Supplementary Material for: Use of aromatase inhibitors in short children and adolescents to increase height gain: A current practice survey and review of the literature

Introduction
Management of pediatric patients with short stature or short predicted adult height (PAH) it is challenging. The use of aromatase inhibitors (AI) has become a therapeutic option. Up to date there is still scarce data about the indications of AI. Our aim was to conduct a survey on the real-world use of AI in pediatric patients with short stature or short PAH.
Methods
We conducted a descriptive, cross-sectional, questionnaire-based study. Participants were collected throughout convenient sampling and by diffusion through different pediatric endocrine societies.
Results
Two hundred and forty-three endocrinologists from 23 countries answered the survey, mostly from South America. A 71.6% indicated AI to improve PAH. The main reason for not using AI was the lack of long-term data on effectiveness.
A 25.9% used AI in prepubertal patients and the most common indication in this group was in boys with congenital adrenal hyperplasia. A 92% of the survey participants used AI in pubertal patients with short stature and short PAH, regardless of the cause, mostly combined with GH.
Most clinicians felt confident about effectiveness of AI in reducing bone age advancement and improving PAH in pubertal male patients. One fifth of the clinicians had to discontinue treatment due to adverse effects.
Conclusion
This survey indicates that the use of AI among endocrinologist in patients with short stature or short PAH is increasing as more studies have come to light. However, questions remain regarding long-term outcomes, highlighting the need for future trials to further reassure its safety and effectiveness.