Progressive Decline in Height Standard Deviation Scores in the First 5 Years of Life Distinguished Idiopathic Growth Hormone Deficiency from Familial Short Stature and Constitutional Delay of Growth

Differential diagnosis between constitutional delay of growth and puberty, idiopathic growth hormone deficiency and congenital hypogonadotropic hypogonadism: a clinical challenge for the pediatric endocrinologist

INTRODUCTION

Differential diagnosis between constitutional delay of growth and puberty (CDGP), partial growth hormone deficiency (pGHD) and congenital hypogonadotropic hypogonadism (cHH) may be difficult. All these conditions usually present with poor growth in pre- or peri-pubertal age and they may recur within one familial setting, constituting a highly variable, but somehow common, spectrum of pubertal delay.

EVIDENCE ACQUISITION

Narrative review of the most relevant English papers published between 1981 and march 2020 using the following search terms "constitutional delay of growth and puberty," "central hypogonadism," "priming," "growth hormone deficiency," "pituitary," "pituitary magnetic resonance imaging," with a special regard to the latest scientific acquisitions.

EVIDENCE SYNTHESIS

CDGP is by far the most prevalent entity in boys and recurs within families. pGHD is a rare, often idiopathic and transient condition, where hypostaturism presents more severely. Specificity of pGHD diagnosis is increased by priming children before growth hormone stimulation test (GHST); pituitary MRI and genetic analysis are recommended to personalize future follow-up. Diagnosing cHH may be obvious when anosmia and eunuchoid proportions concomitate. However, cHH can either overlap with pGHD in forms of multiple pituitary hormone deficiencies (MPHD) or syndromic conditions either with CDGP in family pedigrees, so endocrine workup and genetic investigations are necessary. The use of growth charts, bone age, predictors of adult height, primed GHST and low dose sex steroids (LDSS) treatment are recommended.

CONCLUSIONS

Only a step-by-step diagnostic process based on appropriate endocrine and genetic markers together with LDSS treatment can help achieving the correct diagnosis and optimizing outcomes.

Letrozole Effect on Final Height of Patients with Constitutional Delay of Growth and Puberty

Introduction

The inhibitory effect of aromatase on predicted adult height and near final height has been studied in patients with constitutional delay of growth and puberty (CDGP).

Aim

This is the first study aimed at verifying the letrozole (Lz) effect on final height of patients with CDGP.

Material and Methods

In this study 8 patients with CDGP underwent treatment with Lz (2.5 mg/day) for a year, and 8 patients with CDGP, who did not receive Lz were followed -up to reaching final height. Height discrepancy was calculated by subtracting PAH from final height measurement.

Results

the final height for Lz and Control Groups were 171± 4.5 cm and 168.8±4.1Cm respectively. The final heights for Lz group were significantly (p=0.04) higher than the control group. Final height in comparison with PAH at the beginning of the study showed significant difference (p=0.022) in Lz group whereas the difference was not significant (p=0.8) in control group. For height discrepancy the measurements were +1.9 cm and +0.1 cm for Lz and control group respectively with significant difference (p=0.04).

Conclusion

Our study, which is the first one in evaluating the impact of Lz on FH, illustrated that Lz treatment will ultimately lead to augmentation of FH in boys with CDGP.

Characteristic dynamics of height and weight in preschool boys with constitutional delay of growth and puberty or hypogonadotropic hypogonadism

OBJECTIVE

Constitutional delay of growth and puberty (CDGP) is a frequent variant of the normal leading to short stature and/or pubertal delay. To distinguish CDGP from hypogonadotropic hypogonadism (HH), we evaluated height, growth and weight pattern of CDGP and HH in the first 5 years of life.

DESIGN AND PATIENTS

We studied retrospectively height and weight in the first 5 years (y) of life in 54 boys with CDGP and 8 boys with HH.

RESULTS

In boys with CDGP, height-SDS decreased (change -0.94 (interquartile range [IQR] -1.69 to -0.05); P < 0.001) between birth and 2 years. BMI-SDS decreased (change -0.38 (IQR -1.21-0.16); P < 0.001) in the same time period. There were no significant changes in height-SDS or BMI-SDS between 2 years and 5 years, while height-SDS (change + 1.49 (IQR 1.02-1.95); P < 0.001) and BMI-SDS (change + 0.91 (IQR 0.12-1.69); P < 0.001) increased between pubertal and adult age. In boys with HH, height-SDS and BMI-SDS did not change significantly in the first 5 years of life. Height-SDS decreased (change -1.39 (IQR -1.96 to -0.67); P = 0.018) significantly between 5 years of life and puberty, while there were no significant changes in BMI-SDS in this time period. At pubertal age, BMI-SDS was significantly (P = 0.001) higher in boys with HH compared with boys with CDGP.

CONCLUSION

Height deflection and weight deflection in CDGP occur already during the first two years of life in contrast to HH. This different pattern of growth and weight might be helpful to distinguish CDGP from HH.