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Idiopathic Hyperplasia Advanced Bone Age

My Boys:

Here are 7 yr old details:  DOB 2/4/01

May 29, 2007 – 102 lbs, 50.59”, Bone age 9 yrs. Chronological age 6 yr 3 mos BMI 26 (metric)

January 28, 2008 – 106 lbs, 53” Bone age 11-12 Chronological age 6yr 11mos

10 yr old:  DOB 9/3/97

November 6, 2007 – 105 lbs, 57.87”, Bone age 13-13.5 yrs, Chronological age 10yr 2 mos  BMI 22.1(metric)

February 22, 2008 – 107 lbs., 58.75”, Chronological age 10yr 5 mos

Both have been diagnosed with benign or idiopathic hyperplasia.  We have become very dedicated to assist them in losing weight.  They have at least lost 3 lbs. each.

Both are also experiencing premature adrenarche with out precocious puberty.

I am 5'11'' and my wife is 5'7".  We fear that they may have short stature regarding the advancement of their bone age.  

What treatments are available that would allow the boys to obtain greater projected heights.   Is HGH effective and what may be the side effects.  We would not want to miss a window of opportunity.
1 Responses
310293 tn?1274743373
whew alot of info and it sounds like you are in excellent hands and have good information, so you have two boys who have slightly advanced bone age, this means the bones are a little more mature than they are. Reasons can be early puberty from the pituitary signalling, or can be influence from the normal adrenal hormones or even obesity and influence from insulin itself which can be secreted in higher amounts due to the weight or inherited insulin resistance. The advanced bone age is important to evaluate and they have clearly done this. Now if we rule out the central cause of early puberty then treatment towards stopping this is controversial but done at times, not harmful per se but if they are not signalling then treatment just isn't very effective. There are other medications that are geared towards blocking more specifically estrogen effect and sometimes folks use these. These are still not widely used and may work but may just be not that helpful, they are influential on the liver and patients need very close monitoring. You are in the hands of an endocrinologist no doubt, we see our premature adrenarche patients (or I do) every 4-6 months and a growth velocity is calculated, if they see a growth velocity of under 5 cm per year then they may consider testing and or discuss growth promoting treatment. But this really should be addressed before bones approach the 12-13 range perhaps. The early adrenarche sounds like a familial benign process that leads to a more annoying effect on the bone maturity and final height.
Weight loss or at least maintainence is key, the main thing is to preserve the bone maturity-the bones cannot get younger(nor can we :(   ) but they can stand still for a little while so the child can catch up, this increases final height prediction.
Work with your peds endo and if you don't have one yet, your ped did a great job and ask them to consider referral to discuss overall plan of care
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