Can we increase adolescent growth?

Department of Pediatric Endocrinology and INSERM U561, Groupe Hospitalier Cochin-Saint Vincent de Paul and Faculte Cochin-Universite Paris V, Paris, France. carel@paris5.inserm.fr

Adolescent growth represents 15-20% of adult height and has been the focus of several treatment interventions, aiming at increasing the amplitude of the adolescent spurt. Importantly, pre- and early puberty are times when patients and families seek medical help and when estimates of adult height are more accurate than in younger children. We review the current approaches aimed at increasing pubertal growth in short children and knowledge about their results and risks. GnRH agonists, when used outside the context of precocious puberty, induce a modest gain (4 cm) when they are used for more than 3 years. Their effects on bone mass, body composition and possibly on psychosocial parameters limit their use. Several trials have now shown that GH can increase adult height of short adolescents with idiopathic short stature or born small for gestational age. However, the amplitude of the effect is modest and of dubious clinical significance. Lastly, the association of both approaches is rather popular among pediatric endocrinologists but still lacks a definite demonstration of its efficacy. In conclusion, we have gained insight in the median effects of some of these treatments and overoptimistic initial expectations are now refocused. However, we still have a long way to go before we truly evaluate the factors affecting the variable individual responses to these treatments, their clinical significance and their cost-benefit balance.