in children with idiopathic short stature S.A. Van Gool1; G.A. Kamp2; H. Visser-van Balen3; J. Looij3; R.J. Odink4; S.M.P.F. De Muinck Keizer-Schrama5; H.A. Delemarre-van de Waal6; W. Oostdijk1; J.M. Wit1 1Leiden University Medical Center, Pediatrics, Leiden, Netherlands; 2Tergooi Hospitals, Pediatrics, Blaricum, Netherlands; 3Utrecht University, Developmental Psychology, Utrecht, Netherlands; 4Catharina Hospital, Pediatrics, Eindhoven, Netherlands; 5Erasmus Medical Center/Sophia Children’s Hospital, Pediatrics, Subdivision Endocrinology, Rotterdam, Netherlands; 6VU University Medical Center, Pediatrics, Amsterdam, Netherlands

creasing to 58 g/kg/day at the onset of puberty) of GH had excellent growth response, but bone age advanced more than in untreated controls and puberty occurred earlier, leading to no change in predicted adult height [4, 5] . Although inappropriate bone advancement has not been observed at dosages ranging from 26 to 53 g/kg/ day [6] , higher dosages might accelerate maturation, thereby decreasing the effect on adult height. Professor Meinolf Noeker of the University of Bonn reviewed the psychosocial aspects of children with ISS and focused on complementary strategies for medical and psychological enhancement of psychosocial outcomes in children with ISS. Many controversies related to diagnosis and management of children with ISS were discussed at the 2007 Consensus Meeting. The definition of ISS was intensively debated, particularly whether it includes familial short stature and constitutional delay of growth and puberty (CDGP). A majority of participants voted to preserve the definition first proposed by Ranke in 1996 [7] . ISS can be subclassified as familial or nonfamilial short stature, and in either case puberty may start at a normal age or be delayed. Thus, both familial short stature and CDGP are included in the definition of ISS. Other issues addressed at the workshop included the overlap between insulinlike growth factor I deficiency and ISS; GH testing; which disorders should be excluded and how; treatment with testosterone or aromatase inhibitors in adolescent boys; use of insulin-like growth factor measurements versus metabolic parameters; definition of nonresponsiveness and management of the child who does not respond to Pediatric endocrinologists encounter numerous children and their parents seeking advice and help for the child’s short stature. In the majority no diagnosis can be made even after conducting a thorough medical history, physical examination and appropriate laboratory screening tests. Thus, the child is categorized as having idiopathic short stature (ISS). However, diagnosis by exclusion is controversial, and so the Growth Hormone Research Society, Lawson Wilkins Pediatric Endocrine Society and European Society for Paediatric Endocrinology sponsored a workshop to reach consensus on the definition, epidemiology, diagnostic evaluation and management of ISS. The committee charged with organizing the workshop identified a large number of issues to be addressed and arranged to conduct two extensive literature reviews [1, 2] . The workshop was held in October 2007, and the end result was a Consensus Statement on the diagnosis and treatment of children with ISS [3] . While this achieved a reasonable degree of consensus on many issues, several controversies remained. The following presentations addressed two such unresolved issues. Professor Pinchas Cohen of the University of California at Los Angeles addressed the issue of growth hormone (GH) dose optimization. In addition to the known dose-response relationship between the natural logarithm of GH dose (within a certain range) and first-year height velocity, he presented data indicating a relationship between dose and bone maturation. One randomized controlled study found that prepubertal children with ISS treated at a high dosage (2 mg/m 2 /day, which is equivalent to a starting dose of 85 \u0002 g/kg/day, slowly dePublished online: January 21, 2009 HORMONE RESEARCH

Introduction: unresolved issues in the management of children with idiopathic short stature.

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The aim of this experiment was to examine the effects of maximal strength training with emphasis on neural adaptations on strength- and endurance-performance for endurance trained athletes. Nineteen male cross-country skiers about 19.7 +/- 4.0 years of age and a maximal oxygen uptake (VO(2 max)) of 69.4 +/- 2.2 mL x kg(-1) x min(-1) were randomly assigned to a training group (n = 9) or a control group (n = 10). Strength training was performed, three times a week for 8 weeks, using a cable pulley simulating the movements in double poling in cross-country skiing, and consisted of three sets of six repetitions at a workload of 85% of one repetition maximum emphasizing maximal mobilization of force in the concentric movement. One repetition maximum improved significantly from 40.3 +/- 4.5 to 44.3 +/- 4.9 kg. Time to peak force (TPF) was reduced by 50 and 60% on two different submaximal workloads. Endurance performance measured as time to exhaustion (TTE) on a double poling ski ergometer at maximum aerobic velocity, improved from 6.49 to 10.18 min; 20.5% over the control group. Work economy changed significantly from 1.02 +/- 0.14 to 0.74 +/- 0.10 mL x kg(-0.67) x min(-1). Maximal strength training with emphasis on neural adaptations improves strength, particularly rate of force development, and improves aerobic endurance performance by improved work economy.

Maximal strength training improves aerobic endurance performance

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Introduction: unresolved issues in the management of children with idiopathic short stature.

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Maximal strength training improves aerobic endurance performance