Adrenarche and bone age

[Guest guest]

We took to see his endocrinologist last week. At age 9 yrs, 9

months, he is now 49 " tall, and he weighs 47 lbs. He's just above

the 3rd percentile for height, but way below for weight, although

he's recently started to eat better and put on some weight. His

growth rate is about 3 " /yr, slightly above average for his age, but

at the conference Dr. H. said that was low for the level of gH that

he's on. Overall, though, we're pretty happy with his growth, and

his Dr. increased his gH dosage slightly, to 1 mg/day.

We're more concerned about his symptoms of adrenarche. Dr. H.

said that Josh was in " early aggressive adrenarche " , that his bone

age should be followed every 6 months, and if it advances, we

should consider an aromatase inhibitor. We discussed this with

Josh's Dr. He's more conservative in using meds than Dr. H. It took

us over a year to convince him to start Josh on gH (2 years ago).

He said that he's reluctant to use aromatase inhibitors; an NIH

5-year study showed that, because they block estrogen, they led

to osteoporosis in many kids. He also said that bone age

measurements are very unreliable; a study they did at Stanford

showed they were only accurate to plus or minus 18 months, so he

doesn't see the point in taking them every 6 months. He will

continue to do them once a year for , but take blood hormone

measurements every 4 months, as they are more reliable indicators of

adrenarche and early puberty. If there are any ominous changes, then

he would re- consider the aromatase inhibitors. (For what it's worth,

Josh's most recent bone age was 108 months at a chronological age

of 116 months.)

Dr. H. was also concerned about insulin resistance in , since

his growth rate was low for his IGF-1 level, and she thought that high

insulin might be driving his adrenarche. She recommended that Josh

should have an OGTT test, but his doctor doesn't believe in those either.

He said that they too are notoriously unreliable and tricky to interpret,

and quite a lot to put a kid through; a fasting glucose test is a

sufficient test for insulin resistance. I'd love to put him and Dr. H. in

the same room and hear them argue about this, because she was quite

adamant that a fasting glucose test wasn't enough, and Josh needed to

have an OGTT.

Anyway, I guess I need to read up some more on these matters, to try

to make sense of the conflicting advice we're getting from these two

doctors. Anyone have any thoughts or suggestions?

- Joe