SAT-194 The use of aromatase inhibitors for idiopathic short stature

Abstract Disclosure: Y.D. Moura: None. M.F. Fernandes Martins: None. B.G. Garcia: None. S. Bertolini: None. G.U. Durão: None. K.C. Queiroz Barreto: None. L. Oliveira Risso da Costa: None. A. Cardoso Rodrigues: None. R. Rodrigues Barroso de Souza: None. L.F. Siqueira Ribeiro: None. V. Cândido Bianqui: None. A. Carvalho de Oliveira Guilherme: None. INTRODUCTION Idiopathic short stature (ISS), as defined by the Brazilian Society of Pediatrics, refers to a height more than 2 standard deviations (SD) below the mean for age, sex, and population, with no apparent organic causes, normal body proportions, and adequate nutrition. According to Pfizer, major risk factors include familial short stature (FSS) and constitutional delay of growth and puberty (CDGP). Clinical signs involve height below the average for age and sex and a predicted final height lower than that of the parents. Diagnosis is based on exclusion criteria, requiring laboratory tests and imaging for bone assessment. Among therapeutic approaches, aromatase inhibitors (AIs) have emerged as an option for boys with ISS. These drugs inhibit the conversion of androgens to estrogens, delaying epiphyseal maturation and extending bone growth. AI use can increase adult height without compromising bone health or pubertal development. Compared to GnRH analogs, which induce temporary hypogonadism, AIs offer a better safety profile, allowing normal pubertal progression. Thus, they represent a promising strategy to optimize growth in this population. METHODOLOGY A systematic search was conducted in PubMed, Cochrane Library, and Scopus to identify studies on AI use in the treatment of ISS in children and adolescents. Included studies comprised randomized clinical trials, observational studies, and systematic reviews published in the last 5 to 10 years in Portuguese, English, or Spanish. Inclusion criteria covered studies evaluating final height, growth velocity, bone maturation, and adverse effects. Research with a high risk of bias or insufficient samples was excluded. RESULTS Studies indicate that AI use, alone or combined with growth hormone (GH), can enhance final height potential and lean body mass with a favorable safety profile. The inhibition of estrogen biosynthesis prolongs longitudinal growth due to its role in bone maturation and epiphyseal closure. Vitamin D deficiency, commonly observed in ISS patients, exacerbates bone fragility, increasing fracture risk. Calcitriol supplementation has shown improvements in bone parameters and reductions in elevated PTH levels. However, improper vitamin D use may lead to complications such as vascular calcification and hyperphosphatemia. Strict monitoring of calcium, phosphorus, and PTH levels is essential to prevent adverse effects. CONCLUSIONISS diagnosis requires excluding other pathologies. AIs have proven effective in delaying bone maturation and promoting growth without impairing pubertal development. However, individualized treatment and careful monitoring of bone parameters are crucial to optimizing outcomes and ensuring long-term safety. Treatment with vitamin C must be strictly controlled, as excess can lead to complications, therefore, new studies are necessary to prove its effectiveness. Presentation: Saturday, July 12, 2025