Clinical benefits of sex steroids given as a priming prior to GH provocative test or as a growth-promoting therapy in peripubertal growth delays: Results of a retrospective study among ENDO-ERN centres

Objectives: Sex steroids, administered as a priming before GH stimulation tests
(GHST) to differentiate between growth hormone deficiency (GHD) and constitutional
delay of growth and puberty (CDGP) or as growth-promoting therapy using
low-dose sex steroids (LDSS) in CDGP, are much debated. We aimed to compare auxological
outcomes of CDGP or GHD children undergoing primed or unprimed GHST
and to evaluate LDSS treatment in CDGP.
Design: Retrospective study among three paediatric University Hospitals in Italy and
UK.
Methods: 184 children (72 females) aged 12.4 ± 2.08 years underwent primed (/P+)
or unprimed (/P−) GHST and were followed up until final height (FH). CDGP patients
were untreated (CDG P−) or received LDSS (CDGP+). The cohort included 34 CDG
P−/P+, 12 CDGP+/P+, 51 GHD/P+, 29 CDG P−/P−, 2 CDGP+/P− and 56 GHD/P−. FH
standard deviation score (SDS), Δ SDS FH-target height (TH) and degree of success
(−1 ≤ Δ SDS FH-SDS TH ≤ +1) were outcomes of interest.
Results: GHD/P+ had better FH-SDS (−0.87 vs −1.49; P = .023) and ΔSDS FH-TH
(−0.35 vs −0.77; P = .002) than CDGP−/P+. Overall, GHD/P+ showed the highest degree
of success (90%, P = .006). Regardless of priming, both rhGH and LDSS improved
degree of success compared to no treatment (89% and 86% vs 63%, P = .0009).
GHD/P+ showed a trend towards a higher proportion of permanent GHD compared
to GHD/P- (30.43% vs 15.09%; P = .067).
Conclusion: In peripubertal children, priming before GHST improves diagnostic accuracy
of GHST for idiopathic GHD. LDSS treatment improves auxological outcomes
in CDGP