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Unlabelled: Early puberty is frequently observed in adopted children. This randomized trial treated 30 adopted children with early puberty and short stature with either gonadotropin-releasing hormone agonist (GnRHa) alone or in combination with growth hormone (GH) for 3 y. Before the start of treatment (T1) in the trial and at discontinuation (T2) the children and their parents underwent a psychological evaluation. At the start of treatment the children did not have increased levels of behavioural or emotional problems as assessed by the Child Behaviour Checklist (CBCL). During treatment the CBCL scores did not increase. Self-perception of the children appeared to be normal, and after 3 y a significantly higher score for acceptance by peers was observed. At T1, an overestimation of future height was present in 80% of the children and 17% of the parents. Lower family stress was observed at T1 and T2 compared with reference values. Intelligence quotient levels decreased significantly during treatment. The findings are discussed with reference to the reported levels of behavioural and emotional problems in adopted children and the psychosocial effects of precocious puberty.Conclusion: This psychological evaluation did not reveal any consistent abnormalities in adopted children with early puberty. Treatment with GnRHa with or without GH did not increase emotional and behavioural problems in adopted children, nor was their self-perception decreased. [ABSTRACT FROM AUTHOR]

To compare final height data after treatment with gonadotrophin releasing hormone agonist (GnRHa) alone or in combination with growth hormone (GH) in short adopted girls with early puberty. A randomized controlled trial. Twenty-six girls with onset of puberty before 10 years of age were treated for 3 years with either GnRHa alone (group A, n = 12) or with GnRHa and GH (group B, n = 14). Mean age at start of treatment was 9·6 years in both groups, bone age was 10·7 (SD 1·1) years in group A and 11·6 (0·8) years in group B. Initial height prediction with average Bayley & Pinneau tables was 149·8 (5·6) and 146·8 (4·8) cm, respectively. Bone age at discontinuation of treatment was 12·3 (0·9) and 13·0 (0·6) years in group A and B, respectively. Height gain defined as the difference between initial height prediction and attained final height, was significantly different between group A and B (5·2 (3·7) and 8·2 (3·4) cm, P < 0·05) using average tables for height prediction. With accelerated tables for prediction the numbers were −1·0 (3·6) and 3·3 (3·5) cm, respectively. At final height, there was no significant difference in height: group A: 155·0 (5·6) cm and group B: 155·0 (5·5) cm. After 3 years of GnRHa treatment in adopted girls with early puberty, FH is significantly higher than initial height prediction. The addition of GH resulted in a limited further increase in height gain. In the interpretation of the results methodological issues concerning height prediction have to be taken into account. [ABSTRACT FROM AUTHOR]

To investigate in a group of short children born small for gestational age (SGA), the effects of 3 years of GH treatment vs. no treatment on bone age (BA), height and bone mineral density (BMD). Also, to evaluate the influence of the severity of growth retardation at start and the GH dose on the gain in height. The study design was an open-labelled, controlled multicentre GH study for 3 years. Non-GH-deficient (GHD) children ( n = 87) were randomized to either a GH group ( n = 61) or an untreated control group ( n = 26). In addition, 12 SGA children had GHD (GHD group) and were treated in parallel. Both the GH and the GHD group were treated with a GH dose of 33 µg/kg/day. BMD was evaluated using dual energy X-ray absorptiometry (DEXA). In addition, data of our first GH trial in which short SGA children were treated with a GH dose of 66 µg/kg/day ( n = 24) were used for comparison of height gain. In contrast to the control group, the GH group showed a significant increase in height ( P < 0·001), as did the parallel GHD group. Bone maturation [Δ bone age (BA)/Δ calendar age (CA)] increased significantly during the first 2 years of GH treatment but slowed-down thereafter. The 3-year ΔBA/ΔCA ratio correlated significantly with the gain in height ( r = 0·6, P < 0·001). At start, mean BMD SDS and mean BMAD SDS were significantly lower than zero. During GH treatment both increased impressively ( P < 0·001). The gain in height of children with severe short stature at start (≤ −3·00 SDS), did not differ between those receiving either a GH dose of 33 or 66 µg/kg/day. Three years of GH treatment in short children born SGA results in a normalization of height during childhood. Also, bone maturation increased proportionately to the height gain. At start, mean values of BMD and BMAD were significantly reduced but normalized during GH treatment. We did not find an indication to treat very short SGA children (H SDS ≤−3·00) with a higher GH dose. We rather suggest to start GH treatment at an early age in order to achieve a normal height before puberty starts. [ABSTRACT FROM AUTHOR]

BACKGROUND Early onset of puberty is frequently observed in adopted children. During treatment with a gonadotrophin releasing hormone agonist (GnRHa), a decrease in height velocity (HV) precludes height gain. OBJECTIVE AND DESIGN We studied the effect of the addition of GH to GnRHa treatment in a 3-year prospective randomized trial in 30 adopted children with early puberty. PATIENTS Mean age (SD) at start of treatment was 9·6 (0·9) years in girls and predicted adult height (PAH) using a segmented bone age (BA) assessment method was 148·0 (5·3) cm. RESULTS HV decreased gradually in both groups with a higher HV in the group with GH addition (group B). No significant difference between the rates of bone maturation [change in bone age (ΔBA)/change in chronological age (ΔCA)] of both treatment groups was observed. After 3 years of treatment, PAH increase was 5·7 (3·8) cm in group A (GnRHa alone) and 10·1 (3·8) cm in group B (P < 0·01). IGF-I levels were higher in group B. HV decreased slowly in both groups during treatment, unlike stabilization of IGF-I levels. CONCLUSION We conclude that, after 3 years of treatment, the addition of GH to GnRHa results in higher HV and a significant increase in PAH compared to GnRHa alone. [ABSTRACT FROM AUTHOR]