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Title: Combined treatment with GH and anastrozole in a pubertal boy with Cushing's disease and postsurgical GH deficiency
Authors: Boronat, Mauro 
Marrero, Dunia
Lopez Placencia, Yaiza 
Novoa Medina, Yeray 
García-Delgado, Yaiza
Novoa Mogollón, Francisco 
UNESCO Clasification: 32 Ciencias médicas
320502 Endocrinología
Keywords: Aromatase Inhibitor Letrozole
Predicted Adult Height
Bone-Mineral Density
Constitutional Delay, et al
Issue Date: 2012
Journal: European Journal of Endocrinology 
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 (-2.34 SDS), and his midparental target height 171.2 cm (-0.95 SDS). Bone age was 13.5 years and predicted adult height 163.2 cm (-2.2 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 (-1.07 SDS). Puberty progressed normally. Compared with population reference data, bone mineral density before GH plus anastrozole treatment was -4.07 SDS in the lumbar spine and -1.85 SDS in the femoral neck. These measures increased to -1.95 and -0.89 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.
ISSN: 0804-4643
DOI: 10.1530/EJE-12-0036
Source: European Journal of Endocrinology[ISSN 0804-4643],v. 166, p. 1101-1105 (Junio 2012)
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