Pediatric Endocrinology Expert Forum
Delaying epiphyseal closure
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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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Delaying epiphyseal closure

I have a 15.5 year old son that was treated with accutane when he was almost14 years old. A bone age x-ray was taken before the start of accutane and the reading was a of a normal 14 year old. After the 20 week accutane treatment we had another bone age x-ray taken and the reading was of a person of 15.5 years of age but the actual age of my son was 14 years 2 months. His height growth since the treatment has been only 1.5 inches. The height of my son was 68.5 inches at the first bone age x-ray. The height of my son at the second bone age x-ray was 69 inches. I became concerned with the advanced bone age reading after the accutane. Recently at 15.5 years of age he had a third bone age x-ray taken because he has experienced very little long bone growth. The reading of the last hand x-ray came back  a person of 17 years old. He  has a bone age advancement of 1.5 years. My question is there a medical way of slowing down his epiphyseal closure and get his long bone growth to catch up so his mature height can reach its potential of what it was supposed to be before the bone age advancement that I believe resulted from taking the accutane. He also had  blood work taken to see his growth hormone level. On a scale of 0 to 6 his Gh reading came back a .2 or 2 tenths which I took as almost 0. Can a teenager have height growth as long as his growth plates have not fused? His plates are currently open but of a 17 year old. Are there ways to slow the epiphyseal premature closing ? He was originally predicted to have a mature height of 73" and the mental strain of a medication changing that is a concern.
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A bone age is a radiological evaluation of growth plates taken for the left hand and wrist, it is compared to standards in an atlas, most commonly used is the Gruehlich and Pyle Atlas, it is very very subjective in regards to one person's interpretation versus another's. We usually never get repeat bone ages any sooner than 6 months apart, the bones just don't mature in healthy kids faster than that and you are always going to get varied readings. It is possible that the first xray was underread and that it is likely that his bones are actually more like that of someone his age. A bone age of about 16-17 is near complete, predicted height is not only calculated on the xray but also compared to the parents heights and midparental height.
You cannot assess gh deficiency based on a single random test, firstly be sure that a pediatric endocrinologist is the one interpreting the xrays, labs etc. Random gh levels tell us not much! the only way to tell if we are gh deficient is with a gh stim test, look at my most recent stim test posting. He is too old and tall enough for me to think that gh deficiency was missed, 5'9" might be perfect for you guys as his parents. The accutane unlikely has affected much, it blocks male hormone effect, can affect the liver and if used wisely does what we want it to specific to the skin with little problems as long as we monitor the liver. If he indeed was having acne he no doubt was having a surge of puberty hormones and these in themselves can advance our bone age-in his case it was very appropriate, the range of normal for someone his age is broad.
I would work with the subspecialist who does this the most to mostly settle your minds, do not keep doing testing. He sounds perfect in everyway!
3 Comments
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Thank you for the reply. What is your opinion of the supplement DIM that is from certain vegetables. It is sold to help control hormone balance in men. Reducing the estrogen levels in men. Would there be any benefit or harm for a late puberty boy taking the product
in hopes of slowing down his epiphyseal closure, giving him more time to grow.
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I had blood work done on my 15.7 year old son that has a bone age of 16.5. His IGF-1 level was 557 and his testosterone serum was 548 which was High on a scale of 0 - 500
ng/dl. Is the high testosterone causing to much estrogen and is speeding up his growth plates. His Estradiol was 26 pg / ml on a scale of 0 - 53. Any thoughts on these results.
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A related discussion, How to verify that bones are completely fused? was started.
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A related discussion, Accutane and Growth was started.
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