Short stature in Noonan syndrome: response to growth hormone therapy

Background-Growth hormone (GH) has been used to promote growth in both the short and long term in a number of dysmorphic syndromes, including Turner syndrome. As this condition shares many clinical. features with Noonan syndrome, it would seem logical to treat the latter group with GH. Aims-To assess the short and long term response to GH therapy in patients with Noonan syndrome. Methods-Analysis of patients with Noonan syndrome in the Pharmacia & Upjohn International Growth Study (this postmarketing database contains data on the majority of patients currently treated with GH in the UK). A questionnaire was also sent to participating clinicians. Results-Data on 66 patients (54 males) were available for study. At the start of GH therapy children were short, compared with both normal and Noonan children. During the first year of GH therapy height velocity increased from a mean of 4.9 to 7.2 cm per year. For patients treated long term with GH, mean height SDS increased from -2.9 pretreatment to -2.6 after one year and -2.3 after five years. Of the 10 patients at near final height, only one had a height above the 3rd centile for normal adults and above the mean for untreated Noonan patients. The mean increment in final height was 3.1 cm (range -1.1 to 6.5 cm). Conclusions-GH therapy in patients with Noonan syndrome will improve height velocity in the short term. Longer-term therapy results in a waning of effect; initial indications are that final height is not improved substantially in most patients.