Adult height in children with short stature and idiopathic delayed puberty after different management

By retrospectively collecting data from nine
Italian centres of pediatric endocrinology, we assessed the
different management and final outcome of children with
short stature and idiopathic delayed puberty. Data were
obtained in 77 patients (54 males, 23 females) diagnosed
and followed-up in the various centres during the last
15 years. Inclusion criteria were short stature at initial
observation and idiopathic delayed puberty diagnosed
during follow-up. At first observation, age was 13.8±
1.0 years and height standard deviation score (SDS) was
–2.6±0.6 in males. In females age was 13.1±0.9 years and
height SDS –2.6±0.4. Local diagnostic and therapeutic
protocols included testing for growth-hormone deficiency
(six centres) and treatment in case of deficiency or, in the
remaining centres, testosterone or no treatment in males,
and no treatment in females. At diagnosis, both in males
and in females, the auxological features (height SDS, target
height SDS and bone age delay) were similar in the patients
treated with growth hormone, testosterone or not treated.
Overall 32 patients received growth hormone (25 males, 7
females), 33 no treatment (17 males, 16 females) and 12
testosterone. There was no difference in the adult height of
males and females in the different treatment groups. In
males there were no differences between adult and target
height SDSs (growth hormone-treated 0.31±0.79, untreated
0.10±0.82, testosterone-treated 0.05±0.95), between adult
and initial height SDSs (growth hormone-treated 1.70±
0.93, untreated 1.55±0.92, testosterone-treated 1.53±1.43)
and percentage of subjects with adult height above target
height. In females, there were no differences between adult
and target height SDSs (growth hormone-treated –0.49±1.13;
untreated 0.10±0.97) and between adult and initial height
SDSs (growth hormone-treated 1.76±0.92; untreated 1.77±
0.98), whereas a significantly higher percentage of patients
remained below target height in the growth hormone-treated
group (6/7, 85.7% vs 5/11, 31.3%) (P=0.02). In conclusion,
the diagnostic and therapeutic management of the patients
with short stature and delayed puberty is different among
Italian pediatric endocrinologists. Our data do not support
the usefulness of growth-hormone therapy in improving
adult height in subjects with short stature and delayed
puberty, particularly in the female sex.