Clinical benefits of sex steroids given as a priming prior to GH provocative test or as a growth-promoting therapy in peripubertal growth delays: Results of a retrospective study among ENDO-ERN centres

<p>Objectives: Sex steroids, administered as a priming before GH stimulation tests<br> (GHST) to differentiate between growth hormone deficiency (GHD) and constitutional<br> delay of growth and puberty (CDGP) or as growth-promoting therapy using<br> low-dose sex steroids (LDSS) in CDGP, are much debated. We aimed to compare auxological<br> outcomes of CDGP or GHD children undergoing primed or unprimed GHST<br> and to evaluate LDSS treatment in CDGP.<br> Design: Retrospective study among three paediatric University Hospitals in Italy and<br> UK.<br> Methods: 184 children (72 females) aged 12.4 &plusmn; 2.08 years underwent primed (/P+)<br> or unprimed (/P&minus;) GHST and were followed up until final height (FH). CDGP patients<br> were untreated (CDG P&minus;) or received LDSS (CDGP+). The cohort included 34 CDG<br> P&minus;/P+, 12 CDGP+/P+, 51 GHD/P+, 29 CDG P&minus;/P&minus;, 2 CDGP+/P&minus; and 56 GHD/P&minus;. FH<br> standard deviation score (SDS), &Delta; SDS FH-target height (TH) and degree of success<br> (&minus;1 &le; &Delta; SDS FH-SDS TH &le; +1) were outcomes of interest.<br> Results: GHD/P+ had better FH-SDS (&minus;0.87 vs &minus;1.49; P = .023) and &Delta;SDS FH-TH<br> (&minus;0.35 vs &minus;0.77; P = .002) than CDGP&minus;/P+. Overall, GHD/P+ showed the highest degree<br> of success (90%, P = .006). Regardless of priming, both rhGH and LDSS improved<br> degree of success compared to no treatment (89% and 86% vs 63%, P = .0009).<br> GHD/P+ showed a trend towards a higher proportion of permanent GHD compared<br> to GHD/P- (30.43% vs 15.09%; P = .067).<br> Conclusion: In peripubertal children, priming before GHST improves diagnostic accuracy<br> of GHST for idiopathic GHD. LDSS treatment improves auxological outcomes<br> in CDGP</p>