Background: GH receptors are present in ovaries and GH may have a physiological role for ovarian function and development.
Objective and hypothesis: The objective of this study was to examine pubertal development and ovarian growth and differentiation during GH therapy.
Methods: Clinical characteristics, reproductive hormones and ultrasonographic examination of the internal genitals were determined in 18 prepubertal girls during 3 years of GH therapy in a Danish sub-study of the North European SGA study (NESGAS), a multinational, randomised, longitudinal study of GH therapy in short prepubertal children born SGA.
Results: Median age at baseline was 4.91 years (4.517.22). Bone age advanced significantly during 3 years of treatment (P=0.007), but did not exceed chronological age. Uterine and ovarian volume increased significantly (1.051.72 ml, P=0.033 and 0.430.9 ml, P=0.005 respectively), but remained within the lower reference ranges. Ovarian follicles became visible in 69% compared to 27% before GH therapy (P=0.025). Precocious puberty was observed in one girl and another girl showed signs of a multicystic ovary.
AMH tended to cluster in the lower part of the reference range, but increased significantly during 3-year of treatment (P=0.028).
SHBG decreased during the first year of GH therapy (P<0.001) and remained low, while an increase in androstenedione and DHEAS was found during 3 years (P=0.043 and P=0.005 respectively). No cases of precocious pubarche were observed.
Inhibin B increased significantly during the first 3 years of treatment, but no significant changes in FSH, LH, estradiol or inhibin A were found.
Conclusions: GH treatment of short SGA girls can generally be considered safe, but as altered pubertal development and ovarian morphology was observed in 2 out of 18 girls, pubertal development and ovarian function should be monitored during GH therapy.
27 Apr - 01 May 2013
European Society of Endocrinology