptide-2 Decreases during Male Puberty. J Endocr Soc 2022; 6:bvac013. [PMID: 35187383 PMCID: PMC8852683 DOI: 10.1210/jendso/bvac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective
Circulating levels of liver-enriched antimicrobial peptide 2 (LEAP2), a ghrelin receptor antagonist, decrease under caloric restriction and increase in obesity. The role of LEAP2 in male puberty, a phase with accelerated energy demand, is unclear.
Methods
We determined circulating LEAP2 levels in 28 boys with constitutional delay of growth and puberty (CDGP) who participated in a randomized controlled trial (NCT01797718), and were treated with letrozole (n=15) or intramuscular low-dose testosterone (T) (n=13) for 6 months. Blood sampling and dual-energy x-ray absorptiometry-measured body composition were performed at 0, 6, and 12 month visits.
Results
Serum LEAP2 levels decreased significantly during pubertal progression (0-6 mo: mean decrease -4.3 [10.3] ng/ml, p=0.036 and 0-12mo: -3.9 [9.3] ng/ml, p=0.033). Between 0 and 6 months, the changes in serum LEAP2 levels correlated positively with changes in percentage of body fat (rs=0.48, p=0.011), and negatively with growth velocity, and estradiol levels (rs=-0.43, p=0.022, rs=-0.55, p=0.003, respectively). In the T group only, the changes in serum LEAP2 correlated negatively with changes in testosterone and estradiol levels. Between 0 and 12 months, the change in LEAP2 levels correlated negatively with the change in HDL levels (rs= -0.44, p=0.022) and positively with the change in insulin (rs=0.50, p=0.009), and HOMA-IR (rs=0.51, p=0.007) levels.
Conclusions
Circulating LEAP2 levels decreased after induction of puberty reciprocally with increased growth rate and energy demand reflecting the metabolic state of the adolescent. Further, the results suggest that estradiol levels may have a permissive role in downregulating circulating LEAP2 levels.
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Affiliation(s)
- Tero Varimo
- New Children’s Hospital, Helsinki University Hospital, Pediatric Research Center, Helsinki, Finland
| | - Päivi J Miettinen
- New Children’s Hospital, Helsinki University Hospital, Pediatric Research Center, Helsinki, Finland
| | - Kirsi Vaaralahti
- Stem Cells and Metabolism Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Physiology, Faculty of Medicine, University of Helsinki
| | - Jorma Toppari
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Centre for Population Health Research, University of Turku, Turku, Finland
| | - Hanna Huopio
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Raimo Voutilainen
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | | | - Matti Hero
- New Children’s Hospital, Helsinki University Hospital, Pediatric Research Center, Helsinki, Finland
| | - Taneli Raivio
- New Children’s Hospital, Helsinki University Hospital, Pediatric Research Center, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Physiology, Faculty of Medicine, University of Helsinki
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Wit JM. Should Skeletal Maturation Be Manipulated for Extra Height Gain? Front Endocrinol (Lausanne) 2021; 12:812196. [PMID: 34975773 PMCID: PMC8716689 DOI: 10.3389/fendo.2021.812196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/23/2021] [Indexed: 01/18/2023] Open
Abstract
Skeletal maturation can be delayed by reducing the exposure to estrogens, either by halting pubertal development through administering a GnRH analogue (GnRHa), or by blocking the conversion of androgens to estrogens through an aromatase inhibitor (AI). These agents have been investigated in children with growth disorders (off-label), either alone or in combination with recombinant human growth hormone (rhGH). GnRHa is effective in attaining a normal adult height (AH) in the treatment of children with central precocious puberty, but its effect in short children with normal timing of puberty is equivocal. If rhGH-treated children with growth hormone deficiency or those who were born small-for-gestational age are still short at pubertal onset, co-treatment with a GnRHa for 2-3 years increases AH. A similar effect was seen by adding rhGH to GnRHa treatment of children with central precocious puberty with a poor AH prediction and by adding rhGH plus GnRHa to children with congenital adrenal hyperplasia with a poor predicted adult height on conventional treatment with gluco- and mineralocorticoids. In girls with idiopathic short stature and relatively early puberty, rhGH plus GnRHa increases AH. Administration of letrozole to boys with constitutional delay of growth puberty may increase AH, and rhGH plus anastrozole may increase AH in boys with growth hormone deficiency or idiopathic short stature, but the lack of data on attained AH and potential selective loss-of-follow-up in several studies precludes firm conclusions. GnRHas appear to have a good overall safety profile, while for aromatase inhibitors conflicting data have been reported.
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