Clinica Pediatrica, Università di Chieti
*Presidente della Società Europea di Endocrinologia Pediatrica (ESPE)
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Key words: Idiopathic short stature (ISS), Children, GH, IGF-1
ISS is defined auxologically by a height below -2 SDS without findings of disease after a complete evaluation by a pediatric endocrinologist (including bone age X-ray, thyroid function, karyotype for girls, and measurements of IGF-I and stimulated growth hormone levels). This definition includes children with “constitutional delay of growth and puberty (CDGP)” and “familial short stature”. According to experts the height criteria to assess therapy vary between -2 and -3 SDS. Oxandrolone and low dose testosterone therapy promote the short-term acceleration of growth with, generally, no decrease in adult height potential, and low dose testosterone is the appropriate therapy for males with mild short stature (> -2.5 SDS) and CDGP. GnRH analogue monotherapy is not recommended in children with ISS. Aromatase inhibition increases predicted adult height in males with ISS, but adult height data are not available. This therapy is currently not recommended for females. Psychological counselling is worthwhile to consider instead of or as an adjunct to hormone treatment. The shorter the child, the more consideration should be given to treatment with GH. Responses are highly variable and depend on dose, length of therapy and other, but presently unknown, factors. IGF-I levels may be helpful in assessing compliance and GH sensitivity. If height prediction is below -2 SDS at the time of pubertal onset in either sex, the addition of GnRH analogues may be considered. GH therapy for children with ISS has a similar safety profile to other GH indications.
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