5.
Do not routinely prescribe aromatase inhibitors to promote growth in children with short stature.
Aromatase inhibitors are used as adjuvant therapy for breast cancer. There is growing acceptance of their use to increase the adult height of children with short stature and some evidence that aromatase inhibitors can at least improve short-term growth outcomes. One recent clinical trial of aromatase inhibitors used in paediatric patients found them to be safe and effective. Even so, there is still little evidence overall that this treatment improves final adult height or is sufficiently safe. A 2015 Cochrane review found a significant proportion of pre-pubertal boys undergoing this treatment suffered mild morphological abnormalities of their vertebrae. More evidence is needed to demonstrate safety and efficacy of aromatase inhibitors before they can be routinely prescribed to promote growth in children with short stature.
Supporting evidence
- Diaz-Thomas A, Shulman D. Use of aromatase inhibitors in children and adolescents: what's new? Curr Opin Pediatr 2010; 22(4):501–7.
- Mauras N, Ross JL, Gagliardi P, et al. Randomized trial of aromatase inhibitors, growth hormone or combination in pubertal boys with idiopathic short stature. J Clin Endocrinol Metab 2016; 6:jc20162891.
- McGrath N, O'Grady MJ. Aromatase inhibitors for short stature in male children and adolescents. Cochrane Database of Systematic Reviews 2015; 10:CD010888.
- Wit JM, Hero M, Nunezs SB. Aromatase inhibitors in paediatrics, Nature Reviews Endocrinology 2012; 8:135–47.
How this list was made
A working group of lead clinicians from APEG brainstormed an initial list of 11 low-value practices in paediatric endocrinology and a preliminary review of the evidence for each was undertaken. An online survey was developed based on these 11 recommendations along with a summary of the evidence for each, and circulated to APEG members for their feedback. For each recommendation, respondents were asked to assign a score from 1 to 5 (where 1 = strongly disagree and 5 = strongly agree) on two criteria: ‘The recommendation is evidence based’ and ‘The recommendation is relevant to paediatric endocrinology in Australasia’. Based on the recommendations which received the highest average total scores, and after a final in-depth review of the related evidence, the final top five were chosen and approved by APEG.
Related recommendations
- 1 Do not rely on random measures of circadian hormones for diagnostic purposes.
- 2 Do not rely solely on bone age measurement for assessing growth in young children with short stature under 2 years of age.
- 3 Do not routinely measure insulin-like growth factor binding protein 3 (IGFBP-3) for workup and diagnosis of childhood short stature.
- 4 Do not initiate gonadotropin-releasing hormone (GnRH) analogue treatment in children outside of central precocious puberty, for the target outcome of delaying puberty and improving final adult height.
- 5 Do not routinely prescribe aromatase inhibitors to promote growth in children with short stature.