Efficacy of Aromatase Inhibitors Plus GH in Male Adolescents with ISS
Overview
This study evaluated the efficacy and safety of combining third-generation aromatase inhibitors (letrozole or anastrozole) with recombinant human growth hormone (rhGH) in adolescent boys with idiopathic short stature (ISS) and advanced bone age. Anastrozole combined with rhGH significantly increased adult height compared to letrozole or GnRH analog (GnRHa) combined with rhGH, with fewer adverse effects observed.
Background
Idiopathic short stature (ISS) is defined as height more than 2 standard deviations below the mean for age and sex without identifiable causes. Recombinant human growth hormone (rhGH) is used to treat prepubertal ISS, but its efficacy is limited in adolescents with advanced bone age due to reduced growth potential. GnRH analogs (GnRHa) are used to delay bone maturation but have limitations including cost and administration route. Third-generation aromatase inhibitors (AIs) such as letrozole and anastrozole have shown promise in delaying bone age progression and augmenting adult height when combined with rhGH, but direct comparisons of their efficacy and safety are limited.
Data Highlights
Group
Number of Patients
AHt SD Score Adjusted for Target Height (Mean ± SD)
Letrozole + rhGH
32
0.60 ± 0.28
Anastrozole + rhGH
32
0.81 ± 0.34
GnRHa + rhGH
32
0.48 ± 0.17
Key Findings
Anastrozole combined with rhGH resulted in the greatest increase in adult height compared to letrozole and GnRHa combinations (P < .01).
Both aromatase inhibitors (letrozole and anastrozole) combined with rhGH significantly increased adult height in adolescent males with ISS and bone age ≥ 13 years.
Adverse monitoring indicators in the AI groups gradually normalized after treatment cessation, indicating a favorable safety profile.
GnRHa combined with rhGH showed less adult height augmentation compared to AI combinations.
Anastrozole was associated with fewer adverse reactions than letrozole.
Clinical Implications
For adolescent males with ISS and advanced bone age, combining aromatase inhibitors with rhGH offers a promising strategy to augment adult height. Anastrozole, in particular, may provide superior efficacy with a better safety profile compared to letrozole or GnRHa. Clinicians should consider these findings when selecting therapies to optimize growth outcomes in this population.
Conclusion
The combination of aromatase inhibitors, especially anastrozole, with rhGH significantly improves adult height in male adolescents with ISS and advanced bone age, with manageable safety concerns. This approach may represent an effective alternative to GnRHa therapy.
References
Tongji Hospital Study 2017-2023 -- Evaluating Aromatase Inhibitors Plus GH in ISS
A structured overview of recent FDA recalls, corrections, and alerts involving medications, ventilators, insulin delivery systems, cardiovascular devices, anesthesia products, and other equipment used in clinical practice.
