International Journal of Clinical Case Reports 2015, Vol.5, No. 45, 1-6
5
dose of GHr has increased the height gain of 4.6 cm.
Other authors report on the contrary a lesser height
gain due to the action of GH, which in promoting bone
maturation, reduced pubertal growth (Bourguignon, 1988;
Tanaka et al., 2002; Saenger, 2003).
Regarding the association of treatment with LHRH
analogues GH, some authors (Frish and Birnbacher,
1995; Cassorla, 1997; Kohn et al., 1999) have sought
to increase growth by slowing pubertal development.
The results of the final height differ according to the
authors. The most important study is that of Cassorla
(Balducc et al., 1995). By associating LHRH analogs
with GHr during 03 consecutive years, he found a
significant increase in adult height compared to those
who received GHr alone (14.0 ±1.6 cm vs 8.0 ±2.4
cm, p <0.05). These results confirm those of Burns et
al. (1981), Hibi et al. (1989), Frish and Birnbacher
(1995) and Mericq et al. (2000).
Other authors did not find this effect on the pubertal
growth. In fact, the short study duration less than 02
years doesn’t permit evaluation of combined treatment
(LHRH analogues and GHR) on the final size (Toublanc
et al., 1989; Saggese et al., 2001). In practice, that
protocol is envisaged in children with a very small
size at puberty. This situation could have been
considered in our patients. The size at puberty was
also affected at diagnosis. The indication of this
combination was not applied because of the
constraints associated with these therapies and the
prolonged duration of the protocol that must be
maintained on at least five years to expect a final size
acceptable (Price and Heidelberg, 1999). Nevertheless,
the magnitude of the pubertal growth rate in GH
treatment is unclear because very dependent on the
clinical context: the severity of GH deficiency and its
isolated nature or combined (Burns et al., 1981;
Frasier et al., 1981; Hibi et al., 1989). It must, however,
emphasize that the stature pubertal gain only 16% on
average (11-21%) of the adult size (Pierson, 1986;
Brauner, 1994). it was very poor for our patients and
significantly different from the average theoretical
value (14.7 ±1.2 cm vs. 28 cm for males and 12.2 ±
1.9 cm vs. 25 cm in girls). The adult final height is
closely related to the size at puberty. This is mainly
influenced by the early diagnosis of GH and regular
and effective therapy with GHr.
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