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Boosting The Late Blooming Male: Use of growth promoting agents in the athlete with constitutional delay of growth and puberty.

Curtis VA, Allen DB - Sports Health (2011)

Bottom Line: Use of rhGH to increase growth in short-statured children with CGD has been challenged for its modest efficacy in increasing ultimate height, high cost, limited evidence for psychosocial benefit, and some unresolved concerns about long-term post-treatment safety.An additional controversy for the young athlete with CGD is the concern for fairness in competition.RESULTS: RhGH is a safe and effective therapy for increasing growth rate in very short children with CGD, but does not markedly increase ultimate stature nor confer a clear benefit in athletic performance. (SORT A) CONCLUSIONS: Prescribing physicians should use rhGH treatment responsibly to bring children disabled by short stature just into the "normal" range. (SORT C).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Endocrinology and Diabetes, University of Wisconsin, Madison, Wisconsin, United States.

ABSTRACT
CONTEXT: The indications for use of growth hormone (GH) have broadened with the availability of unlimited recombinant human growth hormone (rhGH). The FDA's approval for use of growth hormone in GH-sufficient patients with idiopathic short stature includes some children with constitutional delay of growth and puberty (CGD), a normal growth pattern variation which includes delayed puberty and prolonged linear growth, usually leading to normal adult height. Use of rhGH to increase growth in short-statured children with CGD has been challenged for its modest efficacy in increasing ultimate height, high cost, limited evidence for psychosocial benefit, and some unresolved concerns about long-term post-treatment safety. An additional controversy for the young athlete with CGD is the concern for fairness in competition. EVIDENCE ACQUISITION: Data sources were limited to peer-reviewed publications. RESULTS: RhGH is a safe and effective therapy for increasing growth rate in very short children with CGD, but does not markedly increase ultimate stature nor confer a clear benefit in athletic performance. (SORT A) CONCLUSIONS: Prescribing physicians should use rhGH treatment responsibly to bring children disabled by short stature just into the "normal" range. (SORT C).

No MeSH data available.


Related in: MedlinePlus

Evaluation of boys with delayed puberty. FH, family history; BUN, blood urea nitrogen; Cr, creatinine; TSH, thyroid-stimulating hormone; fT4, free tetraiodothyronine (thyroxine); IGF-1, insulin-like growth factor 1; ESR, erythrocyte sedimentation rate; LTs, liver tests; CGD, constitutional delay of growth and puberty; LH, luteinizing hormone; FSH, follicle-stimulating hormone; HH, hypogonadotropic hypogonadism; CNS, central nervous system.
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Related In: Results  -  Collection


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fig1-1941738110386705: Evaluation of boys with delayed puberty. FH, family history; BUN, blood urea nitrogen; Cr, creatinine; TSH, thyroid-stimulating hormone; fT4, free tetraiodothyronine (thyroxine); IGF-1, insulin-like growth factor 1; ESR, erythrocyte sedimentation rate; LTs, liver tests; CGD, constitutional delay of growth and puberty; LH, luteinizing hormone; FSH, follicle-stimulating hormone; HH, hypogonadotropic hypogonadism; CNS, central nervous system.

Mentions: A boy older than 14 years with no physical signs of puberty deserves evaluation. In addition to thorough medical and family history, a bone age radiograph is the most helpful initial study. This radiograph of the left hand provides valuable information regarding the child’s prior tempo of growth and his remaining growth potential. It can be an approximate guide in determining when the individual can expect to experience pubertal changes (bone age, 11.5-12.0 years for boys) and, based on height prediction techniques, a rough estimate of final adult height. If the bone age is appropriately delayed, if there is no systemic disease or syndromic features, and if the family history is consistent, the child may require no further workup than observation for pubertal progression over time. If these conditions are not met, the child may require further endocrinologic workup, including the measurement of gonadotropins, testosterone, and evaluation for other disease (Figure 1).


Boosting The Late Blooming Male: Use of growth promoting agents in the athlete with constitutional delay of growth and puberty.

Curtis VA, Allen DB - Sports Health (2011)

Evaluation of boys with delayed puberty. FH, family history; BUN, blood urea nitrogen; Cr, creatinine; TSH, thyroid-stimulating hormone; fT4, free tetraiodothyronine (thyroxine); IGF-1, insulin-like growth factor 1; ESR, erythrocyte sedimentation rate; LTs, liver tests; CGD, constitutional delay of growth and puberty; LH, luteinizing hormone; FSH, follicle-stimulating hormone; HH, hypogonadotropic hypogonadism; CNS, central nervous system.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3117584&req=5

fig1-1941738110386705: Evaluation of boys with delayed puberty. FH, family history; BUN, blood urea nitrogen; Cr, creatinine; TSH, thyroid-stimulating hormone; fT4, free tetraiodothyronine (thyroxine); IGF-1, insulin-like growth factor 1; ESR, erythrocyte sedimentation rate; LTs, liver tests; CGD, constitutional delay of growth and puberty; LH, luteinizing hormone; FSH, follicle-stimulating hormone; HH, hypogonadotropic hypogonadism; CNS, central nervous system.
Mentions: A boy older than 14 years with no physical signs of puberty deserves evaluation. In addition to thorough medical and family history, a bone age radiograph is the most helpful initial study. This radiograph of the left hand provides valuable information regarding the child’s prior tempo of growth and his remaining growth potential. It can be an approximate guide in determining when the individual can expect to experience pubertal changes (bone age, 11.5-12.0 years for boys) and, based on height prediction techniques, a rough estimate of final adult height. If the bone age is appropriately delayed, if there is no systemic disease or syndromic features, and if the family history is consistent, the child may require no further workup than observation for pubertal progression over time. If these conditions are not met, the child may require further endocrinologic workup, including the measurement of gonadotropins, testosterone, and evaluation for other disease (Figure 1).

Bottom Line: Use of rhGH to increase growth in short-statured children with CGD has been challenged for its modest efficacy in increasing ultimate height, high cost, limited evidence for psychosocial benefit, and some unresolved concerns about long-term post-treatment safety.An additional controversy for the young athlete with CGD is the concern for fairness in competition.RESULTS: RhGH is a safe and effective therapy for increasing growth rate in very short children with CGD, but does not markedly increase ultimate stature nor confer a clear benefit in athletic performance. (SORT A) CONCLUSIONS: Prescribing physicians should use rhGH treatment responsibly to bring children disabled by short stature just into the "normal" range. (SORT C).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Endocrinology and Diabetes, University of Wisconsin, Madison, Wisconsin, United States.

ABSTRACT
CONTEXT: The indications for use of growth hormone (GH) have broadened with the availability of unlimited recombinant human growth hormone (rhGH). The FDA's approval for use of growth hormone in GH-sufficient patients with idiopathic short stature includes some children with constitutional delay of growth and puberty (CGD), a normal growth pattern variation which includes delayed puberty and prolonged linear growth, usually leading to normal adult height. Use of rhGH to increase growth in short-statured children with CGD has been challenged for its modest efficacy in increasing ultimate height, high cost, limited evidence for psychosocial benefit, and some unresolved concerns about long-term post-treatment safety. An additional controversy for the young athlete with CGD is the concern for fairness in competition. EVIDENCE ACQUISITION: Data sources were limited to peer-reviewed publications. RESULTS: RhGH is a safe and effective therapy for increasing growth rate in very short children with CGD, but does not markedly increase ultimate stature nor confer a clear benefit in athletic performance. (SORT A) CONCLUSIONS: Prescribing physicians should use rhGH treatment responsibly to bring children disabled by short stature just into the "normal" range. (SORT C).

No MeSH data available.


Related in: MedlinePlus