Aromatase-inhibitors Treatment Alone or with GH Increases Final Height in Short-Statured Pubertal Boys - Real-World Data

Abstract Context Short-statured mid-pubertal boys with predicted adult height (PAHt) below the third percentile are a therapeutic challenge. Aromatase inhibitors (AI) delay estrogen-driven epiphyseal fusion and possibly enhance adult height (AHt). Objective To assess the efficacy of AI treatment on AHt in mid-pubertal boys with a short PAHt due to advanced bone age (BA) or idiopathic short stature (ISS). Design Retrospective study. Setting Tertiary pediatric endocrine referral center. Patients and methods Two groups of mid-pubertal boys treated with AI were studied: 27 boys with fast puberty compared to matched untreated controls and 16 boys with ISS treated with GH and AI compared to those treated with GH only. Anthropometric measurements, BA and PAHt, were tracked. AHt was compared across groups. Main outcome measures Achieved AHt in AI-treated boys versus controls and the PAHt. Results The median duration of AI treatment was 2.8 years for the AI-only group and 2 years for the GH&AI group. Throughout treatment, AI-treated groups gained height similarly to controls, showed a decrease in BASDS (AI only: P=0.009; GH&AI: P=0.029), and an improvement in PAHt (AI only: P=0.003; GH&AI: P=0.037). Compared to controls, AI-treated children achieved greater AHt (AI only: 166.6±3.1 cm vs. 163.4±1.3 cm, P=0.003; GH&AI: 167.3±6.1 cm vs. 164.9±3.5 cm, P=0.194). The difference between AHt and PAHt at baseline was more pronounced in the AI-treated groups (AI only: 3.8±3.5 cm vs. -0.3±5.0 cm, P=0.001; GH&AI: 7.5±5.2 cm vs. 4.3±3.6 cm, P=0.050). Conclusions AI treatment extends the growth period, resulting in an AHt surpassing initial predictions. Our findings underscore the potential of AI treatment in mid-pubertal boys with a short PAHt due to advanced BA and in those treated with GH for ISS.