Pediatric Endocrinology Expert Forum
Advanced Bone age & Growth Hormone
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Questions in the Pediatric Endocrinology forum are answered by Dr. Deanna L Aftab Guy. Topics covered include adrenal problems, diabetes insipidus, menstrual irregularities, obesity, parathyroid abnormalities, pituitary abnormalities, puberty concerns, rapid growth, rickets and bone disease, short stature, and thyroid.

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Advanced Bone age & Growth Hormone

I have a 10 year old son had brain tumor Germinoma 2 years ago. He had growth burst before he was diagnosed then stop growing.His bone age is 11 when he was 7.5 years old at that time. He completed chemo and radiation Aug last year and had 2 bone scan which were in May and Nov this year. The May scan said his bine age is 9.5 and the Nov 's says 12 yo.

Anyway he had GH test Dev 4th and shows Growth hoemone is extremely low.

My questions are: What caused his advanced bone age? Is there any way that we can delay his puberty and slow down his bone grow? HE will stat his GH therapy soon. We would like to see you, would it be possible to set up an app as soon as possible?

Thank you so much!!

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You are more than likely with a pediatric oncologist in a children's hospital, many of those facilities also have endocrinologists that work side by side with the cancer patients, many have pituitary problems like gh deficiency, hypothyroidism, delayed or early puberty. Advanced bone age can be due to early puberty, effects from the adrenal gland hormones or obesity as well as other things. GH is usually not considered in a child who is a cancer survivor unless they are at least 2 years out in remission, simply due to the fact that it is a growth factor and if there are any cells remaining they too can grow. Delaying puberty is addressed with medications and these can be discussed with an endocrinologist. You are mentioning starting gh and this is something that is closely monitored by your oncologist and endocrinologist together to be sure all is good and response is good with no side effects. Ask your endo about the puberty hormones and advanced bone age concern. Bone age is not as advanced as prior xray so this is good.
Work with your pediatrician first in regards to need for referral.
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Thank you so much for your response.

I did ask his endocrinologist to see if there is a way to slow down his bone age but I was told there is no way.If his bone age is not advanced, I would rather wait longer to start his growth hormone instead of now. since his bone scan of May was not read corectly. I am not sure how fast his bone age is growing now. I am just wodnering if Lupron will be helpful.
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