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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

Height velocity curve for males aged 2 to 20 years. Late maturer curve approximated for 2 standard deviation (± 2 SD) delay. From Tanner JM, Davis PSW. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr. 1985;107:317-329. Reprinted with permission.
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fig2-1941738110386705: Height velocity curve for males aged 2 to 20 years. Late maturer curve approximated for 2 standard deviation (± 2 SD) delay. From Tanner JM, Davis PSW. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr. 1985;107:317-329. Reprinted with permission.

Mentions: CGD is a normal variation of growth and pubertal development characterized by prolonged prepubertal growth, delayed onset of puberty, and extended adolescent growth. As noted above, this is typically a familial trait, but it can be “acquired” if there have been prior self-limited but growth-suppressing illnesses. Children with CGD growth pattern are typically born of normal size and track toward a percentile line appropriate for parental heights during the first year, but then they display a more rapid slowing of growth in the toddler years, resulting in downward crossing of percentiles. They typically grow at a normal growth velocity during childhood until the immediate prepubertal period, during which growth rates often slow considerably in the absence of sex hormone (predominantly, estrogen) stimulation of the growth hormone (GH) axis. Puberty eventually occurs in normal sequence; the individual has full attainment of secondary sexual characteristics and a normal adult height (often slightly less than that predicted by parental heights) and all at a later time. The child with CGD often comes to clinical attention in middle school, when average peers are midpubertal and experiencing peak height and weight growth. Meanwhile, the child with CGD is still growing at a prepubertal rate (4 to 6 cm per year). Often exaggerating this discrepancy is the physiologic relative “growth hormone deficiency” that occurs before the onset of the pubertal growth spurt. The GH system becomes less robust in late childhood in anticipation of the pubertal hormones taking over. When there is a delay in puberty, there can be extreme slowing of the growth rate before the pubertal growth spurt occurs (Figure 2). Further adding to distress for boys is the fact that girls have generally completed their growth at this time and this is the age of heightened peer pressure to fit in. For the young athlete, this can be particularly distressing, as the intensity level of competition takes a jump at this time as well. In contrast to girls, in whom pubertal development can be a detriment, male pubertal development almost always confers a competitive advantage for sports.


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)

Height velocity curve for males aged 2 to 20 years. Late maturer curve approximated for 2 standard deviation (± 2 SD) delay. From Tanner JM, Davis PSW. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr. 1985;107:317-329. Reprinted with permission.
© Copyright Policy
Related In: Results  -  Collection

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

fig2-1941738110386705: Height velocity curve for males aged 2 to 20 years. Late maturer curve approximated for 2 standard deviation (± 2 SD) delay. From Tanner JM, Davis PSW. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr. 1985;107:317-329. Reprinted with permission.
Mentions: CGD is a normal variation of growth and pubertal development characterized by prolonged prepubertal growth, delayed onset of puberty, and extended adolescent growth. As noted above, this is typically a familial trait, but it can be “acquired” if there have been prior self-limited but growth-suppressing illnesses. Children with CGD growth pattern are typically born of normal size and track toward a percentile line appropriate for parental heights during the first year, but then they display a more rapid slowing of growth in the toddler years, resulting in downward crossing of percentiles. They typically grow at a normal growth velocity during childhood until the immediate prepubertal period, during which growth rates often slow considerably in the absence of sex hormone (predominantly, estrogen) stimulation of the growth hormone (GH) axis. Puberty eventually occurs in normal sequence; the individual has full attainment of secondary sexual characteristics and a normal adult height (often slightly less than that predicted by parental heights) and all at a later time. The child with CGD often comes to clinical attention in middle school, when average peers are midpubertal and experiencing peak height and weight growth. Meanwhile, the child with CGD is still growing at a prepubertal rate (4 to 6 cm per year). Often exaggerating this discrepancy is the physiologic relative “growth hormone deficiency” that occurs before the onset of the pubertal growth spurt. The GH system becomes less robust in late childhood in anticipation of the pubertal hormones taking over. When there is a delay in puberty, there can be extreme slowing of the growth rate before the pubertal growth spurt occurs (Figure 2). Further adding to distress for boys is the fact that girls have generally completed their growth at this time and this is the age of heightened peer pressure to fit in. For the young athlete, this can be particularly distressing, as the intensity level of competition takes a jump at this time as well. In contrast to girls, in whom pubertal development can be a detriment, male pubertal development almost always confers a competitive advantage for sports.

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