advanced bone age

[NLON]

I have an 8 and half year old girl, with a bone age that is about 10 and half years old. She is at the 40th percentile for her chronological age. I am 5' 9" tall and her father is close to 5' 7". She is of normal weight and all her blood tests have come back pretty much normal except a stimulation test that showed her to be around a 12 and half year old for hormone levels.... otherwise the hormones are 'normal'. The concern is that she may end up being very short. What could be causing this?

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[Deanna L Aftab Guy, MD]

Lisa, a stimulation test (stim test) is an endocrine term for a test to assess a hormone response to a stimulus. It helps us assess for deficiencies or overproduction of hormones. In regards to puberty the test to see if the brain is maturely signalling is called a leuprolide stim test, a medication called leuprolide is given and levels of the pituitary puberty hormones are meaured before and after. Leuprolide is a copy of the hormone that our brain makes during pubertal signalling, in a child who is already having pubertal signals the levels of the puberty hormones rise very high, in a child who is not maturely signalling the levels of the puberty hormones in response to leuprolide should be lower. It lets us know if the brain is still asleep or if this child is in true puberty in regards to the pituitary.

A growth hormone stim test is done with different medications to assess our brains ability to make growth hormone, this is done by giving medications that allow release of gh and we measure the response before and after to be sure that a child is not growth hormone deficient.

[smell724]

hello my name is lisa my daughter is 7yrs old and has a bone age of 11yrs old she has had tests but nothing has shown up yet she has 2 have more blood tests. i have also been told that she might end up being short. i just wanted 2 no what a stim test is .

[NLON]

Unfortunately I do not have stim test (Gh) results. We are seeing a pediatric endocrinologist.
My daughter was put on Lupron for about 5 months after the stim test was done... but now she has been off lupron for 2 months. The doctor feels that my daughter is really not being blasted enough by the hormones that cause puberty to be the reason for her advanced bone age. Something else may be doing this, and so we are just watching her for now.

[Deanna L Aftab Guy, MD]

I just posted a similar reply to another posting see below, however early puberty is what needs to be assessed, you say that she had a stimulation test, rather than give age level what was the exact level of the hormones tested and what kind of test did she have? if she is indeed having early puberty, at 8 1/2 this takes a little thought, is this normal variation or do we need to consider stopping things to preserve final height. If you had a stim test you are definitely in the hands of a pediatric endocrinologist, sit down with them and talk about your options.