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

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).

Figure 1.

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.

Figure 2.

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.