Combined treatment with GH and anastrozole in a pubertal boy with Cushing's disease and postsurgical GH deficiency

Abstract

Growth failure is a characteristic manifestation of pediatric Cushing's disease. Catch-up growth is usually incomplete after cure of the disease, and final height is often compromised. Possible mechanisms for this phenomenon include postoperative persistence of GH hyposecretion and absence of retardation of bone maturation in spite of GH deficiency. This report describes the outcome in the case of a boy with Cushing's disease for whom GH replacement therapy was combined with anastrozole, an aromatase inhibitor, in order to delay skeletal maturation and extend the available time for linear growth. The case of a 14 years 4-months-old pubertal male (Tanner stage III) with GH deficiency after successful surgical treatment of Cushing's disease is presented. His height was 147.2 cm (K2.34 SDS), and his midparental target height 171.2 cm (K0.95 SDS). Bone age was 13.5 years and predicted adult height 163.2 cm (K2.2 SDS). Combined treatment was administered for 2.5 years. GH was maintained up to age 18 years. Anastrozole induced a substantial deceleration of bone age. Near-final height at 18 years was 169.5 cm (K1.07 SDS). Puberty progressed normally. Compared with population reference data, bone mineral density before GH plus anastrozole treatment was K4.07 SDS in the lumbar spine and K1.85 SDS in the femoral neck. These measures increased to K1.95 and K0.89 SDSs respectively, at 18 years, when GH was discontinued. Combined treatment with GH and aromatase inhibitors could be a therapeutic alternative to improve the stature of pubertal boys with Cushing's disease and postsurgical GH deficiency.

MANAGEMENT OF ENDOCRINE DISEASE: Paediatric Cushing's disease

“…Results demonstrate that this regime usually enables adequate catchup growth and adult height within range of target height for the majority of patients (57). Combined treatment with GH and aromatase inhibitors may also be a therapeutic alternative in pubertal patients (58).…”

Consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence: Part 2, specific diseases

“…Results demonstrate that this regimen usually enables adequate catch-up growth and adult height within the range of target height for the majority of patients 106,128 . Combined treatment with GH and aromatase inhibitors to reduce bone maturation induced by oestradiol could also be a therapeutic alternative in pubertal Consensus statement patients 129 . Normal body composition and BMD are more difficult to achieve 128,130 .…”