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Objective: To evaluate the effects of asthma and inhaled corticosteroids (ICS) in children on the final adult height., Methods: A search was performed to collect studies evaluating the relationship between asthma and ICS in children and the final adult height in PubMed, BCI, EMbase, Web of Science, CNKI and Wanfang databases, then a systemic review and Meta analysis were conducted., Results: Six studies evaluating the relationship between childhood asthma and the final adult height were enrolled. Three of them indicated that the final adult height was not influenced by childhood asthma. Two of them suggested a mild effect, and the effect was correlated with severity of childhood asthma. One of them indicated that a lower final adult height related to childhhod asthma was found only in black females without a high school education. Four studies evaluating the relationship between ICS and the final adult height were included. Compared with the non-ICS treatment group, healthy control group and the target height, ICS treatment had no effects on the final adult height., Conclusions: Childhood asthma does not or only mildly decrease the final adult height. ICS treatment does not significantly affect the final adult height.

Objective: To investigate the efficacy of letrozole for delaying bone maturation and increasing predicted adult height in boys with idiopathic central precocious puberty (ICPP) who have a bone age above 13 years and a short stature, and its adverse effects., Methods: Twenty ICPP boys with a bone age above 13 years and a short stature were randomly divided into letrozole treatment (n=10) and control groups (n=10). The letrozole treatment group received oral letrozole [2.5 mg/(m(2)·d), Qd] for 6 months, while the control group received no treatment and was observed periodically. Bone age, growth rate, height standard deviation (SD) score, predicted adult height SD score, sexual maturity, and levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone, testosterone (T), estradiol (E2), progesterone (P), and androstenedione (ASD) were measured. The letrozole-related adverse reactions were evaluated., Results: After 6 months of treatment, both groups had a significantly increased bone age, but the letrozole group had a significantly slowed increase in bone age compared with the control group (13.82 ± 0.23 years vs 14.47 ± 0.30 years; P<0.05); compared with the control group, the letrozole group had a significantly increased predicted adult height SD score (-1.69 ± 0.26 vs -1.91 ± 0.35; P<0.05) and a significantly increased T level (4.9 ± 0.9 nmol/L vs 4.4 ± 0.8 nmol/L; P<0.05). There was no significant difference in testicular volume between the two groups. The treatment led to no significant changes in growth rate, Tanner stage, and levels of FSH, LH, P, E2 and ASD in the two groups, and there was no significant difference in these indices between the two groups. No adverse reactions were observed during letrozole treatment., Conclusions: Letrozole delays bone maturation and increases predicted adult height in ICPP boys with a bone age above 13 years and a short stature, and it causes no obvious adverse reactions.

Objective: To determine the effect of gonadotropin releasing hormone agonist (GnRHa), by itself alone or in combination with recombinant human growth hormone (rhGH), on height in young girls (bone age≥10 years) with idiopathic central precocious puberty (ICPP)., Methods: Eighty girls with ICPP (9.0±0.7 years old) from six medical centers across Southeast and Southwest China participated in this study. They were allocated to treatment with GnRHa+rhGH (n=31) and GnRHa (n=49) respectively. Girls in the GnRHa+rhGH group (bone age 11.18 ±0.53 years) were treated with GnRHa for 25.29±6.92 months and rhGH for 12.87±7.02 months. Girls in the GnRHa group (bone age 11.03 ±0.50 years) were treated with GnRHa for 25.96±8.95 months. The height standard deviation for bone age (HtSDS-BA), predicted adult height, near-adult height and net height increase before and after treatment were recorded for girls in both groups., Results: HtSDS-BA was significantly improved after treatment for both groups (P<0.01) and the HtSDS-BA value was superior in the GnRHa+rhGH group over the GnRHa group (P<0.01). Values in near adult height (157±6 cm vs 157±4 cm), net height increase after treatment (4.68 cm vs 3.89 cm), and predicted adult height after drug withdrawal (161±5 cm vs 158±5 cm) were higher in the GnRHa+rhGH group than the GnRHa group, but the differences were not significant., Conclusions: Both GnRHa plus rhGH and GnRHa alone can improve the near adult height in girls with ICPP with a bone age ≥10 years to a similar extent. Adult height predicted based on bone age in ICPP girls following drug withdrawal is usually overestimated and precautions should be taken when this parameter is used.

Objective: To evaluate the effect of combined use of stanazolol (ST) on the final adult height (FAH) in girls with idiopathic central precocious puberty (ICPP) and apparently decreased linear growth during gonadotropin-releasing hormone analog (GnRHa) therapy., Method: Sixty-three girls with ICPP and decreased velocity of growth of height (HV<4 cm/yr) during GnRHa therapy were divided into 3 groups based on the following types of interventions:group 1 (n = 20), GnRHa+ST [25-30 µg/(kg·d) every 3-month followed by 3-month discontinuation], group 2 (n = 21), GnRHa+recombinant human growth hormone [rhGH, 1-1.1 U/(kg·w)], group 3 (n = 22), GnRHa alone.HV, the advancement of bone age (BA) for chronological age (CA) (ΔBA/ΔCA) and FAH were compared among groups., Result: (1)Total duration of ST combination therapy was (12.22 ± 3.62) months, while total duration of combination of rhGH was (13.22 ± 6.80) months. (2)HV increased significantly in both group 1 [ (2.79 ± 0.60) cm/yr vs. (6.27 ± 1.98) cm/yr, P < 0.01] and in group 2 [(2.80 ± 0.50) cm/yr vs. (6.25 ± 1.98) cm/yr, P < 0.01] during combined therapy, but maintained at low levels in group 3 [(3.95 ± 1.10) cm/yr vs. (3.34 ± 0.95) cm/yr, P > 0.05].No significant differences of ΔBA/ΔCA were found among the three groups [0.25(0.11∼0.28), 0.22(0.15∼0.31),0.19(0.10∼0.32), P > 0.05]. (3)FAH was significantly higher than predicted adult height (PAH) before combined therapy, as well as higher than target height (THt) in both group 1 [(156.25 ± 2.90) cm vs. (150.78 ± 3.70) cm, P < 0.01, (156.25 ± 2.90) cm vs. (153.94 ± 2.62) cm, P < 0.01], and in group2 [ (157.33 ± 4.69) cm vs. (152.61 ± 3.92) cm, P < 0.01, (157.33 ± 4.69) cm vs. (154.39 ± 4.72) cm, P = 0.01].In group 3, FAH was similar to PAH [(153.88 ± 2.6) cm vs. (152.54 ± 5.86) cm, P > 0.05], and was less than THt [(153.88 ± 2.6) cm vs. (155.60 ± 4.52) cm, P = 0.02]. (4)In girls treated with ST, no hirsutism, clitorism or hoarse voice was recorded.No polycystic ovary syndrome was found by B-mode ultrasound., Conclusion: Intermittent combined use of low dose ST therapy can increase HV and thus improve FAH in girls with ICPP and apparently decreased linear growth during GnRHa therapy.

Objective: Long-term inhaled corticosteroids are the preferred treatment for asthma, but their safety still controversial. The aim of the present study was to explore the effects of inhaled corticosteroids on bone age and growth in children with asthma., Methods: Seventy-three children with asthma received inhaled fluticasone treatment at a starting dosage of 250 μg/d for 3 months, when the dosage was reduced by a third. Three months later, the patients were treated with fluticasone at a dosage of 125 μg/d for 6 months. Bone age, heights and weights were measured before and one year of treatment., Results: The increase in the heights, weights and RUS (radius, ulna and short finger bones) bone age of the children with asthma after one year of treatment was not significantly different from healthy children. There were no significant differences in body mass index (BMI) before and after one year of treatment, however the level of carpal bone age [-0.2(-0.6,0.8) years] was delayed after therapy compared to before treatment [-0.5(-1.0,0.6) years] (P<0.05)., Conclusions: Treatment with inhaled corticosteroids for 1 year may suppress the level of carpal bone age, but the level of RUS bone age, heights, weights and BMI are not affected. It is necessary to monitor the growth of children with asthma who receive long-term inhaled corticosteroid treatment.

Objective: To study the impact of gonadotropin-releasing hormone analogs (GnRHa) on body mass index (BMI) in girls with idiopathic central precocious puberty (ICPP)., Methods: One hundred and thirty-four girls with ICPP were enrolled. Fifty-seven out of the 134 girls were treated with GnRHa for 1.69±0.43 years. The height, weight, bone age and BMI were measured before treatment, at the end of the treatment and after reaching near adult height and compared with those in the untreated 77 girls., Results: The adult predicted height standard deviation score (SDS) at the end of treatment was significantly higher than that before treatment (P<0.01) and was similar to the target height SDS in the GnRHa treatment group (P>0.05). With GnRHa treatment, the near-adult height SDS was higher than the target height SDS (P<0.01). At the end of treatment, the BMI SDS slightly increased compared with pretreatment level (P>0.05). A significant reduction in the BMI was observed when reaching the near-adult height in the GnRHa treatment group compared to the level of pretreatment and the untreated group (P<0.01). However, the BMI in the GnRHa treatment group before treatment, at the end of the treatment and after reaching near adult height remained in the normal range (±1 SD)., Conclusions: GnRHa may improve the final height in girls with ICPP. The alterations of BMI after GnRHa therapy fluctuate in a normal range.

Objective: To analyze the effect of complex nutrients on growth and development, intelligence and nutrition state of 6-12 years old children in two continuous years., Methods: According to the rural school's similar condition, such as social economical statement, education condition and proportion of students entering schools, 6 rural schools were respectively selected in Xishui County of Hubei Province as the experimental group and control group. In the former, middle and later periods (2004, 2005, 2006 ), growth and development, nutrition state and intelligence were analyzed and compared., Results: The increase of height and weight in experimental group were higher than those of the control group. In 2 years, height in experimental group increased 12.9 cm, while the control group increased 11.5 cm. Weights increased in experimental group were 6.6 kg, while the control group increased 5.2 kg. Girl's bone density in experimental group increased from 0.236 g/cm in 2004 to 0.280 g/cm in 2006. The hemoglobin contents of 4 age group's children in experimental group increased significantly (P < 0.05) . While the anemia prevalence decreased 25 .8% in 2 years, the control group decreased 7.2%. Moreover, other results showed that the complex nutrients also have some effect on the intelligence in experiment group., Conclusions: The complex nutrients supplement could improve the rural school children's growth and development, bone and intelligence.

Objective: To study the effects of treatment with gonadotropin-releasing hormone analogs (GnRHa) on final height, weight and pubertal development in girls with central precocious puberty., Methods: Twenty-six girls with central precocious puberty were treated with GnRHa for an average of 19.2+/- 8.4 months. Pretreatment and posttreatment predicted adult heights (PAH) were evaluated based on the Bayley-Pineau table. The patients, heights and weights were measured monthly. Bone age (BA) was evaluated using Greulich-Plyle. Height standard deviation score for BA [HtSDS (BA)] was measured. After discontinuation of treatment, the patients were followed-up for the observation of height, weight, BA and menstruation., Results: Final height averaged 158.0+/- 4.0 cm in the 26 girls, which was greater than their target height (155.3+/- 4.4 cm; P< 0.01) and consistent with their posttreatment PAH (158.4+/- 5.2 cm). The final height was positively corrrelated with initial height, PAH and HtSDS(BA). There was a positive correlation in the body mass index before and after treatment (r=0.724, P< 0.01). Menarche occurred 13.2+/- 6.1 months after discontinuation of treatment, with a mean menarche age of 12.2+/- 0.7 years., Conclusions: GnRHa may increase final height in girls with central precocious puberty. Their final heights may be correlated with their initial heights and PAH. The pubertal development after GnRHa treatment in girls with central precocious puberty may be matched with normal children.

Objective: Based on peer-reviewed random-control studies, effects of calcium supplement and intake of milk on bone mineral density (BMD) and growth in children were evaluated., Methods: Meta-analysis was applied to review published data in random-control studies related to the effects of calcium supplement and milk consumption on BMD, body height and body weight in children., Results: Eleven peer-reviewed papers published during 1993 to 2006 were selected in this study. Homogeneity test showed that random effect model should be selected for weighting and pooling data. The combined means of improvement in BMD, height and body weight in children with milk intervention were 2.01 (0.92 - 3.09), 0.25 (0.09 - 0.41) and 0.63 (0.33 - 0.93), respectively, and the data from children with calcium intervention were 1.05 (0.66 - 1.43), -0.10 (-0.25 - 0.05) and -0.75 (-1.98 - 0.49), respectively., Conclusion: Both milk and calcium intakes could improve BMD of children significantly, and the difference in BMD gain through milk intake was the same as that with calcium intervention, however, compared with the control group, increasing milk intake did significantly promote growth and development of children compared to the calcium supplement group.

Objective: To determine whether long-term treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate influences the growth in height and weight of children., Methods: Analyses were performed on 146 school age children (126 boys) diagnosed as ADHD and treated with methylphenidate [0.27-0.64 mg/(kg.day)] for methylphenidate group and 29 children with ADHD who did not receive any medication for ADHD (controls). These children were followed-up for 2-4 years. Changes in height and weight after long-term treatment with methylphenidate were recorded and the factors affecting growth of height, weight, and height velocity were analyzed., Results: The change of difference between patients' height and mean height in methylphenidate group and controls was (-1.86 +/- 0.82) cm (paired t test, t = 27.335, P < 0.001) and (-0.26 +/- 0.51) cm (P < 0.05), respectively; the change of height standard deviation score (SDS) in methylphenidate group and controls was -0.14 +/- 0.23 SD (paired t test, t = 7.326, P < 0.001) and +0.05 +/- 0.10 SD (P < 0.05), respectively. When the height change and height SDS change in methylphenidate group and controls were compared by using independent-samples T-test, the t value was -10.078 and -4.262 respectively, P for both was < 0.001. Both of bivariate correlation analysis and stepwise multiple-regression analysis indicated that the duration of treatment contributed significantly to the variance in change of height (P < 0.001); but age, sex, DSM-IV type, NJ22 degree and dose of methylphenidate did not contribute significantly to the variance of height. The mean height velocity from 1st to 4th year was 4.28 cm/year, 4.90 cm/year, 4.98 cm/year and 4.95 cm/year, respectively. With Friedman test, Chi-square = 253.673, P < 0.001. The change of difference of patients' weight to weight for height after methylphenidate was (-0.14 +/- 1.25) kg (paired t test, t = 1.326, P > 0.05)., Conclusion: Small but significant deceleration of height velocity is the identified long-term side effect of methylphenidate, the magnitude of height deficit is related to duration of treatment. The height velocity was significantly attenuated in the first year. Methylphenidate had no significant influence on weight.

Objective: Gonadotropin-releasing hormone agonist (GnRHa) is widely used for the treatment of precocious puberty, but there was no identical regime for the dosage and the interval of administration. The aim of this study was to assess the feasibility of subcutaneous administration of Triptorelin with a prolonged interval (six weeks) for the suppression of pituitary-gonadal axis and clinical signs in girls with idiopathic central precocious puberty (ICPP)., Methods: Forty-six girls with ICPP were enrolled in this trial and were divided into two groups at random, with 26 patients in group A and 20 in group B. There were no significantly differences in chronological age, height, weight, age at clinical onset of puberty and bone age between the two groups before treatment. Triptorelin (Decapeptyl, 3.75 mg) was administered subcutaneously (SC) at 6 weeks intervals in group A or intramuscularly (IM) at 4 weeks intervals in group B. Both forms were given for more than 12 months consecutively. During the period of treatment, the clinical parameters including height, weight, pubertal stage, bone age, uterine volume and ovarian size were documented. The serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and estradiol (E(2)) were monitored using immunoenzymometric assay., Results: Both treatment regimes can completely suppressed the pituitary-gonadal axis. The clinical signs of pubertal development regressed or stabilized in all patients. Breast developments, as reflected by Tanner staging, were regressed. Uterine volume decreased after treatment, however, this decrease did not reach statistical significance. Mean ovarian volume did not change significantly during treatment. The height velocity was significantly decreased from a pretreatment value of 6.3 +/- 1.4 cm/year to 5.8 +/- 1.2 cm/year in group A and 6.7 +/- 1.3 cm/year to 5.4 +/- 1.0 cm/year in group B, respectively. The rate of skeletal maturation was reduced significantly during treatment. The ratio of bone age/chronological age was 1.2 +/- 0.2 or 1.3 +/- 0.3 at the onset of therapy and decreased significantly after the treatment to 0.7 +/- 0.2 or 0.9 +/- 0.1, respectively. The predicted adult height increased significantly and progressively during therapy. The levels of serum LH, FSH and E(2) were returned to the prepubertal condition after 6 - 8 weeks treatment and remained suppressed for the duration of treatment. No significantly side effects of therapy were noted. The most common adverse event during SC treatment was that a non-irritating, 1 cm in diameter mass can be palpated at the site of subcutaneous injection in the abdominal wall of group A patients. It gradually decreased in size, and disappeared after 8 - 12 weeks. Two girls had minimal withdrawal virginal bleeding episodes after the first injection., Conclusion: Both IM and SC triptorelin administration were clinically effective. They can induce profound suppression of hypothalamic-pituitary-gonadal axis while stabilizing height velocity, slowing bone maturation and increasing predicted adult height. These results suggest that subcutaneous injection of triptorelin in 6 weeks intervals at a dosage of 3.75 mg was a safe and acceptable regime for ICPP with good efficacy.

The associations of the Bsm1 polymorphism of vitamin D receptor gene and blood lead, zinc protoporphyrin and physical development in 476 environmental lead-exposed children were studied. After blood lead level, age, sex and education level of the patients were adjusted by analysis of covariance, the children with B allele had larger head circumference than those with bb genotype(P = 0.02). While the subjects were stratified by blood lead level and sex, the statistically significant difference in head circumference between different Bsm1 genotypes was found only in high-blood-lead subgroup and in male subgroup. No significant influence of Bsm1 polymorphism on blood lead level, zinc protoporphyrin, height and weight was found, suggesting that the Bsm1 polymorphism of VDR gene may modify the effect of lead on the skull development of children highly exposed to lead.

Objectives: To investigate the effects of calcium and vitamin D supplementation in fortified milk on physical development in Chinese school girls aged 10 - 12 years., Methods: A non-randomized, double-blind intervention trial was carried out at nine primary schools of Beijing for two years. Seven hundred and fifty-seven girls (with an average age of 10.1 years) were recruited from nine primary schools in Beijing, China. They were divided into three trial groups, a control group (n = 259) having regular diet without milk supplementation, Group 1 (n = 238) having regular diet supplemented with 144 ml/d of calcium-fortified milk, and Group 2 (n = 260) having regular diet supplemented with 144 ml/d of calcium and vitamin D-fortified milk. Data of dietary intake and physical activities were collected by questionnaire, and height, weight, sitting height and knee height were measured before, during and after intervention., Results: Two years after intervention, the percentage increases in height and weight were significantly greater in Groups 1 and 2 than those in control group (9.52%, 9.26% and 8.59% in height, and 34.53%, 35.38% and 30.91% in weight, respectively). The percentage increase of sitting height was greater in Group 1 than those in Group 2, and then than that in control group (9.21%, 8.58% and 7.87%, respectively). The percentage increase of knee height was significantly greater in Group 1 than that in Group 2 and control group (9.00%, 8.37% and 8.44%, respectively)., Conclusion: Calcium and vitamin D-fortified milk supplementation could promote their physical development in girls aged 10 - 12 years.

Objective: To study the effect of iodine supplementation on infant mortality and growth in Xinjiang., Methods: Urine iodine, height and head circumference (HC) of children aged 5 years in two townships was measured before and yearly after iodine supplementation of irrigation water. Height and HC were expressed as Z scores (United States children used as the reference group). Neonatal and infant mortality rates were obtained from official records in three counties from 1988 to 1999, and analyzed by a logistic regression model., Results: The odds ratio of infant mortality decreased 56.49% and neonatal mortality 65.71% respectively after iodination; there was no significant difference in the odds ratio of infant or neonatal mortality between experimental and control areas without iodination. In Langru township, the mean height of 5 year-old children increased from 95 cm in 1992 to 106.9 cm in 1998 - 1999, and HC from 48.4 cm to 50.5 cm. Median urine iodine increased from <10 to 176 micro g/L. In Bakechi township, mean height increased from 91 cm in 1993 to 106.5 cm in 1998 - 1999, HC from 48.7 to 49.6 cm, and median urine iodine from 39 to 138 micro g/L., Conclusion: In Xinjiang, adequate iodine treatment markedly decreased infant and neonatal mortality, and largely preventing stunting of height and HC in children.

Objective: The relationship between polymorphisms of ALAD and VDR genes and individual susceptibility of lead poisoning was investigated in children highly-exposed to lead., Method: Four hundred and sixty-nine children were recruited into this study and the blood lead, ZPP, hemoglobin as well as three physical developmental indexes (head circumference, height and weight) were measured. VDR and ALAD gene polymorphisms were analyzed by the methods of PCR-RFLP., Results: The subjects with ALAD2 allele had higher ZPP level (10.12 micro mol/L vs 12.87 micro mol/L) (P = 0.017). The subjects with B allele has larger head circumference than only with b allele (51.19 cm vs 50.75 cm) (P = 0.028)., Conclusions: It was suggested that the ALAD gene polymorphism modified the relationship between blood lead and ZPP and the VDR gene variants influenced the skull development in children living under lead-polluted environment. The polymorphism of ALAD and VDR genes might serve as the molecular inherited factors modifying the susceptibility of lead poisoning.

The blood lead (PbB) levels of pregnant women and their babies were followed up since the third month of pregnancy until their babies were 2 years old. The general condition of delivery, family history of the pregnant women, feeding and development of infants were investigated. Prenatal and postnatal PbB levels and their effects on infant growth were analysed. The result showed a significant negative correlation of PbB level of pregnant women near delivery, and in umbilical cord with the growth of infants. Multiple regression analysis showed a negative correlation between PbB level and height, weight of infant at 1 and 2 years old.

An epidemiological study on the effect of strontium in drinking water on body shape development, bone age, prevalence of caries and dental fluorosis was carried out. The results show: there is a certain promotion on the development of bone age of school-age children, especially of girls, and there is no obvious impact on body shape developing when the concentration of strontium in drinking water is only 10 mg/L. The correlation between strontium in drinking water and the prevalence of caries in children could not get a conclusive evidence in this paper. A further epidemiological investigation is necessary if the role of strontium against caries should be proved.

Objective: To study the effects of low level lead exposure on physical growth and development in young children., Methods: Blood lead level and indicators for physical growth and development, such as body height and weight, and head and chest circumferences were measured in randomly sampled 1,969 children aged 1 - 6 years in Shanghai. Z scores for these indicators were calculated for each of them based on their age and sex-specific norms for children in urban and suburban Shanghai. And, regression analysis of blood lead level was conducted on them., Results: Geometric mean of blood lead level was 0.400 micromol/L in young children of Shanghai, and 744 (37.8%) of 1,969 children were equal to or higher than 0.483 micromol/L. Geometric mean of blood lead level correlated in reverse to the Z scores for their body height, weight and head circumference, even if adjusted for the potential confounding factors., Conclusion: Low level lead exposure could cause adverse effects on their physical growth and development in young children of Shanghai.

After eliminating confounding factors, the study was made on the relationship between height, collagen metabolism, hair zinc and excessive fluoride intake. 140 schoolchildren aged 12-13 years born and reared in endemic fluorosis areas were surveyed. The results were as follows: 1. The average height of children with dental fluorosis III degree (DF III degree) was appreciably smaller than that of children without dental fluorosis. Among children with excessive fluoride intake, a negative correlation between the height and fluoride level in staple foods was seen. 2. The more the fluoride ingested, the higher the urinary THP excreted, showing that fluoride intoxication interfered with the collagen metabolism. 3. Among children with excessive fluoride intake, the height showed negative correlation with urinary THP/Cr, suggesting that the effect of fluoride on collagen metabolism indicated the mechanism of height retardation. 4. As compared to control group with the excessive fluoride intake but without dental fluorosis group, there was a significant reduction in hair zinc in group with DF III degree, suggesting that the zinc in the body decreased because of zinc metabolism disturbance by excessive fluoride intake. But among cases with excessive fluoride intake, no appreciable correlation between hair zinc and height was found. Therefore, it could not be confirmed that the effect of fluoride on zinc metabolism affected the height development.

We report a case of congenital hypothyroidism, presenting with growth and mental retardation since childhood, but in which the diagnosis was not made until he was 17 years old. Because of such an unusually long delay in treatment, we focussed on the growth catch-up. This included the change of skeletal growth, puberty and mentality after a 4-year treatment period. He was 114 cm in height (height age 5.5 years) with the upper segment measuring 60 cm and lower segment 54 cm (U/L ratio 1.1). His bone age was that of a six year old and he had no secondary sexual characteristics. IQ testing showed a full scale IQ of 68, verbal IQ 74 and performance IQ 64. After 4 years of treatment, his height caught up to 152 cm (height age 12.5 years), with the upper segment 77.2 cm, and that of lower segment 74.8 cm (U/L ratio 1.03). The bone age had advanced to that of a 17 year old. His pubic hair emerged after 18 months of therapy (at a chronologic age of 18.5 years), accompanied by a normalization of testosterone and a normal response to a GnRH test. His IQ test was rechecked after 2 years of treatment. His full scale IQ was 78, verbal IQ 77 and performance IQ 83. In the mean time, the patient got a job being more alert, active and self-confident following his growth catch-up.