Linear growth as a function of age at onset of puberty and sex steroid dosage: therapeutic implications

Puberty plays a dual role in growth: height velocity is markedly accelerated while the rate of skeletal maturation is also increased with resultant fusion of epiphyseal cartilages. Thus, puberty can be considered as a growth-promoting event as well as the final height-limiting process. This concept is illustrated by early exposure to sex steroids such as occurs in central precocious puberty or congenital adrenal hyperplasia. These conditions accelerate growth but result in short adult height (1–6). The basic question addressed in this paper is how hormonal changes at puberty and the age of their occurrence influence growth rate and adult height. This query has practical implications including timing and dosage of sex steroid replacement therapy in hypogonadal patients and the use of GnRH agonist therapy in patients with precocious puberty or short stature. These issues may have profound social import since numerous (mostly uncharted) psychological aspects of adolescence may be related to stature and the timing of sexual development.