Adult Height in Growth Hormone Deficiency: Historical Perspective and Examples From the National Cooperative Growth Study

Abstract

There are few historical data on final or adult heights after the completion of long-term growth hormone (GH) therapy in children with GH deficiency (GHD). Adult height has been defined as that achieved at chronologic ages ranging from 18 to 30 years, at bone ages ≥13 years (girls) and ≥15 years (boys), at growth velocities ≤1 to 2 cm per 6 to 12 months, at the “cessation of growth,” at “1 year after the completion of pubertal development,” and that at which patients are either “satisfied with their height” or have attained an “accept adult stature.” Without GH treatment, children with GHD have a mean adult height standard deviation score of −4.7 (range, −6.1 to −3.9). After treatment, the standard deviation score range from −4.7 to −1.2 (pituitary GH [pitGH] 2–4 times a week) and from −1.4 to −0.5 (recombinant human [rhGH] GH 3 times a week to daily) in women and from −3.6 to −1.1 (pitGH) and from −1.3 to −0.7 (rhGH) in men. Because there is no uniformly applied definition of adult height, comparisons are difficult, but historical data suggest that posttreatment heights are greater with rhGH than with pitGH. Using the National Cooperative Growth Study database, we found that the criteria used to define adult height affected the apparent outcome. When chronologic age ≥20 years for men and ≥18 years for women was the only criterion, 27% of patients grew ≥5 cm after having reached this age. Adding the requirement of advanced puberty before adult height could be considered to have been attained reduced the proportion of those who later grew ≥5 cm to <10%, but also decreased the number of patients available for analysis. A combination of criteria for adult height (chronologic and bone age ≥16 years for boys and ≥14 years for girls plus advanced puberty plus growth rate of <2 cm per year) left only 1% of patients with later growth of ≥5 cm.