Growth promotion by oxandrolone in a girl with short stature and early pubertal development treated with growth hormone and gonadotropin-releasing hormone-analogue. A case study.

Gonadotropin-releasing hormone (GnRH)-analogues are widely used for treating precocious puberty, and occasionally in short patients and patients with growth-hormone deficiency, in order to delay pubertal development and increase final height. Yet, many of these children only decelerate growth velocity and neither improve in final height nor even in height prediction. As GnRH-analogue treatment dramatically reduces sexual steroid levels, I hypothesized the need for steroid hormone substitution during this treatment. Growth promotion was tried in a healthy girl, with a very unsatisfying height prediction of only 144 cm, using a combination of GnRH-analogue (75 micrograms/kg/4 weeks), plus growth hormone (4 IU/m2/d), plus oxandrolone (1 mg/d). Knemometric measurements of lower leg growth velocity demonstrated that GnRH-analogue alone depresses growth. Additional GH administration only sporadically increases growth velocity, and not until the additional substitution of oxandrolone does growth velocity catch up and return to near pretreatment level. In spite of a 10.3 cm increase in body height during the 15-month period of observation, little bone age progression took place, and height prediction improved from 144 cm to over 149 cm after 9 months, and to 152 cm after 15 months of observation.