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Final Height in Girls with Precocious Puberty Treated with GnRHa and Oxandrolone« Back to Volume 22, Issue 3, September 2006 - Table of Contents Vottero et al assessed the benefits of adding oxandrolone (OX; 0.06 mg/kg/d orally) on the height outcome of girls with central precocious puberty (CPP) who received gonadotropin-releasing hormone analog (GnRHa) treatment (leuprolide acetate, 3.75 mg IM every 28 d) and whose height velocity decreased below the 25 th percentile for chronological age. The adult height reached by 10 patients with CPP treated with GnRHa plus OX (group 1) was significantly higher than their pretreatment predicted adult height (PAH) (162.6 ± 2.3 vs 154.8 ± 1.7 cm) and target height (162.6 ± 2.3 vs 158.0 ± 1.9 cm), while 10 subjects with CPP treated with GnRHa alone (group 2) reached an adult height similar to the pretreatment PAH (151.9 ± 1.2 vs 155.4 ± 2.1 cm), but significantly lower than target height (151.9 ± 1.2 vs 156.6 ± 1.4 cm; P<0.005). The difference between final height and pretreatment PAH of patients in group 1 was significantly different from that in group 2 (7.8 ± 2.3 vs –3.8 ± 2.3 cm; P<0.02), as was the difference between final height and target height (4.6 ± 1.8 in group 1 vs –4.2 ± 1.1 cm in group 2; P<0.005) (Figure). No side effects were noted in either group of patients. The authors concluded that combined GnRHa and OX therapy is a viable treatment option for girls with CPP and marked growth deceleration during treatment with GnRHa alone. Editor’s CommentIt is well known that in some patients with CPP the growth deceleration during GnRHa therapy may be marked and may preclude an expected improvement in predicted adult height. The addition of growth hormone (GH) to the GnRHa therapy may result in increased final height. 1,2 In this study Vottero et al compared the final height of girls with CPP and growth deceleration while on GnRHa alone, who were subsequently treated with a combination of GnRHa and OX or GnRHa alone. The final height significantly exceeded the target height at the end of the combination treatment and was significantly higher than that of the GnRHa treated girls. Results of this study compare favorably with those obtained in other studies1,2 by the addition of GH to GnRHa. Oxandrolone, a non-aromatizable androgen with a high anabolic to androgenic ratio when compared to testosterone, has been used to stimulate growth in boys with constitutional growth delay and delayed puberty. The OX administration is oral, relatively inexpensive, and devoid of significant side effects. In contrast, GH treatment requires daily subcutaneous injections, is extremely expensive, and its use may be associated with rare, although substantial side effects. This study seems to demonstrate the effectiveness of oral OX for the treatment of patients with CPP whose growth velocities during GnRHa treatment decline significantly; however, studies in a larger number of patients, including boys, will be necessary before this modality of therapy becomes established. Roberto Lanes, MD References - (linked to
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Volume 24 Number 1
May 2008
www.GGHjournal.com
ISSN 1932-9032
, PAH at start of GnRHa; 
, target height; 
, final height. Results are shown as mean ±SEM. *,P<0.05 final height of patients treated with GnRHa plus Ox vs. their PAH and target height; &,<0.05 final height of patients treated with GnRH alone vs. their target height.
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