First experience using an aromatase inhibitor in combination with growth hormone to improve growth prognosis in a 14-year-old boy with growth hormone deficiency after treatment of craniopharyngioma. A case-report

This article describes the first experience of successful use of growth hormone (GH) in combination with an aromatase inhibitor (AI), in a 14-year-old boy. At the age of 7, he presented with headaches, nausea and vomiting, and MRI revealed a craniopharyngioma (CP). An Ommaya system was implanted, and radiation therapy was performed. As a result of treatment, GH deficiency and secondary hypothyroidism developed. At age 9 years, signs of puberty appeared. Growth rate remained satisfactory until the age of 14 years. At the age of 14 growth rate slowed down, which was the reason for appointment. Upon examination, the bone age was 16 years and the projected final height without therapy was 162 cm. Given the poor growth prognosis, IA anastrozole in combination with GH was prescribed. During two years of therapy the growth gain amounted to 12.5 cm. This observation demonstrates that normal growth rates in patients with CP do not indicate preserved somatotropic function of the pituitary gland. With preserved sexual function, early or premature puberty may be observed. In such cases, IA can be prescribed in addition to GH — these are medications that inhibit the closure of growth. GH therapy in combination with IA is highly effective and safe in patients with GH deficiency after treatment of KF during puberty and allows to achieve good growth parameters.

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