Albanese, Assunta; (1996) Growth and segmental proportion in children with prepubertal growth delay and constitutional delay of growth and puberty: Natural history and the effect of therapeutic intervention. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

Despite being considered a variant of normal, constitutional delay of growth and puberty (CDGP) is a condition which should be regarded as a disorder. Final height and body proportion attainment in boys and girls who had a delayed onset of pubertal development were retrospectively analysed. Final height was below both genetic target and the expected normal range for the adult population. A relatively short sitting height was a characteristic feature of delayed puberty at presentation and did not correct at final height attainment. Predictive factors of final height outcome at presentation were identified. Attempts have been made to prevent body segmental disproportion and hopefully improve final height attainment by treating growth delay before delayed puberty was manifest. Oxandrolone was used in short boys in late prepuberty and growth hormone (GH) in short children during childhood. Preliminary data suggest height and growth deceleration in sitting height may be preventable with early anabolic steroid treatment. High dose GH treatment improved short-term growth in these children, but this was followed by a significant growth deceleration when GH treatment ceased. Doubts have been raised on the efficacy of oral testosterone to induce a growth acceleration in boys with CDGP. It has been demonstrated, using a randomised study, that a similar anthropometric response is obtained using either oral oxandrolone or oral testosterone. The interaction between sex/anabolic steroids and GH has been studied in clinical models to understand the mechanisms involved in the pubertal growth spurt. Finally the modulation of the somatotrophic - IGF-1 - IGF BP-3 axis and of gonadotrophin secretion following administration of GH to prepubertal short children with growth delay has been studied. In conclusion these data suggest a new approach to therapy in CDGP may be necessary. Treatment may be appropriate not only for psychological reasons but also for optimising both final height and body proportion..

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