PUBERTY IN CHILDREN WITH IDIOPATHIC GROWTH-HORMONE DEFICIENCY ON GROWTH-HORMONE TREATMENT - PRELIMINARY-ANALYSIS OF THE DATA FROM THE KABI-PHARMACIA-INTERNATIONAL-GROWTH-STUDY

In total, 524 children (335 boys, 189 girls) with idiopathic growth hormone deficiency (GHD) who had entered puberty after at least 1 year of growth hormone (GH) treatment were studied. Spontaneous onset of puberty occurred in 319 boys and 174 girls, and puberty was induced in 16 boys and 15 girls. Median chronological and bone ages at onset of spontaneous puberty were 14.8 and 13.4 years in boys, and 13.3 and 11.8 years in girls, respectively. Age at onset of spontaneous puberty was correlated to age at start of GH treatment. Puberty was induced at a median chronological age of 16.0 years in boys and 14.4 years in girls. Height velocity increased in the year before spontaneous puberty in boys and girls, and rose further to a maximum (median, 8.3 cm/year) in the first year of puberty in boys. In girls, the maximum height velocity occurred in the year before puberty (median, 6.5 cm/year). Height velocity during the first year of puberty was inversely correlated to age at puberty onset (r = -0.56, p = 0.0001). After medical induction of puberty, height velocities in the first year of puberty were 5.4 and 3.4 cm/year for boys and girls, respectively. The change in median height SDS from start of GH treatment to puberty onset was +0.7 in boys and +0.8 in girls, and when corrected for bone age was -0.3 in boys and +0.6 in girls. GH doses were decreased from the start of treatment to puberty onset, decreased further during the first 2 years of puberty in boys, but increased in the second year of puberty in girls. Height velocity was positively correlated to dose of GH in the first year of puberty in boys (r = 0.27, p = 0.002) and girls (r = 0.27, p = 0.02). The relationship between dose and height velocity, when controlled for age by covariance analysis, was lost in girls but maintained in boys. In a subgroup of boys who were younger at diagnosis, the dose-height velocity relationship was greater (r = 0.59, p = 0.001) than for the total group. In the first year of pubertal growth in boys with idiopathic GHD on GH treatment, there is a dose-response relationship.