ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Pediatr Nephrol. 2017;32:949-964

This is a comprehensive review on growth and sexual maturation during puberty in children with chronic kidney disease (CKD). Despite attention to preserve growth potential during pre-puberty and the availability of recombinant human growth hormone (rhGH), the achievement of normal pubertal height gain remains a challenge in CKD. In pre-dialysis patients, therapies to improve pubertal growth rely on preservation of renal function and use of rhGH. In patients with end-stage CKD, early transplantation with steroid withdrawal within 6 months allows for normal pubertal development in most patients. No randomized controlled trial (RCT) has tested the impact of rhGH during puberty in CKD, but this could address questions regarding both short-term growth responses and also final height. As for other chronic diseases characterized by growth deceleration and pubertal delay, innovative treatments have been proposed, including recombinant IGF-1, as a monotherapy or in combination with rhGH, and targeting suppression of cytokine signalling. The latter is a theoretical possibility because the chronic inflammatory state associated with CKD contributes to GH resistance (1). Gonadotropin-releasing hormone analogs arrest pubertal progression, but the potential growth benefit would occur at the psychological cost of delayed sexual maturation. Since epiphyseal growth plate fusion is induced by local estrogen action, the inhibition of estrogen synthesis represents a potential therapeutic option. In boys, aromatase inhibitors may extend the growth phase, without affecting pubertal development and thereby increase the window for rhGH therapy. Although some case reports are promising, evidence on its efficacy and safety is needed. In particular, the osteopenic effect of aromatase inhibitors on the reduced bone mass and density in CKD children should be assessed in controlled prospective trials before such treatment can be recommended

1. Farquharson C, Ahmed SF. Inflammation and linear bone growth: the inhibitory role of SOCS2 on GH/IGF-1 signaling. Pediatr Nephrol 2013; 28: 547–556.