What interventions can increase adult height in children with short stature?

Interventions to Increase Adult Height in Children with Short Stature

Growth hormone (GH) therapy is the most effective intervention for increasing adult height in children with short stature, with evidence showing a median gain of 5-7 cm in final adult height compared to untreated children. 1

Growth Hormone Therapy: Patient Selection and Indications

GH therapy should be considered for the following groups:

• Children with growth hormone deficiency (GHD)
• Children with chronic kidney disease (CKD) with height below the third percentile and height velocity below the 25th percentile 1
• Children with idiopathic short stature (ISS) with height SDS ≤ -2.25 2
• Children with Turner syndrome 2

Specific Criteria for Initiation

For children with CKD:

• Height below the third percentile for age and sex
• Height velocity below the 25th percentile
• Age older than 6 months
• Growth potential remaining (open epiphyses)
• Other treatable causes of growth failure have been addressed 1

For children with idiopathic short stature:

• Height SDS ≤ -2.25
• Growth rates unlikely to permit attainment of normal adult height
• Open epiphyses
• Other causes of short stature excluded 2

Dosing and Administration

• Standard dosage: 0.045-0.05 mg/kg/day by daily subcutaneous injection 1
• For children with GHD: Up to 0.3 mg/kg/week divided into daily injections 2
• For children with CKD: Up to 0.35 mg/kg/week divided into daily injections 2
• For children with ISS: 0.3 mg/kg/week 2

Expected Outcomes

For Children with CKD:

• Median increase in adult height: 7.4 cm in boys and 7.0 cm in girls 1
• Standardized height improvement: 1.1 SDS (range 0.2-1.6 SDS) 1

For Children with ISS:

• Mean increase in adult height: 5.2 cm (2 inches) 3
• Adult height greater than predicted in 82% of males and 83% of females 2
• Mean difference between adult height and pretreatment predicted height: 5.2 cm in males and 6.0 cm in females 2

For Children with Turner Syndrome:

• Adult height gain: 5.0-8.3 cm depending on treatment protocol 2

Duration of Therapy

• Continue until final height is reached (epiphyseal fusion)
• For CKD patients: Continue until renal transplantation or final height 1
• Treatment duration typically ranges from 4-6 years 2, 4

Monitoring and Safety

• Baseline fundoscopy before initiating GH therapy 1
• Regular monitoring of height, weight, and pubertal development
• Monitor for potential adverse effects:
  • Intracranial hypertension (rare)
  • Glucose intolerance
  • Slipped capital femoral epiphysis (rare)
  • Progression of scoliosis

Cost-Benefit Considerations

The cost-benefit ratio should be carefully considered before initiating GH treatment 1. Current estimates suggest treatment costs exceed $35,000 per inch (2.54 cm) gained in adult height for idiopathic short stature 5.

Special Populations

Infants with CKD:

• Consider GH therapy for infants older than 6 months with CKD to accelerate length and weight gain 1

Pubertal Patients:

• GH therapy initiated during puberty can still result in significant height gains
• Data from the Pfizer International Growth Database showed significant cumulative increases in mean height SDS of 1.0-1.3 until near-adult height in CKD patients who started GH in early or late puberty 1

Common Pitfalls to Avoid

1. Delaying treatment until too late in puberty when growth potential is limited
2. Not addressing other treatable causes of growth failure before starting GH
3. Using inadequate dosing (lower doses show less effect)
4. Discontinuing therapy prematurely before reaching final height
5. Not considering the psychological impact of short stature and treatment burden

GH therapy represents the most evidence-based intervention for increasing adult height in children with short stature, with demonstrated efficacy across multiple conditions including GHD, CKD, ISS, and Turner syndrome.