Kawai M, Momoi T, Yorifuji T, Muroi J, Yamanaka C, Sasaki H, Furusho K
Department of Paediatrics, Faculty of Medicine, Kyoto University, Japan.
Clin Endocrinol (Oxf). 1998 Jan;48(1):53-7. doi: 10.1046/j.1365-2265.1998.00348.x.
Recently, we reported that GH therapy without gonadal suppression (GS) decreased the final height of boys with non-GH-deficient short stature by decreasing the height standard deviation score (SDS) for bone age (BA) during puberty. Combination therapy with GH and GS has been reported to suppress bone maturation and improve final height in some cases. We evaluated the effects of combination therapy with GH and GS using cyproterone acetate on the final height of boys with non-GH-deficient short stature.
Fifty nine boys with non-GH deficient short stature were observed retrospectively until they reached their final height. The boys were divided into 3 groups: Group A consisted of 26 boys who were not treated with GH, group B consisted of 13 boys who were treated with GH alone, and group C consisted of 20 boys who were treated with combination therapy with GH and GS using cyproterone acetate. At the start of observation, the height SDS for BA and projected height were matched among these three groups.
The mean +/- SDS of the final height for groups A, B, and C were 162.7 +/- 5.3 cm, 155.4 +/- 4.9 cm, and 161.9 +/- 3.2 cm, respectively. GH therapy did not affect the height SDS for BA during the prepubertal period. GH therapy without GS decreased the height SDS for BA during puberty in group B. Combination therapy with GH and cyproterone acetate increased the height SDS for BA between 12 and 14 years BA in group C. However, after GS therapy was discontinued at 14 years BA, the height SDS for BA gradually decreased and eventually reached the same value as that in group A.
GH therapy during the prepubertal period did not improve the final height of boys with non-GH-deficient short stature. GH therapy without GS decreased pubertal height gain, resulting in reduced final height. Combination therapy with GH and GS using cyproterone acetate decelerated the bone maturation during puberty which might be accelerated by GH therapy, but did not improve the final height which might have been attained without treatment.
最近，我们报道了在无性腺抑制（GS）的情况下进行生长激素（GH）治疗，会通过降低青春期骨龄（BA）的身高标准差评分（SDS），从而降低非生长激素缺乏性身材矮小男孩的最终身高。据报道，生长激素与性腺抑制联合治疗在某些情况下可抑制骨骼成熟并提高最终身高。我们评估了使用醋酸环丙孕酮进行生长激素与性腺抑制联合治疗对非生长激素缺乏性身材矮小男孩最终身高的影响。
对59名非生长激素缺乏性身材矮小的男孩进行回顾性观察，直至他们达到最终身高。这些男孩被分为3组：A组由26名未接受生长激素治疗的男孩组成，B组由13名仅接受生长激素治疗的男孩组成，C组由20名接受生长激素与使用醋酸环丙孕酮的性腺抑制联合治疗的男孩组成。在观察开始时，这三组之间的骨龄身高SDS和预测身高相匹配。
A组、B组和C组最终身高的平均±SDS分别为162.7±5.3厘米、155.4±4.9厘米和161.9±3.2厘米。生长激素治疗在青春期前阶段不影响骨龄的身高SDS。B组中无性腺抑制的生长激素治疗在青春期降低了骨龄的身高SDS。生长激素与醋酸环丙孕酮联合治疗使C组在骨龄12至14岁之间骨龄的身高SDS增加。然而，在骨龄14岁时性腺抑制治疗停止后, 骨龄身高SDS逐渐下降，最终达到与A组相同的值。
青春期前阶段的生长激素治疗未改善非生长激素缺乏性身材矮小男孩的最终身高。无性腺抑制的生长激素治疗减少了青春期身高增长，导致最终身高降低。使用醋酸环丙孕酮的生长激素与性腺抑制联合治疗减缓了青春期可能因生长激素治疗而加速的骨骼成熟，但未提高未经治疗时可能达到的最终身高。
